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Diabetes Medication and CKD

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super_mum1001

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Firstly I want to note that I understand any changes to my medication will need to be discussed with my GP, but I thought I'd get some opinions from people who have been through similar scenarios.

I've been a diabetic for over 20 years, my last blood test showed a hba1c of 72 and since then I've made major diet and exercise changes and will continue to do so (LCHF). I've also recently been told I'm at CKD Stage 3b (37%).

I'm currently on the following medication:
  • Morning: Inovkana 300mg, Glicazide 80mg
  • Evening: Glicazide 80mg , Metmorfin 1g / Stiagliptin 50mg
Given my decreased kidney function does anyone have any views on changes to medications I might want to make? I'm trying to lower my carbohydrates but I might need some additional medication after my next hba1c result. My blood sugar seems to spike the most after lunch so not sure if medication at that time is better placed?

Below is an extract from my libre app last time I was using it:
 
Hi there, first question then is what do you have for your lunch?, having said that if your pre lunch reading is 8.9 then it looks like lunch wasn't problematic, it's the 'fasting' levels that are high. I'm not sure your medication works in the way that insulin does, ie the timing of it being crucial and working specifically with whatever is going into your mouth but others may know. If you continue on the LCHF diet you might be very surprised by your next hb1ac but of course, as you say with the medication you are on you MUST discuss with your GP about any necessary adjustments and actually you may find yourself dropping some meds if you manage to lower your glucose levels. Would you mind telling us a typical days meals as that helps people to give advice based on their own experiences. x
 

Complex stuff.

On the kidney front; I reached stage 3(a) CKD with an eGFR of 55.
After a few of these I decided that it might be my low fluid intake, and forced myself to drink about 2 pints of water a day (not feeling at all thirsty) before my next blood test.
My eGFR was then up into the 70s.

I may be wrong but I think that may show that my kidneys are still working but my blood isn't being flushed through if I drink to my thirst.

Drinking enough is defined in many ways. One is drink whenever you are thirsty. Another is drink until your urine is pale straw colour. Another is drink at least 2 litres of water a day (no real evidence).

So might be worth checking if you are regularly drinking enough to flush everything through.

My last eGFR (no pre-flush) was in the 60s and marked as "normal" by the surgery, but that might have been in the "normal for Norfolk" category.
 
I am including a paper from the USA, which does also mentions some UK practices, regarding many of the drugs you are using. It is a bit technical, but it does have an easy-to-use table towards the end.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4732385/

It looks like Metformin is one that may need a haircut but at 1 g/day it is not maxed out so may be ok at 1g.

As a user of Gliclazide myself, I would suggest that going low carb should allow you to drop this one as your sugar levels drop, and is probably the one that could cause hypo's especially at the dose you are on. I find my 40 mg/day can drop my sugars by 4 mmol/l quite easily following an LC meal.
 
Thanks. I've got my next hba1c next month and I'm hoping it's in the 50-60 range at least!

Typical Day of Eating:
Morning - Small amount of oatbran with almond milk and some nuts on the side.
Lunch - Chapati (Indian flatbread made from a mix of almond flour and wheat flour) and lentil soup with salad
Snack - 0 carb soya yogurt and a handful of berries
Dinner - Mushrooms, Broccoli and one hashbrown

I'm not sure if the effect of glicazide has diminished over the years but I feel it does not have that much effect even at 80mg. Again will retest hba1c next month to see where I'm at. I've seen documents on Inovkana being used for end stake kidney disease so I'll probably continue to use this unless doctor advises otherwise and increase my water intake to 2 litres a day.

Does anyone have any experience with any other medication that I might want to explore?
 
Invokana (otherwise known as Canagliflozin) can cause kidney damage as can Forxiga its close relative).
https://www.medicalnewstoday.com/articles/326234#side-effects

Some report that it can improve kidneys that are already damaged by diabetes. I think this is by increasing the outflow of urine which will help with the eGFR ratio leading to physicians claiming repair happening, but this is not backed up by proper studies it seems. Be wary of this claim.

This medicine has some very nasty side effects.
 
Try dropping (i.e. leave out, not drop on floor then eat!!!) the chapatti to see if your lunch levels improve. I find legumes (beans pulses and lentils) cause my glucose levels to spike quite badly. Try a different vegetable soup instead? Test before and again 2 hours after eating it to see the rise then decide.

Your Gliclazide probably became less effective if your Insulin Resistance got worse. It may still be useful later when the LCHF has taken effect and reduced the IR.
 
You might find this helpful @super_mum1001
https://www.healthline.com/nutrition/best-foods-for-kidneys
I can't advise you about medication, unfortunately, but keeping phosphate levels down can slow down kidney disease,
I wish you the best of luck!
 
There are several formulae available for calculating fluid intake based on body mass. However, these do not factor in additional needs due to exercise, hot weather etc. Also the fluid can also come from food like fruit, vegetables, soups etc as well as from drinks. I too have concerns about my kidney function and am going to see what happens if I drink plenty of water before my annual blood tests. Normally I have black, unfiltered coffee and that may be pushing up my cholesterol readings as well.
 

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Thanks for the heads up, looks like I need to do more research around this drug and discuss further with my GP. Hopefully there are good alternatives if this is not suitable for me.

I'm trying to limit my chapati intake although it's been a staple as part of my diet for most of my life so it's easier said than done! Trying different flour mixes which are lower in carb (e.g almond, coconut).
 
Have a look at Bulgar Wheat. Not sure if it makes chapattis stick together, but it may be better than standard processed wheat flour. But before you do that, just do some bgl checks on the chapatis you already use. If they are causing spikes then seek alternatives. Maybe paratha would spike you less? I love stuffed paratha. or puri.
 
I occasionally make socca which are like chapattis but made with chickpea flour. Chapattis made with almond and chickpea flour together should reduce the carb content.
 
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