Have Diabetes-Related Kidney Disease? Changes to Care You Might Need

High blood pressure and diabetes are the top causes of end-stage renal (kidney) disease.¹

If you have diabetes-related kidney disease, changes to your diabetes care are likely necessary. Here are a few factors to consider when managing kidney disease.

Changes to medications

Many diabetes medicines are filtered out of your body through the kidneys. That means your kidneys must work well to use these medicines. Some medicines need to be stopped, or their dose lowered, if you have kidney disease. Otherwise, the medicines can stay in your body longer than they should and may cause side effects.¹

Insulin

In my experience as a Certified Diabetes Care and Education Specialist (CDCES), insulin is a perfect example of this. I've worked with several people with diabetes and kidney disease taking insulin.

Usually, we need to lower the doses of their long-acting insulin. This type of insulin tends to stay in their body longer than before their kidney health changed. For many, that means they usually struggle with low blood sugars in the overnight and early morning hours.¹

Metformin

Metformin is another common medicine needing dose changes based on kidney health. Many people mistakenly believe metformin causes kidney damage. That is not true. It can, however, cause metformin-associated lactic acidosis (MALA), a rare but serious condition, in those with reduced kidney function.^2,3

Depending on the health of your kidneys, your doctor may recommend changing your metformin dose or stopping the medicine if your kidney health is poor. This prevents metformin from building up in your body and possibly making you sick.^2,3

SGLT-2 inhibitors

An option from this group of diabetes medicines may be added to your treatment plan to help prevent some diabetes complications. Studies have shown that SGLT-2 inhibitors can slow kidney damage and lower your risk for heart disease.¹

SGLT-2 inhibitors that are prescribed in the United States include:¹

• Empagliflozin (Jardiance®)
• Canagliflozin (Invokana®)
• Dapagliflozin (Farxiga®)
• Ertugliflozin (Steglatro®)

Newer diabetes medicines give your medical team more options for treating diabetes when you have kidney disease. In general, though, the more severe your kidney disease, the fewer options you have for diabetes medicines. In some cases, insulin may be the best treatment. Changes to non-diabetes medicines may also be needed.

More frequent lab work

The usual yearly cadence to test your kidney health will be required more often, at least every 6 months if you have kidney disease. These tests can include:

• A urine test called the urine albumin-creatinine ratio (uACR)
• A blood test called the estimated glomerular filtration rate (eGFR)

You should consult a kidney specialist (nephrologist) if you have high protein levels in your urine or if your eGFR is less than 30.¹

Nutrition changes

Depending on your level of kidney disease, you may need to change your eating patterns. Eating smaller amounts of protein can slow kidney damage if you have severe kidney disease but are not on dialysis.

Your doctor also may advise you to lower the amount of sodium in your food to help your blood pressure and fluid levels. In some cases, you may need to avoid foods high in potassium.

Consulting a registered dietitian is a great resource to help you understand your nutritional needs and how to fit these changes into your daily life.¹