Diabetes & Chronic Kidney Disease: A Concise Patient Guide

Diabetes occurs when your body can’t properly regulate blood sugar (either insufficient insulin or resistance to its effects).
- Over time, high blood sugar damages small blood vessels, including those in the kidneys.
Chronic Kidney Disease (CKD) means that kidney damage is present or there decreased kidney function
- CKD is often staged based on eGFR (estimated glomerular filtration rate) and the presence of protein in the urine (albuminuria).

Stage	eGFR (mL/min/1.73 m²)	What’s happening	Symptoms you might see
Stage 1	≥ 90 (normal or high) with evidence of kidney damage	Kidneys are still filtering well, early damage may be detectable by urine tests	Usually no obvious symptoms
Stage 2	60–89	Mild decline in function, structural/urine changes	May still feel normal
Stage 3	30–59	Moderate loss of kidney filtering ability	Fatigue, fluid retention, elevated BP
Stage 4	15–29	Severe reduction in kidney function	More symptoms: swelling, warnings to prepare for possible kidney replacement care
Stage 5	<15	Kidney Failure / End Stage Renal Disease (ESRD)	Dialysis or transplant needed

High blood sugar constricts or clogs tiny blood vessels in the kidneys, reducing their filtering ability.
Protein (albumin) leaks into the urine when filters are damaged (albuminuria).
High blood pressure, common in diabetes, further accelerates kidney damage.
Some medications or overuse of painkillers (e.g., NSAIDs) may harm kidneys; always review medications with your provider.

Take all diabetes medications as prescribed by your healthcare provider
Monitor blood sugar (or use CGM/SMBG) especially in later CKD stages (higher risk of hypoglycemia), as directed by your healthcare provider
HgbA1c targets should be personalized (often between <6.5% and <8.0%) based on your kidney stage, other conditions, and hypoglycemia risk

ACE inhibitors or ARBs are commonly prescribed to protect kidneys in people with diabetes and CKD
Keep your systolic/diastolic pressures close to target ranges as advised by your healthcare provider

Focus on whole foods: vegetables, fruits, legumes, high-fiber grains, unsaturated fats.
Moderate protein intake (often ~0.8 g/kg body weight) for CKD stages 1–4 unless dialysis is needed (discuss protein needs with your healthcare provider/dietician)
Limit sodium (often <2 g/day) to reduce pressure on kidneys and control fluid retention, as directed by your healthcare provider
Reduce processed meats, refined carbs, and sugar-sweetened drinks

Aim for moderate physical activity (e.g. walking, light resistance) as you’re able
Maintain a healthy weight (or lose weight cautiously if overweight)
Avoid or quit smoking
Stay well hydrated, but follow limits your healthcare provider sets (especially in later CKD)

Regular checkups with your nephrologist and diabetes care team
Routine labs, as ordered by your healthcare provider: eGFR, urine albumin, electrolytes, lipids, etc.
Your healthcare provider will adjust medications as kidney function changes
Be alert for signs of worsening CKD or complications

Rapid weight gain or swelling (“edema”)
Unexplained fatigue, nausea, or poor appetite
Elevated blood pressure (obtain specific guidance from your healthcare provider)
Changes in urination (more, less, foamy urine)
Difficult sleeping or concentrating
Muscle cramps
Signs of low blood sugar (especially if kidney function is low)
- Early (Mild–Moderate) Signs
  - Shakiness or tremors
  - Sweating (even when it’s not hot)
  - Fast or pounding heartbeat
  - Feeling anxious, nervous, or irritable
  - Sudden hunger
  - Dizziness or lightheadedness
  - Headache
  - Tingling in lips, tongue, or fingertips
- Later (More Severe) Signs
  - Confusion or difficulty concentrating
  - Blurred or double vision
  - Weakness or tiredness
  - Slurred speech
  - Clumsiness, trouble walking straight
  - Sudden behavior or mood changes
  - Seizure or loss of consciousness (if untreated)
- Always ask your healthcare provider for specific advice on when to call to report symptoms, and when to seek urgent/emergency care.