Treatment of hyperglycemia in patients with diabetes

Nephropathy occurs in 20-40% of diabetic patients and diabetes mellitus is the most common cause of ESRD. the aim of this study was review the metabolism of glucose and treatment of diabetes in patients with this disease. Chronic renal failure is typically associated with insulin resistance, decrease of insulin secretion and, in advanced renal failure, decreased insulin degradation. Decrease of insulin degradation can lead to a marked decrease in insulin requirement or even the cessation of insulin therapy in type 2 diabetes and the development of spontaneous and severe hypoglycemia. Although, several large studies have found no significant correlation between glycemic control and survival of patients with ESRD, however, for prevention of diabetes-related damage to other organs, good glycemic control should be considered as a significant treatment goal.The goal of glycemic control in diabetic patients on chronic dialysis is the fasting blood glucose below 140 mg/dL, one-hour postprandial value of less than 200 mg/dL and the glycated hemoglobin level between 6 to 7 in type 1 diabetics, and between 7 to 8 in type 2 diabetics. Glipizide is metabolized by the liver and therefore is the oral hypoglycemic drug of choice in many patients with chronic renal failure.Repaglinide is also principally metabolized by the liver but hypoglycemia is common among patients with severe renal impairment and Initiation of treatment should therefore be with 0.5 mg daily and close careful monitoring of blood glucose levels is essential. Metformin should be avoided in patients with ESRD due to increased risk of rare but potentially fatal lactic acidosis.