INS and Insulin resistance: Initially, the glucose control becomes worse as renal function deteriorates, resulting from increasing insulin resistance.[25] As falling of renal function continues, the marked fall in insulin clearance allows a lower dose of insulin to be given, along with an improvement in glucose tolerance.[26, 27] With the starting of hemodialysis, the insulin requirement will depend upon the net balance between the improvement of tissue insulin sensitivity and the restoration of hepatic insulin metabolism.