Administration of insulin glargine thrice weekly by medical staff at a dialysis unit: a new insulin regimen for diabetic management in physically impaired patients undergoing hemodialysis

Diabetic patients undergoing hemodialysis may have difficulty in self-injecting insulin due to physical impairment or other disabilities. We hypothesized that postdialysis administration of insulin glargine by medical staff would improve diabetes care in this high-risk patient group. In this report, we describe six hemodialysis patients with type 2 diabetes and inadequate glycemic control who were admitted to our hospital. All patients had an inability to self-inject insulin due to visual impairment and/or stroke symptoms. Therefore, they had been unable to receive insulin treatment at the outpatient dialysis clinics within the last few months. After admission, the patients were administered insulin glargine after each hemodialysis session, thrice-weekly. Regarding glycemic control, blood glucose profiles including the circadian variation of 13-point blood glucose values for 48 h, hemoglobin A1C (HbA1C), and glycated albumin (GA) were evaluated before and after insulin treatment. Post-dialysis administration of insulin glargine significantly reduced blood glucose levels, particularly during the first 24 h after injection. HbA1C and GA levels were significantly decreased after 6 months, with no increase in the incidence of severe hypoglycemic episodes. Although further large controlled studies are needed, post-dialysis administration of insulin glargine by medical staff may improve glycemic control in physically impaired diabetic patients undergoing hemodialysis at outpatient clinics.