Hypoglycemia and Kidney Disease: Risks, Prevention and Management

Editors note: Original publish date: Mar 3, 2023 – Updated on June 1, 2024

Blood glucose (sugar) usually fluctuates within a healthy range throughout the day due to many factors, such as eating a meal, exercising, or disease. If your glucose levels go above or below a specific healthy range, your body may suffer damage.

Patients who have hypoglycemia and kidney disease are at an increased risk of other complications and further disease progression if either disease is not effectively managed.

Key Points:

• The kidney plays an essential role in the regulation of glucose homeostasis, fluid and electrolyte balance, and the excretion of waste products.
• Chronic kidney disease (CKD) is a significant risk factor for developing Hypoglycemia with or without the presence of diabetes.
• Hypoglycemia is also a common compilation in CKD patients, more so if they also have diabetes.

Hypoglycemia Overview

Hypoglycemia occurs when blood sugar levels drop below 70 mg/dL. When your blood glucose levels drop low enough, intervention or treatment must occur to bring the sugar levels back to your target range. Hypoglycemia can also be referred to as insulin shock or an insulin reaction.

Causes of hypoglycemia

Hypoglycemia is common for people with type 1 diabetes and may occur in people with type 2 diabetes who are taking certain medications and insulin.

Causes of hypoglycemia include:

• Insulin. Taking too much insulin is a known cause of low blood glucose. Accidentally injecting straight into the muscle or injecting the wrong insulin type may also cause hypoglycemia. Older types of insulins are a source of blood glucose dropping, generally overnight.
• Food. The types of food you eat may cause low blood glucose. Not consuming enough carbohydrates or the composition of your meal (which can affect the absorption of carbohydrates) may cause low blood glucose. The amount and timing of when you take your insulin with meals may also cause low blood glucose levels.
• Physical activity. Although regular exercise has many benefits, it can lower blood glucose levels for either a short or a long period of time.

Other possible causes of hypoglycemia may include the following:

• Spending time at high altitude
• Sudden changes in heart or kidney function
• Consuming alcohol on an empty stomach
• Weather conditions such as heat and humidity
• Menstruation
• Going through puberty (hormonal changes)

Signs and symptoms of hypoglycemia

Signs and symptoms of low blood sugar are different for everyone and may change over time.

Some signs and symptoms of hypoglycemia may include the following:

• Hunger
• Palpitations (fast heartbeat)
• Sweating
• Shaking, trembling, tingling
• Nausea
• Vision changes (blurry vision)
• Dizziness
• Confusion or irritability
• Anxiety or nervousness

When blood glucose levels drop below 70 mg/dL, the hormone epinephrine (adrenaline) is released, which causes some symptoms of hypoglycemia. If the blood glucose levels continue to drop further, the brain stops receiving enough glucose to function. If these severe low blood glucose levels stay for too long, the brain will be starved of glucose, which may lead to seizures, a coma, or be fatal.

The only accurate way to know if your blood glucose is low is to check your glucose levels.

Types of hypoglycemia

• Severe low blood sugar. Blood sugar below 54 mg/dL is considered severe and may make you feel faint (passing out). Other symptoms may include feeling weak, having seizures, having difficulty walking or seeing clearly, and feeling confused. A severe event needs someone to help you recover.
• Nocturnal (night time) low blood sugar. Some people may experience low blood sugar levels while they sleep. This may happen for numerous reasons, such as and is not limited to drinking too much alcohol, taking too much insulin, having a very active day, or being physically active near bedtime.

Kidney Disease and Low Blood Sugar (Hypoglycemia)

In healthy people, the kidneys regulate glucose homeostasis by releasing glucose into circulation (via gluconeogenesis), uptaking glucose from the bloodstream to meet the body’s energy requirements, and reabsorbing it. When the kidneys reabsorb glucose, they generally retrieve as much glucose as possible, leaving the urine practically free of glucose.

Can kidney disease affect blood sugar levels?

Kidney disease is a chronic condition that damages the kidneys, reducing their ability to function properly. The kidneys filter blood, removing waste products, toxins, and excess water from the body. They also play an essential role in helping control blood pressure, stimulating the production of red blood cells, and keeping the bones healthy.

There are five stages of kidney disease, which refer to how well the kidneys are functioning. Stages 1-3 are classified as the early stages, with the kidneys still able to filter waste out of the blood. Stages 4-5 are the late stages of CKD and are characterized by severe kidney damage or kidney failure.

CKD is an independent risk factor for hypoglycemia and further increases the risks already present in people with diabetes. CKD may also impact or restrict the types of antidiabetic therapy options in diabetic patients. This may increase the risk of cardiovascular disease or mortality.

Additional CKD risk factors for hypoglycemia:

• Altered drug metabolism
• Malnutrition
• Anorexia
• Infections
• Impaired renal glucose release
• Associated heart and liver disease
• Problems linked to dialysis

Kidney Failure and low blood sugar

Hypoglycemia, which is associated with kidney failure, may be caused by multisystem failure of the kidneys. The development of low blood glucose due to kidney failure is generally complex and can involve one or several mechanisms that can differ from patient to patient.

Both non-diabetic and diabetic patients with end-stage renal disease (ESRD) on hemodialysis may be at high risk for low blood glucose.

While low blood glucose is a serious health risk for patients with CKD, managing blood glucose is an important intervention for helping to reduce the likelihood of diabetic patients developing ESRD. If patients are unable to control their blood glucose effectively, they may be predisposed to episodes of hypoglycemia.

Preventing and Managing Hypoglycemia

Preventing hypoglycemia involves practicing good management interventions and learning to detect low blood glucose so that it can be treated early. One method is monitoring blood glucose with CGM (continuous glucose monitoring) or a meter. Your healthcare provider will help you determine how often you should test your blood glucose levels.

Monitoring your diet and carbohydrate intake is another important management step for preventing hypoglycemia. Your dietician will help you develop a meal plan to control your glucose consumption.

Mild to moderate low blood glucose may be treated by consuming carbohydrates, while severe low blood glucose may require emergency glucagon. If you have any concerns about managing or treating your hypoglycemia, talk to your healthcare provider so that they can help you with a diabetes management plan.

Panoramic Health

Panoramic Health is an integrated provider group delivering the future of kidney care. Our mission is to improve patients’ outcomes by slowing disease progression and improving their quality of life. We do this through the distinctive capabilities of our comprehensive care model, which brings together an integrated provider group with operational support, clinical support, and data & analytics at scale.

Through partnerships with practices, providers, payers, and health systems, we work to advance the usage of clinically validated best practices and cutting-edge data analytics across a continuum of reimbursement models.

*The content presented in this article is for informational use only and should not be construed as medical advice or replace the medical advice of a qualified physician.