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Draft: not yet reviewed by a clinician

Use this page to prepare questions for your care team. It does not replace their advice. Your own targets and doses come from your nephrologist, diabetes team and renal dietitian.

For caregivers and family

In short

You do not need medical training to make a big difference. KDIGO says education works best when it includes care partners (KDIGO 2024, practice point 5.3.2), so ask to join visits and classes. The most important things to learn are: how to spot and treat a low, and how to give glucagon (ADA 2026 §6); the person's sick-day plan; their dialysis routine and access checks; and when to call 911. Caring is tiring. The ADA asks teams to check caregivers and family members for distress too (ADA 2026 §5), and US law can protect your job while you care (US Department of Labor).

Your numbers

If you see Do this Source
Glucose under 70 mg/dL, and they can swallow Give 15 g of fast sugar (4 glucose tablets); recheck in 15 minutes; repeat if still low ADA 2026 §6
They cannot swallow, cannot be woken, or are fitting Give glucagon, turn them on their side, call 911 glucagon instructions; NIDDK
Blood ketones 1.6–2.9 mmol/L Call their team now (emergency room if no answer) Get help now
Blood ketones 3.0 mmol/L or more, or any ketones with vomiting so they cannot keep fluids down Call 911 Get help now
Fistula or graft bleeding not stopped after 10–15 minutes of firm pressure Keep pressing and call 911 AKF
If you see Do this Source
Glucose under 3.9 mmol/L, and they can swallow Give 15 g of fast sugar (4 glucose tablets); recheck in 15 minutes; repeat if still low ADA 2026 §6
They cannot swallow, cannot be woken, or are fitting Give glucagon, turn them on their side, call your emergency number glucagon instructions; NIDDK
Blood ketones 1.6–2.9 mmol/L Call their team now (emergency department if no answer) Get help now
Blood ketones 3.0 mmol/L or more, or any ketones with vomiting so they cannot keep fluids down Call your emergency number Get help now
Fistula or graft bleeding not stopped after 10–15 minutes of firm pressure Keep pressing and call your emergency number AKF

FMLA (US): up to 12 weeks a year of unpaid, job-protected leave to care for a spouse, child or parent with a serious health condition, which can be taken in short blocks (US Department of Labor).

Lows and glucagon

  • Signs of a low include shaking, sweating, hunger, irritability and confusion. At night: nightmares, crying out, or damp sheets (NIDDK).
  • Never wait because of potassium or a fluid limit. Treat first. Glucose tablets are the best choice on a kidney diet (Treating a low).
  • Glucagon should be prescribed for everyone who uses insulin. Nasal and ready-to-use forms need no mixing (ADA 2026 §6). Ask the team or pharmacist to show you how to use the one you have, and check the expiry date.
  • After giving glucagon: turn the person on their side, because they may vomit, and call 911. When they are awake and can swallow, give them something to eat (glucagon instructions).
  • Never put food or drink in the mouth of someone who cannot swallow safely.

Sick days

  • Ask for a copy of their written sick-day plan, and know where the ketone meter and strips are.
  • Illness often raises glucose and ketones, and insulin must never simply be stopped. Your job is to help them follow the plan and call the team (Sick days).
  • Watch for vomiting, not keeping fluids down, deep or fast breathing, or confusion: see Get help now.

Dialysis days and access checks

  • In-center hemodialysis is usually three sessions a week of about 4 hours, at set times (NIDDK). Help them get there: missed or shortened sessions are risky (In-center hemodialysis).
  • Lows after dialysis are common: most come in the 24 hours after a session. Pack glucose tablets and a snack for the trip home (JBDS 2022; Insulin on dialysis).
  • Access checks: the person should feel the buzz (thrill) of a fistula or graft every day. Call the unit if it stops. Help them avoid blood pressure cuffs, blood draws, tight sleeves and heavy bags on that arm (NKF).
  • Home dialysis: most home hemodialysis programs ask for a trained care partner. You will be trained alongside the person (NKF). Ask about back-up plans and respite.

Medicines

  • Keep a copy of their medicine list, with doses as the prescriber wrote them, and update it after every visit or hospital stay (Your medicine list).
  • Many common medicines, such as some pain relievers, are risky with kidney disease. Check with their pharmacist before buying anything over the counter (Medicines to avoid).

Looking after yourself

  • Caregiver burnout is real. Tell your own doctor, and the person's team: the ADA asks diabetes teams to screen family members and caregivers for distress too (ADA 2026 §5).
  • Ask the dialysis social worker about local support, respite and transport. US dialysis teams must assess the person's family and support needs and offer education to family members (42 CFR 494.80 and 494.90).
  • Talk to someone who has been there: NKF PEERS matches care partners with trained mentors by phone (NKF).
  • Use FMLA if you need time off work to care (US Department of Labor).
  • If you feel hopeless or think about harming yourself, call or text 988 (US) (Mood and stress).

What to do

  • Learn to use their glucose meter or CGM app, and where the glucose tablets and glucagon are.
  • Ask the team or pharmacist to show you how to give their glucagon.
  • Get a copy of the sick-day plan, the medicine list and the wallet card.
  • Save the numbers for their kidney, diabetes and dialysis or transplant teams in your phone.
  • Join at least one education session or clinic visit (KDIGO 2024, practice point 5.3.2).
  • Agree who covers if you are ill or away.
  • Book one regular thing for yourself each week.

Examples

A low after dialysis. On the drive home, your father is sweaty and muddled. You stop, check his glucose: 58 mg/dL (3.2 mmol/L). He can swallow, so you give 4 glucose tablets and recheck in 15 minutes: 92 mg/dL (5.1 mmol/L). He eats his packed snack (ADA 2026 §6).

Glucagon at night. Your wife cannot be woken and her CGM reads LOW. You give her nasal glucagon, turn her on her side and call 911. When she wakes and can swallow, you give her juice and a snack (glucagon instructions; NIDDK).

Burnout. You have been the home dialysis partner for a year and feel exhausted. You tell the unit's social worker, who arranges some in-center sessions for respite and puts you in touch with a peer mentor (NKF).

Ask the care team

  1. Can you show me how to use the glucagon we have?
  2. What is the sick-day plan, and when should I call you?
  3. What should I watch for after dialysis sessions?
  4. Can I join the education sessions and clinic visits?
  5. What support, respite or transport is available for us?

Get help now if…

Call 911 (or your local emergency number)

They cannot be woken, cannot swallow or are fitting with a low (give glucagon first); chest pain; severe breathlessness or cannot lie flat; ketones 3.0 mmol/L or more, or any ketones with vomiting so they cannot keep fluids down; a fistula bleed that will not stop. Full list: Get help now.

Call their team today

Vomiting or not eating, lows that keep coming back, a missed dialysis session, no buzz in the fistula (call the unit right away), or cloudy PD fluid (keep the bag). After a transplant, a temperature over 100 °F (37.8 °C) means calling the transplant center right away (NIDDK).

Sources

Not yet reviewed by a clinician. Facts and sources last checked 2026-10-06.