Managing Diabetes and Peritoneal Dialysis

I work with many patients who have diabetes and who get their dialysis through peritoneal dialysis (PD) treatments. Peritoneal dialysis is one of the treatment options a kidney doctor may prescribe. Some patients have experienced body weight gain almost immediately after starting PD. Some remain about the same weight as when they started their treatments. Other patients may require more insulin to help control their blood sugar levels. One thing I’ve learned is that each patient is different, requiring an individualized prescription for dialysis and meal planning.

Choosing PD Therapy

Having diabetes should not discourage you from choosing PD as a renal replacement therapy. However, like with any other medical treatment, it’s important to be educated about everything related to your health.

For example, as a person with diabetes, you probably already know about eating regular meals. This means having about the same portion sizes and carbohydrate content, plus consistent timing of meals and snacks. Incorporating physical activity on a daily basis is encouraged. Even if you are not able to walk or run, you can still do exercises while sitting or lying down. Last but not least, medications such as insulin require monitoring your blood sugar (BS) levels. The right amount of medication based on your BS levels, dietary intake and physical activity is essential.

Dextrose in PD Solution

Each bag of peritoneal dialysis solution contains dextrose, which is a form of sugar. Depending on how much urine you still make and how much fluid you need to remove, you will either use the 1.5%, the 2.5% or the 4.25% solution. The 1.5% solution is the lowest in sugar and calories. Your PD nurse will provide education about these different concentrations and when to use each one.

The range of calories absorbed from each bag of PD solution depends on the dextrose concentration as well as your transport rate. The extra calories absorbed from each bag of solution is different for each patient, but in general:

• A 1.5% bag delivers 90 to 100 calories
• A 2.5% bag delivers 100 to 168 calories
• A 4.25% bag delivers 200 to 284 calories

Fluid Control and PD

A higher concentration of dextrose is used to remove more fluid. By limiting salt, processed foods and fast foods in your diet you will not be as thirsty. A lower sodium intake also helps control fluid retention, or edema.

Blood Sugar Control and PD

Your blood sugar levels can also affect fluid balance. High blood sugar levels will increase thirst and possibly cause you to drink more fluid. This creates a vicious circle. If you gain too much fluid, you have edema and you will need to use the higher concentration of PD solution to remove that extra fluid. Using the higher concentration of dextrose (4.25%) adds more calories. This may increase your blood sugar levels. As a result, more insulin may be required. These extra calories may cause weight gain which may require you to use even more insulin. Avoiding this vicious circle means better blood sugar levels, fluid and weight control, less thirst and less insulin.

Teamwork

If you are considering PD therapy talk to your doctor about your diagnosis and specific condition to find out if PD would be a good option for you. Successful PD therapy and diabetes management takes a team. Your doctor’s instructions and prescriptions, nurse’s training and monitoring, dietitian’s nutrition education, social worker’s guidance and loved ones’ support work together to help with your success. It takes a team to succeed and you are the most important part of this team.

For more information read “Diabetes and Peritoneal Dialysis” by Dr. Mark H. Shapiro.