FREQUENCY AND CLINICAL PATTERNS OF HYPOGLYCEMIA AMONG CHRONIC KIDNEY DISEASE PATIENTS ON INSULIN THERAPY AT AYUB TEACHING HOSPITAL, ABBOTTABAD

Abstract

Background: Hypoglycemia is an important complication of insulin therapy in patients with chronic kidney disease (CKD). Declining renal function may increase the risk of hypoglycemia because of reduced insulin clearance, impaired renal gluconeogenesis, variable nutritional intake, intercurrent illness, and changes in insulin requirements. Patients with advanced CKD and those receiving hemodialysis are particularly vulnerable. However, local data describing the frequency and clinical patterns of hypoglycemia among insulin-treated patients with CKD are limited. This study was conducted to determine the frequency and describe the clinical patterns of hypoglycemia among patients with CKD receiving insulin therapy at Ayub Teaching Hospital, Abbottabad. Methods: A descriptive observational cross-sectional study was conducted in the Medical Unit of Ayub Teaching Hospital, Abbottabad, from 1 May 2026 to 1 August 2026. A total of 175 adult patients with established CKD receiving insulin therapy were enrolled through non-probability consecutive sampling. Hypoglycemia was defined as a blood glucose level <70 mg/dL, with level 1 defined as 54–<70 mg/dL, level 2 as <54 mg/dL, and level 3 as an event requiring assistance from another person. Demographic, clinical, CKD-related, insulin-related, and hypoglycemia-related variables were recorded using a structured proforma. Data were analyzed using IBM SPSS Statistics and presented as frequencies, percentages, and appropriate descriptive measures. Results: Among 175 insulin-treated patients with CKD, 59 (33.7%) experienced at least one hypoglycemic episode, while 116 (66.3%) had no documented episode. A total of 96 hypoglycemic episodes were recorded among the affected patients. Of these, 48 (50.0%) were level 1, 37 (38.5%) were level 2, and 11 (11.5%) were level 3 episodes requiring assistance. Among patients experiencing hypoglycemia, 31 (52.5%) had one episode, 16 (27.1%) had two episodes, 7 (11.9%) had three episodes, and 5 (8.5%) experienced four or more episodes. Sweating was the most common clinical manifestation (57.6%), followed by tremulousness (45.8%), dizziness/light-headedness (42.4%), generalized weakness (39.0%), and palpitations (30.5%). Confusion or altered behavior occurred in 23.7%, while seizures and loss of consciousness were reported in 6.8% and 11.9%, respectively. Morning episodes were most frequent (30.2%), followed by afternoon (26.0%), evening (24.0%), and night (19.8%). Reduced oral intake or anorexia was documented in 30.2% of episodes, while missed meals occurred in 24.0%. Oral carbohydrate or glucose was used for 63.5% of episodes, whereas 25.0% required intravenous dextrose. The frequency of hypoglycemia increased with advancing CKD stage, from 16.7% in stage 3a to 47.5% among patients with stage 5 CKD receiving hemodialysis. Hypoglycemia was also more frequent among patients receiving multiple daily injections (43.5%) and among those with diabetes duration >10 years (43.5%). Conclusion: Hypoglycemia was common among insulin-treated patients with CKD, affecting approximately one third of patients in this study. Episodes ranged from mild symptomatic events to severe episodes requiring assistance or intravenous treatment, with recurrent episodes also observed. Hypoglycemia was more frequently encountered in advanced CKD, particularly among patients receiving hemodialysis, and was commonly observed in the setting of reduced oral intake and missed or delayed meals. These findings highlight the need for regular glucose monitoring, careful individualization of insulin therapy, attention to nutritional intake and dialysis timing, and early recognition of hypoglycemia in patients with CKD.