The risk for hypoglycemia, especially in those using insulin or
insulin secretagogues, increases with declining renal function. In
those with later stages of CKD, altered drug metabolism may affect
the clearance of certain medications. Uremic factors, including
gastroparesis, poor appetite, fatigue and taste changes, compound
the risk. Furthermore, reduced kidney mass impairs renal gluconeogenesis
and can predispose an individual toward hypoglycemia.
Treatment of hypoglycemia should follow CDA guidelines (12), but
care should be taken to avoid hyperkalemia (by using higher
potassium treatment options such as orange juice) and fluid overload.
Fast-acting carbohydrates that are suitable for those with
renal impairment include dextrose tablets, hard candies, honey
and non-cola regular pop instead of commonly recommended
treatments such as juices or cola beverages.