[Specific issues of dialysed diabetics in outpatient practice]

Approximately 40% of patients on dialysis have diabetes mellitus (DM). The basic characteristic of those patients are numerous associated organ complications, especially heart and artery diseases. These and other associated complications in dialysed diabetic patients have a modified pathogenetic and clinical picture and contribute to their poorer prognosis. Anaemia, immunodeficiency as well as malnutrition are manifested earlier and in a more significant manner. Dialysis therapy has the same rules for diabetic and non-diabetic patients. Tolerance to ultrafiltration is lower and haemodynamic instability is easier to provoke in diabetics than in non-diabetic patients. The use of a dialysis solution is beneficial from the point of view of glucose concentration balance. Insulin doses are lower as a result of extended insulin half-time. There is also a degree of insulin resistance, but it can be managed to a great extent by adequate dialysis. There are no fixed guidelines for insulin dosing; the doses roughly amount to half of the doses in patients with normal renal function. The assessment of diabetes compensation is based on glycated haemoglobin, and glycated albumin is also recommended in certain cases. Deciding on the therapy (oral antidiabetic drugs vs. insulin therapy or a combination of both) is based on diabetic care standards; cooperation between the diabetologist and the dialysis doctor is desirable. Customized, specifically designed and targeted intervention in diabetic patients may slow down the progression of diabetic vascular changes, improve diabetes compensation and the patients' quality of life.