Abstract
We have experienced hypoglycemic attacks in 3 non-diabetic patients under dialysis treatment from Following conclusions seemed to be warranted. 1. Patients studied here were two females and one male. Their ages ranged from 39 to 50 years old (mean of 44.6), and their underlying disease was chronic glomerulonephritis in all. 2. Their durations of dialysis ranged from 58 to 94 months (mean of 77.3). 3. Hypoglycemic attacks in 3 patients appeared from 30 to 240 min after the start of dialysis (mean of 130), and at that time, their blood glucose levels were 40-50 mg/100 ml (mean of 47.5). In hypoglycemic attacks, removed glucose ranged from 17.9 to 27.5 gm (mean of 22.7) in each dialysis. In the days showed hypoglycemic attacks during dialysis, they didn't eat enough foods before dialysis in all. 4. We examined intravenous glucose tolerance test (iv-GTT) in these 3 subjects, showing almost normal K-values. From these results, we concluded the mechanism of these hypoglycemias during dialysis as follows; (1) In the long-term dialysed patients, they had already abnormal glucose metabolism, characterlized by decreased glycogen storage (liver and muscle), delayed glycogenolysis and elongation of insulin half-life. (2) They had so loss of appetite that they couldn't take foods before dialysis, when patients showed hypoglycemic attacks. These situations might accelerate them to develope pre-hypoglycemic states. (3) Even small amounts of removed glucose (20-30 gm) by the dialysis might eventually result in hypoglycemia (dialysis induced hypoglycemia) in these patients. We must care of the hypoglycemic symptoms during dialysis, when patients have been undertaken for long-term dialysis treatment (more than 5 years). As for the prevention of these dialysis induced hypoglycemias, we assumed that patients should eat enough foods before dialysis, and not be treated with dialysis using dialysate without glucose.
