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Why are my father’s blood sugar and creatinine levels fluctuating?

Q: My father, 64 years old, is currently undergoing dialysis twice a week, which started a month back. His blood pressure is normal but his sugar levels are not coming down and show a huge variation. Also, his creatinine levels have not come down and show fluctuation (4.6 mg/dl). He is under a strict diet regime and takes 12 units of insulin thrice a day. Please advise what could be the reason for his fluctuating sugar and creatinine levels?

A:It is a difficult situation. Good control is still needed despite renal failure as it will prevent further complications. Because of glucose in dialysis fluid sometimes blood glucose increases after dialysis. With kidney failure, as such blood glucose starts falling and patients may experience episodes of low glucose levels. Insulin is needed for control. Short acting insulins are better for control. You did not mention about the type of insulin he is taking. I suggest you switch over to rapid analogues like Novorapid/Humalog R thrice a day with good control on dietary intake. Also keep a watch on HbA1C, and if <7%, then do not worry about the mild fluctuations in blood glucose levels. For more specific advice it will be nice if you can pass on the blood glucose profile and type of insulin he is on.

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