Decreased renal clearance of insulin |
Decreased hepatic clearance of insulin |
Impaired renal insulin degradation |
Increased insulin half-life for reasons other than renal or hepatic conditions |
Decline in renal gluconeogenesis |
Deficient catecholamine release |
Other impacts of uremia on glucose homeostasis |
Diminished food intake because of problems such as anorexia, diabetic gastroparesis |
Protein-energy wasting (malnutrition-inflammation complex) |
Loss of body weight and fat mass |
Comorbid conditions |
Hypoglycemia during hemodialysis treatments |
Effects of peritoneal dialysis on glucose metabolism |
Prescribed medications |
Imposed dietary restrictions |
Low hemoglobin A1c owing to confounding by uremia or anemia |
Kovesdy CP, Park JC, Kalantar-Zadeh K. Glycemic control and burnt-out diabetes in ESRD. Semin Dial 2010; 23:148–156. Copyright John Wiley and Sons, 2010; used with permission.