In CKD patients, hypoglycemia occurs more easily even in the absence of diabetes, for impaired renal gluconeogenesis, reduced renal degradation of insulin, co-existing comorbidities (such as protein-energy wasting and diabetic gastroparesis), as well as inhibition of hepatic glucose output and stimulation of insulin secretion by uremic metabolites.36 This evidence concerns the gene INS and Hypoglycemia.