Carbohydrate Supplement before Hemodialysis to Prevent Hypoglycemia and Low Blood Glucose in Diabetic and ESKD Patients
Rungnapa Laortanakul, MD¹, Watanyu Parapiboon, MD¹
Affiliation : ¹ Department of Medicine, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
Objective: The benefits of carbohydrate supplementation before hemodialysis (HD) in diabetic patients are unclear. The present study assessed the impact of a pre-dialysis carbohydrate snack.
Materials and Methods: A quasi-experimental study was conducted in type 2 diabetes patients undergoing HD with baseline blood glucose levels between 80 and 200 mg/dL across six centers in Nakhon Ratchasima Province, Thailand. Blood glucose was measured at baseline and at 1, 2, 3, and 4 hours during HD. A 15 g carbohydrate snack was given 15 to 30 minutes before the start of HD. The incidence of hypoglycemia and blood glucose levels below 90 mg/dL during HD were compared between sessions with and without the snack. Secondary outcomes included intradialytic hypotension and patient satisfaction.
Results: One hundred thirteen participants, with a mean age of 56 years and a BMI of 24 kg/m², were included. Participants had a mean diabetes duration of 13 years, HbA1c of 6.5%, and had been on dialysis for 33 months. Forty-four percent were not on anti-diabetic medication. Hypoglycemia during HD occurred in 0.4% of sessions. Low blood glucose during HD decreased from 29.2% without the snack to 20.4% with the snack (risk reduction 0.08, 95% CI –0.02 to 0.2, p=0.12). Intradialytic hypotension was comparable between groups, and most participants reported high satisfaction with the snack.
Conclusion: From the quasi-experimental study, carbohydrate snacks before dialysis show a trend to reduce low blood glucose during HD without increasing intradialytic hypotension.
Received 18 February 2025 | Revised 7 September 2025 | Accepted 22 September 2025
DOI: 10.35755/jmedassocthai.2026.2.02734
Keywords : Carbohydrate supplement; Diabetes; Hemodialysis; Hypoglycemia
