Introduction

Diabetes mellitus, in particular type 2, has become more common, and the trend is likely to continue.1 Associated comorbidity is also more common—for example, diabetes is now the most common cause of dialysis dependent renal failure in the Western world.2 In the United Kingdom between 1991 and 1998, the incidence of new patients on dialysis increased from 67 to more than 90 patients per million population, and the prevalence of diabetes in people receiving dialysis has increased from 16% to 19%.3

The increasing demand for dialysis and slower growth in capacity for haemodialysis has reinforced the need for an integrated approach to providing dialysis. Peritoneal dialysis is the preferred option for a proportion of patients with end stage renal failure.4 A subgroup of patients has difficulties with removing fluid. This can be improved with an alternative osmotic agent based on a polymer of glucose—icodextrin.5 We report a severe potentially clinical consequence of using icodextrin in a diabetic patient, which although mentioned in a specialist journal is still not widely recognised. This issue is even more important given the increasing number of diabetic patients with end stage renal failure. About 500 patients in …