Diabetes & Chronic Kidney Disease: A Concise Patient Guide

1. What Are Diabetes and CKD?

• 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).

2. CKD Stages 1–5: What They Mean

3. How Diabetes Damages the Kidneys

• 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.

4. What You Can Do to Protect Your Kidneys

✅ Goals & Key Actions

Control Blood Sugar (Glycemic Control)

• 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

Control Blood Pressure

• 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

Adopt a Kidney-Friendly Diet & Nutrition

• 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

Stay Active & Healthy Overall

• 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)

Monitor & Work with Experts

• 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

5. Red Flags: When to Call Your Doctor

• 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.  

Sources:

• https://www.kidney.org/sites/default/files/11-10-0209_diabetes.pdf
• https://www.kidney.org/kidney-topics/diabetes-and-kidney-disease-stages-1-4
• https://www.uptodate.com/contents/definition-and-staging-of-chronic-kidney-disease-in-adults?search=chronic%20kidney%20disease&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3
• https://diabetes.org/living-with-diabetes/hypoglycemia-low-blood-glucose/symptoms-treatment
• https://my.clevelandclinic.org/health/diseases/15096-chronic-kidney-disease
• https://kdigo.org/wp-content/uploads/2022/10/KDIGO-2022-Clinical-Practice-Guideline-for-Diabetes-Management-in-CKD.pdf
• https://www.cms.gov/files/document/chronic-kidney-disease-disparities-educational-guide-primary-care.pdf

Medical Disclaimer

This resource is provided for educational and informational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. The information presented is general in nature and may not apply to every individual or health situation.

Individuals should consult their physician or another qualified healthcare professional for personalized medical advice, diagnosis, or treatment recommendations related to their specific health conditions.

Do not ignore or delay seeking professional medical advice because of information contained in this resource.

Call 911 if you are experiencing a medical emergency.