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Objective: To establish evidence of the clinical validity of the nursing diagnosis risk for ineffective blood glucose (00489) pattern self-management in patients undergoing hemodialysis. Method: A case-control study was conducted between May and August 2024 at a hospital in northeastern Brazil, involving 60 patients, 30 in the case group and 30 in the control group. An association was considered present when the risk factor, associated condition, or at-risk population had a p-value < 0.05 and an odds ratio > 1. Results: The risk factors insufficient knowledge about the signs and symptoms of hyperglycemia and hypoglycemia and inadequate food intake were prevalent. Conditions associated with diabetes mellitus and the use of high-flux dialyzer filters, an at-risk population characterized by patients with a longer history of diabetes mellitus increased the likelihood of the outcome. Conclusion: Evidence was obtained for the clinical validity of the nursing diagnosis risk for ineffective blood glucose pattern self-management in hemodialysis patients, demonstrating associations with the related conditions and at-risk population. Implications for nursing practice: The findings contribute to advancing discussions in the scientific and healthcare fields by providing evidence on the elements that predispose hemodialysis patients to glycemic alterations.