TCOYD The Podcast! Chronic Kidney Disease and Diabetes - What You Need to Know to Protect Your Kidneys
Chronic kidney disease (CKD) is one of the most common complications of diabetes, but here’s the tricky part: you can have it for years without feeling any symptoms. The good news? Kidney disease can often be detected early, and with the right screening, treatments, and lifestyle changes, its progression can be dramatically slowed.
In this episode, Dr. Steve Edelman and Dr. Jeremy Pettus are joined by nephrologist Dr. Bethany Karl to break down what everyone with diabetes should know about kidney health. Dr. E also steps into the patient seat to share his own experience living with chronic kidney disease, from discovering it without symptoms to navigating kidney tests and newer treatments. Together, they explain the two simple tests that can uncover kidney problems, why blood pressure and cardiovascular health matter, and how today’s growing toolbox of medications is giving people with diabetic kidney disease more reasons for hope.
Excellent episode TCOYD with lots of great info from all three docs! I’m 67, a longtime Type 2 and my Northern California Kaiser-Permanente docs monitoring the fluctuating protein in my urine is my No. 1 concern these days.
If your uACR is above the upper limit of normal, I would treat ASAP. No monitoring, treat.
CKD 3B 64 years old E10.22. My question to you with Type 1 and other nephrologists is: Controlling BP, diet and blood glucose has been the standard line of defense for over 20 years. Recently the advocacy for GLP-1 intervention has been touted by those promoting it. With glycemic variability and using exogenous insulin what have the outcomes been versus glycemic variability and cardiovascular outcomes?
You are correct in that there has been a lot of research and talk around glycemic variability and why that is not good, however, it’s not written in stone still to this day. You and I can both agree that keeping blood sugars from bouncing around too much (that closer mimics a healthy person) has to be a good thing.
What can you do for Proteinuria?
Here’s an article we published recently that discusses 6 pillars of therapy that can help to reduce protein in the urine: https://tcoyd.org/2025/02/diabetes-kidney-disease-treatment/
TID 42 years. I’ve not had protein in my urine and BUN and creatine have been stable. After 2 years on Zepbound 2.5mg, my eGFR went from 60 to 78. I was thrilled. That was the only change along with a high protein diet.
That’s fantastic. I’d be curious to know what happened to your urine albumin to creatinine ratio as well – did it also improve?
My Endo has never had me do a 24hr urine collection. I’m seeing him soon and am assuming I should request an order.
We don’t do 24-hour urine collections anymore. All we need is a sample to test the uACR, and on a standard metabolic panel they measure eGFR.
⁸8th hi
I have one kidney and my GFR is 47 and I’m on the Sartan and before I started taking losartan my GFR was 55 now it’s 47
That’s not a big decline, and GFR can go up and down easily, depending on how hydrated you are when you get your blood test. I would look at other indices, including your urine albumin to creatinine ratio. And what I have learned from my own situation, is to not panic over small changes in either direction.
Wonderful podcast and very timely, as I recently was diagnosed with kidney disease. I have a little protein in my urine, my gfr is 55, and I’m a LADA diabetic since 2018 using a pump. My potassium was high last test but being on a low potassium diet has put it in the normal range.
My endocrinologist is researching Kerendia to see how it reacts with my other medications before prescribing it, as I have Parkinson’s disease as well for
23 years.
Thank you for such a thorough podcast.
Anita
Thank you so much for your kind words!
I have been a type 1 diabetic for 45 years now. I have also had two heart attacks with CHF. My last A1c was 5.9, and I manage with omnipod and CGM Dexscom7. In 2023 was diagnosed with CKD. Was told it was from over use of Advil. I was on Jardiance and Spironolactone which I was taken off both after the CKD diagnosis. Would Farxiga still be recommended?
Jardiance and Farxiga are very similar. If you have CKD, the general recommendation is to be on an SGLT inhibitor, if your doctor says its ok. Kerendia was also approved for the treatment of CKD in people with type 1, but it would really make sense for you to speak to a kidney specialist.
Thank you so much,I learned so much.
Happy to hear that…thank you for listening! 🙂
Thank you so much for this information. Keep up the good work.
Thanks…appreciate it!
Great info. There is a lot of scary stuff on the internet about CKD. Thank you for this reliable, sensible education.
Thank you for your kind words.
Excellent! I am an RN, type 2 diabetes for approx 20 years. I have been taking Metformin and sl scale insulin. On GLP med, Boundary for a year. Lost 54 lbs. B/P controlled with Metoprolol, and diuretic hydrochloradiazide. Recently had LG hernia repair, removed lap band placed 25 years ago, and removed fallopian tube ( decreases incidence of ovarian CA). Surgery went very well. Preop labs ok, sl low NA. But now low magnesium, 4 times in hospital to get IV magnesium
Despite taking magnesium, MD changes variety of MG, now taking MG glycinate. Treating with kidney MD as feel low MG could be from kidneys instead of ongoing loose stool. I feel ok, tired, but no cramps..why low MG? Was ok prior to surgery? I am 69
Gosh, thank you for writing us. I feel badly about your situation. I will be totally honest with you – I have no clue. This is really a good question for a kidney specialist. I do not want to send you in the wrong direction.
Great talk everyone! I always love to share this information with my patients. I’ll be more diligent in checking for kidney lab work done, and teaching clients to request them for baseline. Thanks again.
Thank you for this podcast and discussing the T2 and CKD relationship. I am type 2, on Licinipril, Farxiga, Kerendia and Ozempic for nearly a year without much change in my urine protein levels and some modest improvement in creatinine levels. I also have x-linked Alport’s syndrome which was just discovered through genetic testing 2 years ago. I have had blood/protein in my urine since birth as did my Mom and also 4 daughters. CKD numbers don’t show up until about 55yrs old, at the same time came the type 2 diagnosis. I am now 65. Any thoughts on other treatments or expectations for future outcome?
You are on four pharmaceutical pillars to prevent your kidneys from getting worse, which it sounds like they are stable. I would also focus on your A1c and blood pressure. We did an article on the six pillars of therapy to treat kidney disease here, if you’d like to read more about it:
https://tcoyd.org/2025/02/diabetes-kidney-disease-treatment/
Wow, such good information! I’ll be sharing a link to this page with the WW Living with Diabetes connect group; I know some members of that group have CKD.
T2, diagnosed in 2018, but that was due to a foot wound which required hospitalization, so I am sure I had it longer – that’s what happens when one does not have regular doctor visits.
CKD stage 3a, currently on 25mg losartan, half a pill in the morning, half a pill at bedtime. Prior to that i was on 12.5mg daily; when bp went up, we went to 25mg. Then I got low blood pressure too often, back down to 12.5mg. Then the day of nephrologist visit my home bp reading was 175- Yeow. It was high at nephrologists office so they waited and took another reading & repeated a few more times until my bp was in the 150s! And that’s when I was put on my current half pill twice a day which seems to be working-I only had one bad low bp espisode; I did let my nephrologist know and she said I could reduced the dosage, but I didn’t & that was only one episode in about 6 months.
I’m currently battling high serum calcium. When I stopped taking my calcium supplements my serum calcium went up. I told my PCP I wanted to stop Atorvastatin for 3 months to see if my serum calcium went down. I have the SLCO1B1 *1/*15 variant which keeps statins in my system longer. I had read that with that variant rare side effects happen more often. Well, my serum calcium went down to the normal range; I had requested an ionized calcium test and that was at the high end of normal. My lipid panel was horrible. I agreed to 10mg Atorvastatin and after 2 months lipid panel was good again & calcium is top of the normal range.
My PTH is high, my calcium at top of the normal range, vitamin D is normal, phosphorus is normal. My nephrologist says the high PTH is due to my CKD. It went from 36.2pg/mL in Nov 2025 to 101.9pg/mL in Sept 2026. Could not get appointment with endocrinologist until 2027, so my PCP requested an e-consult. The endo’s response was “ Would continue to monitor intermittently (every 6 months) for hypercalcemia/hypophosphatemia that would point to this being related to primary hyperparathyroidism rather than CKD.” I of course worry about the accuracy of the information he was given- he was told my calcium went down after stopping calcium supplement, and that I had osteoporosis when I really have osteopenia. As my sister had had hyperparathyroid and I saw how exhausted she was all the time, I really couldn’t believe that I could have it also!I do have appointment with endocrinologist in January that was made before the e-consult. The e-consult endocrinologist did not feel that a visit with endocrinologist was necessary at this time.
You really took a lot of time to write me this information. I’m glad you’re going to see an endocrinologist, although your case is fairly complicated. I would approach the visit knowing that he or she won’t fix it the first appointment, and try not to overload your endo with too much data at first. Good luck.