A1C in CKD

[Alexie90]

hello. has anyone heard that the A1C "goal" for a diabetic is not the same if the diabetic has CKD? since I started diabetic treatment 2.5 years ago, it seems like my Dr's have focused on my A1C only. my A1C goes down to 6.4 great. but the Metformin can be hard to take at times with side effects, so the dose was lessened a little. oopps now my A1C goes up to 6.8. different Resident Dr says oh lets put your Metformin dose back. great. A1C back down but guess what? my eGFR isnt as good and my CKD is worsening even though my A1C is fairly controlled.

I always thought that the A1C goal for diabetics was below 7%, so 6.4% is good. but then today I'm told by a new Resident that no they actually want me at 6.5-7.5% since I have CKD. seems odd, but is lower A1C not always good when you have CKD?

started Jardiance a month ago. was just above the FDA starting limit at 46 (FDA says 45 is cut off for starting). eGFR came back as 52 today. hopefully it stays there this time. also resident MD is sending me referral for nephrologist. I had asked about my solitary kidney (right kidney isnt working) but eGFR has been declining maybe faster than it should at times.

[jodaer]

I can only relate to my situation but No. I've been diabetic for over 20 years, CKD about 4. I've always been told to get/keep my diabetes under control and that helps with kidney function. Most of that time I was on Metformin, and it did what it was supposed to do until my eGFR fell below 30. Then I had to stop immediately, and the nightmare began. I did get started on Jardiance, but it has done nothing for my diabetes. After trying Trulicity and glipizide and an A1C raising to 7.8 I'm now on insulin. At my last neph appointment she said I needed to get better control of my diabetes. My endo told me that she was good with 7.6 because of my age, 80. I told her I wasn't, but she didn't like that answer.

[Darlenia in reply to jodaer]

Yes, I completely agree with you. Some doctors give some leeway to DKD patients re their A1Cs since the disease makes everything so erratic anyway. Yet my hubby was told that the lower A1Cs are best. It's not the meds that really hurt the kidneys, it's actually glucose (sugars/carbs) that does the damage. And it can be very unpredictable when total collapse will occur. Gosh, my hubby had good A1Cs when the last sugar molecule (or something like that) took his kidneys out virtually overnight. The article below suggests that wearing sensors and keeping glucose in a decent range all the time (not waiting for a periodic A1C report) should be considered by everyone. It's nice that both you and my hubby wear one. Appreciate what you've done for yourself.

diatribe.org/your-a1c-may-n...

[Alexie90 in reply to Darlenia]

thats interesting. I use to test my glucose when I was on insulin, manually no wearable device, but the dr said they would solely go based on my A1C. my A1C and glucose are better but sure enough my eGFR went down for some reason and now I'm stage 3A/B depending on the day of the week apparently

[Darlenia in reply to Alexie90]

I understand your situation. Doctors like A1Cs because it's one figure showing an average of all the highs and lows in your sugars over the months. (It's like seeing a grade on a report report at the end of a semester - a snap shot of all your work.) But, unfortunately, it's the seriously high sugar "spikes" that clobber your kidneys, sometimes many times daily. That's why wearing a sensor is so nice since it continuously sends feedback so you can make immediate adjustments - eliminating as much as possible those over-the-top spikes. People on insulin can usually get those easily; it's not so easy for those on tablets. I really feel for you. Tell you diabetes management doctor that you want one since your kidneys are being attacked - maybe he can pull some strings to get you one.

[Jayhawker in reply to Alexie90]

My nephrologist has told me that metformin is hard on kidneys but glucose is harder. But there will be somewhat quicker deterioration in renal function when taking metformin. I’m not sure about other newer meds.

I was only in metformin for about 4 months before getting my A1C in check and keepingbigg to there consistently gif 12+ years pre-transplsnt. Post-transplant is a new ball game though.

Jsyhaeker

[Bassetmommer NKF Ambassador]

CKD and diabetes is such a dance. My hubby has diabetes that is hard to control. He also has CKD. He went on Farxiga, and it improved both his CKD and his diabetes. He is now at 6.5. But he is also on two types of insulin. His endrocolongist wants him low 6. He is 72. The better the A1c, the less stress on the kidneys.

There is also Januvia. I took that for years.

Also, labs are picture of the day and time you had it taken. So it will fluctuate.

[Thomas6 in reply to Bassetmommer]

Okay

[KidneyCoach NKF Ambassador]

I will add that Metformin is not recommended for CKD in lower stages. It definitely can damage the kidneys. Blessings

[Jayhawker in reply to KidneyCoach]

Exactly!

[darkstar1974]

Certainly, there is a direct correlation with higher A1C and worsening CKD.

Also,I was told by my endocrinologist that CKD can give false/lower A1C readings due to the way red blood cells decay with CKD and anemia, even if it's slight. I wasn't able to find to many studies that supported this only to say there was possibly some effect on A1C with CKD anemia.

My nephrologist recommends focusing more attention to blood sugar control.

Regardless, the lower the A1C , and your blood sugar overall the better your CKD outcomes will be.

The link below will translate A1C the an avg blood glucose.

A1C of 6.5 equals 140.

professional.diabetes.org/d...

[Darlenia in reply to darkstar1974]

Excellent table. The American Diabetes Association does great work. Thank you.

[S_dillow]

ive never heard of that.mine is 6.5 right now and im on the usual dose of metformin.

[KidneyCoach NKF Ambassador]

A1C of 8 is too high imho. Any endocrinologist would encourage a number below 7. Is there a specific reason why your goal is 8?

[KidneyCoach NKF Ambassador]

Thanks for the articles. Very informative and good to know about newer research. I am having too many low BS in the mornings. 43 was mine this morning with no real symptoms or indications to warn me. I've had to reduce my long acting insulin. I was off insulin for 9 years. I'd like to manage it well enough to stop insulin again. We shall see. Blessings

[Darlenia in reply to KidneyCoach]

Oooh Kidney Coach! That's scary....a low of 43 is very dangerous. My hubby passed out from low sugar without any warning while behind the wheel, all alone. He said he was fully there, then lights out. He woke up in an ambulance, shocked he wasn't in his car, driving down the road. He kept say he had no warning - none at all. He now wears a Dexcom.

[Jayhawker in reply to Darlenia]

Truly scary! I’ve had morning glucose readings in the 50s when I was first learning how to manage the insulin. Of course I immediately messaged my endo’s nurse. They made some adjustments in my dosing.

However, my A1C last week was 6.3 so I’m not happy. I’m in type II boot camp this week and next really focusing on menus and such. I’ve also messaged my endo again late this afternoon. I’ll see what I hear back from them.

Meanwhile, I’m STILL battling this post-transplant CMV situation. That seems to create lots of fluctuations in my glucose readings. My CMV surfaced the first week of June so I’ve had CMV viral load in target range for only 4 of weeks this summer, two of which were while I was still on Valcyte. So, basically I was only in CMV target range for two weeks without medication support. Unfortunately I have lots of negative side effects from the anti-viral medication. This has not been easy or fun.

Nevertheless, after some serious pushing for a better treatment plan with both short and long term goals, the transplant center has referred me to see an infectious disease specialist who specializes in recurrent CMV virus treatment in solid organ transplant recipients. I have my first appointment with her Monday at 11am. I’m hoping for some forward motion on this situation. 🤞

Jayhawker

[Darlenia in reply to Jayhawker]

Oh Jayhawker. That CMV is really really has a hold on you. I truly hope that infectious disease specialist can take care of it. My hubby recently took valacyclovir for his shingles and is now off of it. He was lucky that he only needed to be on it for a week. I thought his labs were going to be messed up but they turned out great. After all you've been through, you're definitely overdue to get some good news too. Please let me/us know what your infectious disease doctor says. It's useful knowing these things; no one knows what may come our way later on. Sending hugs and positivity your way!

[Jayhawker in reply to Darlenia]

I’m hoping the addition if the infectious disease specialist will be beneficial for CMV management. It’s the transplant nephrologist they shifted me to full time at my request who made the referral. In all honesty, when looking at my data since last Feb, this likely should have been done sooner. However, she seems to realize that this data is indicative of that typifying those who have serious issues with recurrent CMV. Those patients are typically referred out to an infectious disease specialist. The following YouTube Video helped me get a better understanding of at least some of this situation.

youtu.be/TFddWfSwAi8?si=9YN...(Not working as expected?)

Jayhawker

[Darlenia in reply to Jayhawker]

Excellent video! I had no idea that there are defined approaches and other meds out there like Maribavir, Letermovir, etc. And then there's all those patient mutations to consider too. It's great you're seeing a solid organ infectious disease super specialist. A very good move!

[jodaer]

I think they are OK with the higher A1C so we die off faster. Diabetics are costly to the medical insurance companies.