Diabetes management becomes especially challenging when associated with chronic kidney disease (CKD). Blood sugar fluctuations can significantly impact daily life, particularly in patients dependent on insulin therapy. This case highlights how careful monitoring and personalized treatment helped stabilize blood sugar levels at Madhumita Clinic, Hubballi.
Case Presentation
A patient with Type 2 diabetes and chronic kidney disease presented with severe fluctuations in blood glucose levels. Blood sugars varied from extremely high in the morning to dangerously low by evening, affecting quality of life and requiring constant precautions.
The patient was on premix insulin (NPH/Regular 30/70).
Investigations: HbA1c: 12%, Creatinine: 1.9
Main Concern: Unpredictable blood sugar fluctuations.
Treatment Approach
Insulin Regimen Adjustment
Shifted from premix insulin to a basal plus regimen with Glargine.
Midnight hypoglycemia was observed.
Modified to basal-only regimen, but fluctuations persisted.
Finally stabilized with alternate-day Glargine 8 units at night.
Outcome
Within two months, blood sugar levels stabilized and hypoglycemic episodes reduced significantly.
Why Did This Occur?
In patients with chronic kidney disease, insulin excretion is variable and reduced, leading to unpredictable sugar fluctuations. Individualized insulin regimens, regular physician consultations, and consistent use of self-monitoring of blood glucose (SMBG) or continuous glucose monitoring (CGM) are essential for achieving stability.
Key Learning Points
Blood sugar fluctuations are common in diabetes with CKD.
Careful insulin titration helps reduce hypoglycemia.
Consistent follow-up with a Diabetologist in Hubli ensures safe and effective diabetes management.
Conclusion
This case demonstrates how personalized diabetes care in CKD patients can restore stability and improve outcomes. Timely intervention, tailored insulin regimens, and ongoing medical support play a vital role in achieving long-term blood sugar control.