Diabetes is one of the most common etiological causes of end-stage renal disease and accounts for a significant proportion of patients requiring dialysis. Dialysis treatment complicates diabetes management by having significant effects on glucose metabolism, fluid-electrolyte balance, and the cardiovascular system. Glycemic control in patients undergoing both hemodialysis and peritoneal dialysis varies depending on the dialysis modality, volume status, and the changing pharmacokinetic properties of antidiabetic drugs, increasing the risk of hypoglycemia and hyperglycemia. Due to the increased risk of hypoglycemia during and after hemodialysis, it is recommended that insulin doses be carefully adjusted on dialysis days and that most oral antidiabetic drugs be avoided in advanced renal failure. In diabetic patients undergoing peritoneal dialysis, systemic absorption of glucose in the dialysate can lead to hyperglycemia and weight gain; therefore, the nutrition plan and insulin requirements should be individualized. While the increased burden of complications and frequent treatment requirements negatively affect the quality of life in diabetic dialysis patients, effective metabolic control and a multidisciplinary approach play a fundamental role in maintaining quality of life.