Abstract
In order to clarify the role of the kidney in glucose homeostasis, the frequency of severe hypoglycemia and the instability of postprandial blood glucose levels in four type 1 diabetic patients undergoing hemodialysis were compared with those in 13 type 1 diabetic patients without renal dysfunction. These determinations were conducted in a type 1 diabetic patient with end-stage renal disease during a 26-month period prior to, and a 26-month period 12 months after, initiation of hemodialysis treatment. The incidence of severe hypoglycemia was significantly higher in the patients on hemodialysis than those without hemodialysis despite lower daily insulin doses in the former group. The postprandial blood glucose levels fluctuated more markedly day after day in the dialysis group compared with those in the non-dialysis group. The impaired production and utilization of glucose by the affected kidneys are most likely to be one of the causes for these disruptions to glucose homeostasis in type 1 diabetic patients on hemodialysis.
