Diabetes, CKD, now reduced metformin. Glucose up

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Been diabetic 20 years, obese but exercise 3 times weekly. 69 years old. My eGFR has dropped from 82 to as low as 36, back to 50 now, in less than two years. Was on 3000mg metformin, after 2 weeks of only 1000mg, sugars up to 20. Last Hba1c was 54. Will eGFR keep dropping at same rate? Hospital don't want you until ready for dialysis, no private nephrologist here. Presume I will have to go onto insulin now. Presently still on 4 gliclazide.

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  • Posted

    Val, what good news to hear that after dropping from 82 to 36, your eGFR has returned to 50.

    As to whether it will "keep dropping at the same rate", that probably depends on what made it drop in the first place, and especially how well your diabetes is controlled.

    You haven't said where you are but I'm a bit shocked to hear that your hospital doesn't want you until you are "ready for dialysis".  I have uncontrollable high BP with a present eGFR of 47 (Stage 3 of Chronic Kidney Disease) and am seeing a renal consultant regularly on the NHS.  Incidentally, my eGFR plummeted by 8 points recently in just over 3 weeks whilst taking a diuretic with a view to it helping my blood pressure. I panicked and it was immediately stopped following which my eGFR gained 7 of the 8 points lost by the time of the next blood test 4 weeks later.  Huge sigh of relief! 

    I'm sorry I can't help you with the insulin problem (I assume you are under a dietician) except to say that as you have mentioned you are "obese", then the main priority, as well as avoiding sugar of course, should be to watch your carb intake and drastically reduce all those carbs that are known to turn to sugar in our bodies, such as potatoes, bread, parsnips etc.  Also avoid all processed foods, ie cold meats, and most things that come out of tins as they nearly all contain sugar.  In case much of your excess weight is due to fluid retention, then include lots of known diuretic-type foods such as asparagus, celery, garlic, melon, fennel.

    And although you say you exercise 3 times weekly, including a brisk walk of about half an hour on most days may also help.  Exercise not only helps with weight loss but can also help the kidney function.

    I do hope something here helps and wish you well.  Do come back and let us know how you get on.

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    • Posted

      Thanks for your reply. I am not in the uk, but we don't have a forum like this where I am. I have been 125kgs, but have been about my present weight for 5 years or so. I am on lots of meds. 5 for bp, which is really good now. They just took me off furosemide. Been good for about 2 years. I had a knee repl.  2 years ago, need another, but now not even on the waiting list! Exercise has helped strengthen the knee. I cannot walk for longer than 10 minutes. My eyes are in trouble too...... Diabetic maculopathy and fluid in wrong place, had lazer near macula 3 months ago, but much worse...only in one eye. Avastin injection, go back in a month. Going to GP today. Blood sugar was 7.5 this am, but within 1 1/2 hrs was 15.1. I had two small poached eggs, and 20 g carb as seedy brown bread. 

      I did very little for 5 years. Until last year, when found B12 was at rock bottom, feel like a person again. My son died in an accident 6 years ago. Also, vitD was 37, s/be 50 to 150. Metformin and omeprazole are the cause of the B12 problem.

       

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    • Posted

      Oh dear, Val, I'm so sorry to hear all that you have been going through, especially the tragic loss of your son - my heart goes out to you.

      As you say you are on 5 meds for BP, I am wondering if one of those is a Beta Blocker, such as Atenolol?  I only mention this because some years ago it was discovered that patients taking a Beta Blocker, such as Atenolol, together with a diuretic, such as Furosemide, were at increased risk of diabetes.  If you are taking a Beta Blocker then perhaps it may help to stabiliise your diabtes now that you are off the Furosemide.

      I can believe how much better you are feeling having sorted out the B12 deficiency as I have a couple of friends who say they feel different people since being given B12 injections.  I have experienced Omeprazole as a stomach protector whilst on steroids but only for a few days as it had a horrid reaction on my bowel and had to be stopped.  An alternative from the same family proved no better, so I resorted to a 'live' (probiotic) fat-free yoghurt for the remaining years on steroids which proved a great stomach protector.  We have a slightly different recommended level for Vit D here in the UK of 75 to 150/200 - the higher figure depending on which area health authority we come under.

      I think it's rather blase of your GP to state that a specialist won't tell you anymore than he does - not so sure they would agree with him.  However, it sounds as though you are being well monitored via blood tests etc and also with your eye treatment.  I do wish you well.  

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    • Posted

      Thanks for your reply. Managed to get my bs down to 6.3 at 8am. 2 weetbix, inst coffee, pills, off to exercise class, 9.00 start.  Checked bs at 9.45: 18.3! 

      Yes, a betablocker, yes furosemide, now only half tablet. 

      Don't know how long to wait before going back to Dr for insulin. Will just record for few days.

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  • Posted

    Hi,

    The most important thing in your situation is to gain control of your weight.  I would not change your diet without advice as this can be dangerous for people with kidney problems.  I would concentrate on keeping control of your portion sizes information can be found online regarding this.  If you do have to go onto insulin I would not cut out carbs as they are needed inbetween injections.

    Where abouts do you live? In the uk if you are diabetic alone you are usually looked after and have regular appointments and if you have kidney issues the NHS usually take good care of you.

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    • Posted

      Thanks for your reply. I probably put most info in the previous reply. I do know what to eat, and don't have a sweet tooth, but yes, portions matter even when the food is "good".
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  • Posted

    GP: back to 1500 metformin, so one at lunchtime as well. Test blood in 2 weeks. No referral. He says they won't tell me anymore than he does. Says the drop from 82 is quite normal in diabetic with all the other problems, and having used NSAIDs until 18 months ago. Probably go onto one long acting insulin inj in the morning very soon. I
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