Diabetes is a serious health condition that affects millions of people worldwide. For those with diabetes, managing the disease can be a complex and challenging task. For those with diabetes and end-stage renal disease (ESRD), dialysis can be an essential part of their care. In this blog, we’ll discuss the connection between diabetes and dialysis, and what patients need to know to stay safe and healthy.
Diabetes can cause a number of complications that can lead to the need for dialysis, including hypertension, heart disease, and nephropathy. (I have all three, having gone through a triple bypass in 2015.) Nephropathy, or kidney disease, is a major complication of diabetes and can cause ESRD. When ESRD occurs, dialysis is necessary to keep the patient alive.
I was first diagnosed as a diabetic in the early nineties via a glucose tolerance test while on active duty in the Navy. I was first diagnosed with the real possibility of Chronic Kidney Failure in the early 2000 timeframe. My diabetic condition progressed from control with diet and exercise to oral meds to insulin plus oral meds until the present day. Same with ESRD only doctors just stated “we’ll watch it.” What they meant was it was going to happen and we’ll just watch it happen. For me, diabetes and dialysis have been a fact of life, that is sooner or later…….
There are two types of dialysis that may be used for those with diabetes: hemodialysis and peritoneal dialysis. The general populace is often confused by this distinction, thinking only that one goes to a dialysis center three times a week for a couple of hours. Hemodialysis involves using a dialysis machine to filter the blood outside of the body. I underwent hemo as it is called for about six weeks while I was getting set up and moving through the queue for peritoneal dialysis aka PD. It is miserable and time-consuming, and a cold experience wipes you out, and I wouldn’t wish it on anybody including my worse enemies (if I had any which I don’t.)
“Although the ancient Egyptians were the first to describe the peritoneal cavity in approximately 3000 BC, the concept of peritoneal dialysis is relatively new. In the late 19th century, Wegner, a German investigator, was the first to use peritoneal solutions in animals.” From here: The solution used is called dextrose dialysate, or dextrose, or more formally dialysate.
What I use is a 1.5% or 2.5% Dextrose solution of Hydrous Dextrose, Sodium Chloride, Sodium Lactate, Calcium Chloride, Magnesium Chloride, and water. 8000 mL or 8 liters of this fluid is pumped into my Peritoneal cavity via a catheter in my stomach 2 liters at a time. When filled it remains there for two hours (dwell) and then is pumped back out (drain.) This takes place four times every night, seven days a week. This is all controlled by the Liberty Cycler apparatus.
Ideally, the drain takes place at 100ml per minute, or 20 minutes for the entire individual drain process. If you add up four dwell periods of two hours each, and four drains at a minimum of 20 minutes each (this rarely happens in this short a timeframe), you end up with eight hours of dwell, and 80 minutes or one hour and 20 minutes of the drain, for a total time on dialysis ideally of nine hours and 20 minutes. This NEVER NEVER happens. With me, it is more like 10 hours and thirty minutes every night. Add to this setup and tear-down times and you can see that PD requires lots of time to accomplish.
Dialysis is not a walk in the park, but short of a kidney transplant, there are no other solutions currently available. I did read that research into using printed kidneys is currently underway. Sign me up. In a follow-up blog, I intend to discuss in more depth the diabetic side of the diabetic dialysis balance.
