What to discuss with your doctor about diabetes and kidney health

Professiona woman sonographer therapi.st working with ultrasound machine at the clinic, making kidney ultrasound for female patient, looking at the screen and pushing buttons on control panel

If you have diabetes and kidney disease, or are at risk, there are some important issues you should discuss with your doctor. Read on to learn more about talking with your healthcare team about diabetes and kidney disease.

Targets

Meeting your diabetes targets – including blood sugar, cholesterol and blood pressure – is key to preventing diabetes complications, including kidney disease. Talk with your doctor about your individual diabetes targets and how to meet them.

Blood sugar and A1C

The table below lists the Diabetes Canada recommendations for A1C and blood sugar targets.

Target

A1C*

Blood sugar

before a meal

Blood sugar two hours after the start of a meal

Most adults

7% or lower

4 to 7 mmol/L

5 to 10 mmol/L
(5 to 8 mmol/L if A1C targets are not being met)

Adults with a low risk of hypoglycemia, to reduce the risk of kidney disease

6.5% or lower

*A1C may not be as accurate a measurement in moderate to severe kidney disease

Cholesterol and blood pressure

The target for low-density lipoprotein cholesterol (the “bad” cholesterol) is less than 2 mmol/L. The target for blood pressure is less than 130/80 mm Hg.

Read also about How do you know if you have kidney disease?

Kidney disease is a common complication of diabetes. Read about diabetes and kidney disease in this article, including symptoms, tests that diagnose it and the five stages of kidney disease.

Medications

If you have kidney disease, or are at risk for it, your healthcare team may prescribe medications. The main treatment is medicine that lowers your blood pressure and prevents or slows damage to your kidneys. The two types of medication that are most often prescribed for this purpose are ACE inhibitors (short for angiotensin-converting enzyme inhibitors) and ARBs (short for angiotensin II receptor blockers).

More recently, newer medications have been shown to help support kidney health in people with diabetes and albuminuria.

Speak with your diabetes healthcare team regarding which medications might be most appropriate for you.

Sick day management

Taking good care of yourself is very important if you have diabetes and kidney disease and become ill. Learn more about sick day management here.

Other factors

Weight management, including what an ideal weight is for you, tips on how to lose weight (if needed) and how to maintain a healthy weight.

Not smoking, including how to access resources to help you quit.

Nutrition, including food choices for eating a heart- and kidney-healthy diet. If you have kidney disease, you may be told to limit salt, phosphorus, potassium and protein in your daily diet. Your healthcare team – particularly a dietitian – can help you make the right choices for your situation.

Read also about How is kidney disease treated in people with diabetes?

Kidney disease in people with diabetes is treated with self-management practices, such as attaining an ideal weight and target blood sugars, not smoking, following a heart- and kidney-healthy meal plan, and taking certain medications.

Your checklist for kidney health

A1C targets (A1C may be falsely lower in kidney disease)

Most adults: 7% or lower
Adults with a low risk of hypoglycemia, to reduce the risk of kidney disease: 6.5% or lower

Blood sugar targets (These targets are accurate in kidney disease)

Before a meal: 4 to 7 mmol/L
Two hours after the start of a meal: 5 to 10 mmol/L (5 to 8 mmol/L if A1C targets are not being met)

Cholesterol target

LDL-cholesterol less than 2 mmol/L

Blood pressure target

Less than 130/80 mm Hg

Medications that may be used

Talk to your diabetes healthcare team about what might be appropriate for you

Other factors

Weight management: What is my ideal weight? How can I maintain a healthy weight?
Quitting smoking
Food choices for eating a heart- and kidney-healthy diet

Download this handy table before your next diabetes-related visit with your healthcare team. It lists the key issues to discuss with your doctor about diabetes and kidney disease.

This article was sponsored by Janssen Inc.

Read also about 5 steps you can take every day to support your kidney health

You may already know that diabetes can affect your kidneys and that high blood sugars, along with other risk factors, can cause kidney disease. That’s why it is important to have regular tests for kidney disease to detect it at an early stage, as there may be few symptoms at that time.

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