# N16 · Glucose, HbA1c, and CGM

Compare HbA1c with measured glucose and the patient’s experience, especially around dialysis.

![Infographic: N16 · Glucose, HbA1c, and CGM](https://urinenephrology.org/visual-reference/images/nursing-n16.png?v=20261003c)

## Ask about the pattern

Review symptoms, meals, diabetes medicines, and glucose values on treatment and non-treatment days. Include lows during recovery or overnight, recent illness, poor intake, and changes in the usual dialysis schedule.

## Interpret HbA1c cautiously

Anemia, ESA therapy, iron treatment, transfusion, and altered red-cell survival can change HbA1c without an equivalent glucose change. A low HbA1c does not establish that diabetes has resolved.

## Glucose <70 mg/dL: treat and recheck

Confirm with the approved meter when needed and use the unit hypoglycemia protocol. If alert and able to swallow, the usual adult pathway uses 15 g fast-acting glucose, then a glucose recheck in 15 minutes; repeat under protocol if still low.

## Cannot swallow or seizure: emergency

Do not give food or drink to a drowsy, unconscious, or unsafe-to-swallow patient. Activate urgent assessment and the unit’s IV glucose/glucagon pathway. Recurrent lows need prescriber review even when HbA1c looks reassuring.

## Use an individualized plan

The diabetes prescriber sets monitoring and treatment targets around hypoglycemia risk and patient goals. Do not independently change insulin or apply a nondialysis HbA1c target universally to people receiving dialysis.

## Document the dialysis-day pattern

Record glucose, sensor/meter agreement, symptoms, last meal, last diabetes dose, dialysis timing, rescue given, and 15-minute response. Include recent ESA/iron/transfusion history when HbA1c disagrees with measured glucose.

## Supporting evidence

- [Supporting guideline or source](https://diabetes.org/living-with-diabetes/hypoglycemia-low-blood-glucose/symptoms-treatment)

## Source lessons

- [N16 Glucose HbA1c and CGM](https://urinenephrology.org/mastery/maintenance-hd/nursing/N16-Glucose-HbA1c-and-CGM.html)

Read alongside the full lessons; the findings and decisions shown here require the stated clinical context.