# N16 — Glucose, HbA1c, and CGM

N16 — Glucose, HbA1c, and CGM FRONT Front · at the chair

**When:** Glucose review, symptoms during treatment, or an HbA1c that disagrees with the patient.

### Do this

1.  Compare HbA1c with capillary glucose or CGM patterns and symptoms. Include treatment days and days off dialysis \[[1](https://urinenephrology.org/mastery/maintenance-hd/nursing/N16-Glucose-HbA1c-and-CGM.html#n16-ref-1)\].
2.  Record recent ESA or iron changes, transfusion, blood loss, and anemia. These can change HbA1c without an equivalent change in glucose \[[1](https://urinenephrology.org/mastery/maintenance-hd/nursing/N16-Glucose-HbA1c-and-CGM.html#n16-ref-1)\].
3.  For suspected hypoglycemia, check glucose promptly and use the unit treatment and recheck protocol. Confirm a discordant sensor reading with the approved meter method.
4.  Bring recurrent lows, high readings, poor intake, and missed meals to the diabetes prescriber; document timing relative to dialysis and medicines.

### Call / escalate

- Altered consciousness, seizure, inability to swallow, or persistent symptoms: activate emergency assessment and the unit hypoglycemia protocol.
- Repeated low readings, marked hyperglycemia with illness, or a mismatch between HbA1c and measured glucose: contact the responsible clinician promptly.

### Don't

- Do not call diabetes resolved because HbA1c is low. Dialysis, anemia, and treatment can make HbA1c misleading \[[1](https://urinenephrology.org/mastery/maintenance-hd/nursing/N16-Glucose-HbA1c-and-CGM.html#n16-ref-1)\].
- Do not independently change insulin or apply a single HbA1c target to every dialysis patient.

N16 — Glucose, HbA1c, and CGM BACK Back · why, and the evidence

### Why

- HbA1c remains useful for follow-up, but its reliability decreases in advanced CKD and is particularly limited during dialysis \[[1](https://urinenephrology.org/mastery/maintenance-hd/nursing/N16-Glucose-HbA1c-and-CGM.html#n16-ref-1)\].
- KDIGO supports CGM-derived glucose management indicator when HbA1c disagrees with measured glucose or symptoms. Direct glucose data help detect variability and hypoglycemia \[[1](https://urinenephrology.org/mastery/maintenance-hd/nursing/N16-Glucose-HbA1c-and-CGM.html#n16-ref-1)\].
- The KDIGO HbA1c target range of below 6.5% to below 8% was written for people not treated with dialysis; it should not be copied into a universal dialysis order \[[1](https://urinenephrology.org/mastery/maintenance-hd/nursing/N16-Glucose-HbA1c-and-CGM.html#n16-ref-1)\].

### Bring this to the review

Symptoms and timing; glucose or CGM values and confirmation; treatment-day pattern; food intake; diabetes medicines; recent ESA, iron, transfusion, or blood loss; action and recheck.

### Go deeper

- [Cardiometabolic Monitoring in Maintenance Hemodialysis](https://urinenephrology.org/mastery/maintenance-hd/cardiometabolic-monitoring-hd.html)
- [Complete screening and health maintenance white paper](https://urinenephrology.org/mastery/dialysis-advanced/screening-tests-hemodialysis.html)
- [N9 · Monthly labs overview](https://urinenephrology.org/mastery/maintenance-hd/nursing/N9-Monthly-Labs.html)

### References

1.  [KDIGO 2022 Diabetes in CKD guideline, chapter 2 (glycemic monitoring).](https://kdigo.org/wp-content/uploads/2022/10/KDIGO-2022-Clinical-Practice-Guideline-for-Diabetes-Management-in-CKD.pdf)

Adapted from the linked Clinical Mastery reviews; updated September 27, 2026. For education; the physician's written order and the unit protocol always govern.


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[Website version](https://urinenephrology.org/mastery/maintenance-hd/nursing/N16-Glucose-HbA1c-and-CGM.html) · Markdown synchronized October 3, 2026.