Health Update, 2 Weeks after starting Lorsartan

[DMH200435]

I made a previous post about my latest nephrology appointment. I want to thank you all for your responses and words of encouragement!

I have chronic kidney disease (stage 3). Two weeks ago lorsartan was started and I noticed midway through that my blood sugars began maintaining dangerously low levels to the point where it was interrupting my daily life. I work as a pediatric nurse and found myself taking more breaks to treat lows and even without using my short acting insulin, my blood glucose readings were maintaining low. I discussed this with my endocrinologist and she stated that my kidney function worsening is causing insulin to remain in my system longer. I asked myself how could this be when just a week and a half ago I wasn’t having these persistent problems. So my insulin doses were decreased, and two days later, I had a horrible hypoglycemic event (today). Prior to leaving home to have labwork done, I checked my glucose level, 122. I live about 15mins from the hospital so it wasn’t a long trip getting there. I had labs done, made it home and I was sweating like crazy. I go to check my blood sugar and I don’t remember what happened after that.

Thank God my family was there, they told me they gave me apple juice and offered bread but I wasn’t coherent enough to eat. After the first apple juice I started to come to. I checked my blood sugar and it was 48. I took in another 8oz. of apple juice and a slice of bread, my blood glucose went up to 76. I ate breakfast and was so tired after, I took a nap. The Nephrology NP that ordered the labwork called me because my labs showed for them my blood glucose was 20! She also said my BUN and creatinine increased (bun went from 18 to 24, creatinine 2.12 to 2.38), but she said it was expected with lorsartan and she’s ok with the result. I looked at all my labs and my gfr also decreased to 28. Why is this better and why are you okay with it??? I returned the call but she was unavailable. After looking into it, a major side effect of lorsartan is hypoglycemia and it’s recommended to speak to your doctor if you side effects are severe. Well I consider this severe no doubt. I messaged her on mychart suggesting to go back to taking lisinopril, I’d rather take a cough over constant lows and worsening kidney function.

I just wanted to share what’s happened to me if anyone else here is also diabetic with ckd and approached with starting lorsartan. This is just my experience.

[jodaer]

What did she say about your low blood sugar? Anything?

[DMH200435 in reply to jodaer]

She wasn't aware of my persistent low glucose levels because I'd only discussed it with my endocrinologist because up until now, I only discussed my glucose readings with my endocrinologist. The frequent lows started on Sunday and I saw my endocrinologist on Wednesday. I did inform the NP about the persistent lows and how the horrible episode I had today was the worst it's ever been. She hasn't responded, I guess she had patients to see in clinic and didn't get back to me. Now it's the weekend, the clinic is closed and I don't feel safe continuing lorsartan.

[jodaer in reply to DMH200435]

I understand now. You have a hard decision to make. Can you discuss with Endocrinologist? Will the endo and neph work together to provide you the best health care or maybe you can get a primary to manage all the info? Please let us know how it goes over the weekend.

[DMH200435]

I made a previous post about how I have changed my diet and have been exercising, losing weight since december, my gfr was 32, creatinine 2.12, and BUN 18 (which was actually improving) prior to starting lorsartan, the drop to 28, increase to 24 BUN and 2.38 creatinine happened in just two weeks the NP said the increase of creatinine and BUN is expected while taking lorsartan, but my kidney function is quickly going in the wrong direction so I don’t know how this is seen as an “okay” thing.

I do know the signs of low blood glucose (I have had diabetes since age 16), I would have to stop multiple times at work to treat low blood glucose. So thank you for telling me what I should know as a nurse. I work day shift. Lows have been happening during both night and day over the past week. Arriving home from labwork I felt lightheaded and sweaty. I was in the process of checking my blood glucose when I went out of it. The labwork I had done had a reading of 20. This all happened within an hour’s time. I did not take my long acting insulin prior to leaving because of how quickly drops have been happening recently and my labs were fasting labs. I ate a night time snack at 11pm bc I feared I would have a low during the night. Typically having a glucose reading of 122 doesn’t instantly drop to 20 in that short amount of time for me. Seen my endo on Wednesday, she decreased my long acting insulin. (I used to take 30 units twice a day- morning/night) Now It was changed to 25 units twice a day. I have had to eat multiple snacks in between meals just to keep my blood glucose in normal range, otherwise it drops and again, these drops are happening without taking my short acting insulin for meals.

My family said they had to stop me from nodding out multiple times, and I was able to drink one 8 oz bottle of apple juice, and I was apprently talking to them in the process (I don’t have any memory of doing this) I came to while in the middle of chewing on bread, my family member was standing in front of me, prompting me to keep going. I am very thankful that I wasn’t alone during this event and it has scared me so bad, I’ve never experienced a low like this because I usually act earlier when experiencing a low (below 70 or at 70 I usually feel the signs) that its never gotten to that point.

I was previously using freestyle libre CGM, but had a bad skin reactions (blisters, rash) even with the use of skin prep, flonase, etc. to prevent it. I have an appointment on the 4th with a diabetes educator to trial dexcom to see if I get the same reaction while wearing it. If not I will be switching to that system. My recent a1c is 6.5 (previously 7.9 back in December) Dexcom is apparently free if I sign up with my employer’s healthy choice program because my A1C falls within the parameters for insurance to cover it. Otherwise it’s initially $600 co-pay and over $300 every 90 days after that. For now I am using Accu Check Guide me to check my blood glucose and I have been testing 3-4 times a day even before starting lorsartan.

My lorsartan dose is 25mg. I am also on amlodipine 100mg. I didn’t have any of these issues with my blood glucose prior than the past two weeks. I’ve never heard of the glucose remaining longer in the system either due to decreased kidney function, but in these two weeks for me, lorsartan has had this effect on my kidney function in this short amount of time. The reason why it was prescribed is because they wanted to treat my proteinuria. As of yet neither the nephrologist or endocrinologist have responded, Today I will see if I can get a hold of their on-call department to get in contact with them.

[S_dillow]

They screwed up

[DMH200435 in reply to S_dillow]

I agree. Also when looking up side effects, I found lorsartan “Reduced awareness of hypoglycemic symptoms and increase the risk of severe hypoglycemia in people with diabetes mellitus. “I’ve also had pins & needles prickling burning feeling in my hands recently, another side effect of lorsartan. I don’t think this med is going to work out for me.

[Bassetmommer NKF Ambassador]

HI DMH,Wow, thanks for sharing this. I am glad you are off the losartan. Some other BP med will work for you. Is there any chance you can get on one of the new drugs, sglt inhibitors, like Forxiga for your diabetes.? My husband is on that, and his highs and lows are much less.

[Nana16 in reply to Bassetmommer]

I believe DMH2004345 is a type 1 diabetic, so Farxiga would not be approved in that case.

[Nana16]

I'm so sorry you are having to go through all that. It must have been horrifying to have been able to manage your diabetes for so long and then suddenly have such a dramatic hypoglycemic event. Also awful that you can't get an immediate response after such a dramatic drop, and I can't imagine that a nephrologist would tell you it's okay to have your numbers go the wrong direction. I know sometimes those can change and one test isn't an indicator of a trend, but I get very nervous when I have a test that is heading the wrong direction.

[jodaer]

Talk to your doctor(s) about Micardis or Telesmartin. I take that, changed from Fosinopril because of the coughing and fatigue issue. It works well for me and is supposed to help with proteinuria. Did I understand you have stopped the losartan?

[DMH200435 in reply to jodaer]

Yes today is the first day I haven’t taken losartan and I have not had any low blood glucose <70 readings so far. I’ve been checking in between meals as well just to still be cautious and no lows. I haven’t been able to reach anyone today to ask for a change in med, so it looks like I will have to wait until Monday.

[Bet117 NKF Ambassador]

DMH200435,

My thoughts; let both doctors know how you have been feeling. Specifically mention the hypoglycemic attacks and side effects that you are feeling from the medication.

Ask for a consultation between them and see what they come up with which would best meet all of your health needs.

You can look up any medication on the Drugs.com App. It will give you side effects, mild, moderate and severe drug interactions of prescriptions.

It also has a place where you put in your present medications and it will let you know about any possible interactions.

My brother is a severe type 2 insulin diabetic who takes with high blood pressure and a blood disorder.

I have seen the frustration of hypoglycemia as well as recently hyperglycemia as a result of the medication that he has to take for the hematology issue. So I can empathize.

Try to stay positive and let them know what is going on.

Reach out to us as well. We are in your corner! It will get resolved. Promise.

Bet

[RoxanneKidney]

When I got put on Lisinopril, I was put on the lowest dose by the neph. Prior to that any bp med given to me by a general practice doc, was 25 mg or higher; and I always stopped taking it due to the side effects. Right now I only need 2.5 mg of lisinopril to manage my protein in urine. Glad we started with a low dose. So the point is, the med might work for you, but you might just need a smaller dose. They should always start with the lowest dose and gradually increase as needed. That just makes sense. Too often they go for the standard dose, but we are not all one-size fits all.