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Tuesday, May 21, 2013
Chronic Renal Insufficieny: Diabetes
I have had Type 1 diabetes for 38 years and have just received my lab panel back. My A1C over the past year has been between 5.9 and 6.4. My lipids are desirable; my creatinine was 1.96 and my egfr 37. My hemocrit was 40.3. MY urine prtein/creatine ratio was .34. I am on vytorin (10/40), lisinopril 40mg BID, cozaar 50mg; norvasc 5mg and hydroclorathazide 50mg. I am wondering at what level I need to be omore worried about kidney dialysis or if I can continue to stave this off with the management I currently am under for my diabetes and renal insufficiency?
The most important part of your care is to control the sugars and the blood pressure, and avoid any meds that can hurt your kidneys (for example, the non-steroidal anti-inflammatory drugs or NSAIDs).
Your labs look good. Your are on a good regimen of medication. It sounds like your doctor is doing a good job and so are you. You did not provide a BP report but the usual target would be a systolic BP of about 125, which might be adjusted by your physician to suit individual patient needs.
This is the same advice I give to all my patients. I also tell them I don't have a crystal ball so the future is uncertain about the outlook for the kidneys. One can hope for the best. Good luck!
Thomas Zipp, MD
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University