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strugglinDiabetic

Kombiglyze XR and Kidney Damage

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strugglinDiabetic

Hello everyone..., I'm new to this forum, and as a matter of fact, I'm new to any online forum. I discovered this forum by accident and super glad I did. I pray that I'm ale to get answers to my many questions. I am not selfish, as I want to be able to share my experiences being a type 2 diabetic for over 10 years, and making MANY mistakes... Nevertheless, a few years ago, I was seeing this diabetic specialist, who at the time, prescribed a "new" medication to me called, Kombiglyze XR. This is a combination drug containing Metformin HD and Saxagliptin. The dosage of each pill was 2.5mg/1000mg. I was to take 2 per day. I was taking this drug for about 3 years and my blood sugar was great. I wasn't having the spokes that I would get prior to taking it. I remember going to this doctor after I read some disturbing new online. I discovered that this drug was pretty strong and could damage kidneys if not carefully observed. I mentioned this to the doctor and he just said that it was for individuals much older than I was and who had other medical issues. I went along with his explanation and did no follow up. Last year, I went to a new primary care doctor and after blood work, she sent me to a kidney specialist. Come to find out that I had stage 4 kidney disease. He started treating me for CKD but then earlier this year, I was hospitalized because my potassium levels were super high. This was discovered after the kidney specialist ordered blood work. After 2 calcium cocktails, they were able to get my potassium level into normal range without dialysis. He then took me off of Kombiglyze XR and Lisinopril. He said those were the root cause of my level going up and at the same time, it damaged my kidneys. Currently, my kidneys are at 13%. I hear nothing but bad thing about dialysis. I'm only 53 years of age. My blood pressure has been great over the past 2 to 3 weeks. ranging from 116/74 to 121/80. However, my blood sugar stays in the range of 90 to 282. I'm currently taking Januvia 25mg 1/day.

 

Could anyone give me suggestions of their take on my condition and how to improve it.

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NoraWI

Welcome to the Forums! Sorry to hear of your DM management problems. No amount of medication can manage diabetes without attention to diet! Diet is key to managing T2 diabetes. Can you identify foods high in carbohydrates? It is not only sugar that you have to avoid. Anything made with grain (flour) immediately converts to sugar in the body. What do you eat?

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predb4

Welcome to the Forums! Sorry to hear of your DM management problems. No amount of medication can manage diabetes without attention to diet! Diet is key to managing T2 diabetes. Can you identify foods high in carbohydrates? It is not only sugar that you have to avoid. Anything made with grain (flour) immediately converts to sugar in the body. What do you eat?

 

i second Nora, just adding to pay attention to foods which may affect your kidney condition in addition to carbohydrates.

a low carb diet can alleviate much of the stress caused by many conditions and the medications that go along with it.

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jwags

We have a member here named Corah. She is our kidney expert. She was a Type 1 who eventually had to have a kidney and pancreas transplant. She can give you specifics and what numbers mean. My ENDO is pushing the drug Januvia which I think is in the same class. I told her I a would prefer insulin. The side effects of these drugs really scare me.

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strugglinDiabetic

Well, lately my diet consist of Kale with white onions and mushrooms, cabbage (tons of it), spring mix salad, a small amount of brown rice, tons of almonds, cranberries, celery and water. I eat a slice of apple pie during Christmas, and my blood sugars went up and stayed for several days...(181 to 200)... It finally came down but it seems as if almost anything I eat raises my levels...  I was reading about the 'dawn effect' I'm not sure if this is my case at times, but sometimes I dread checking my numbers. I'm not on insulin, however I do take Januvia 25 mg per day. I eat oatmeal with no sugar or sugar substitute. I do use Brummel & Brown Spread (made with yogurt).

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strugglinDiabetic

Hello Corah, when you get this, I'd love the opportunity to ask you a couple of questions in regards to kidney damage and issues that relate to my condition with dealing with diabetes and ckd.  Please..., anyone can jump right in (smiles).

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Kit

Everything you listed there will raise your blood sugar. All plants are made of carbohydrates and all carbs raise blood sugar. Especially the oatmeal and rice. Cranberries often have added sugar as well.

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strugglinDiabetic

oh my...! What would you suggest...? I sorta knew rice would raise it because it is nothing but sugar, however, I'm surprised that Kale and Cabbage is also the culprit.

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Kit

As I mentioned, some will raise more than others. The goal is to limit your carb intake but not eliminate it totally. Cabbage and kale, while low, do still contain carbs. However, because they are low, they are safer than cranberries, rice, and oats.

 

How many games of carbs do you tend to eat on your average day?

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jwags

What we can eat as diabetics is an individual thing. I did very low carb for about 9 years and it actually made me more sensitive to csrbs. I actually lost way too much weight. So last month I started to add carbs back in. All vegetsbles are safe for me including kale, mushrooms, dsrk greens, cabbage, beans and lentils. I seem to be sensitive to all rice so I avoid it. I prefer a vegetarian diet but I get better numbers with meat and eggs. I have even added some bread back in my diet and so far bgs are OK. DP is basically a dump of glucose that happens early in the morning. I also get DP at other times a day if I am exercising or not eating.

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strugglinDiabetic

My estimation is about 160 grams per day. Before now, I didn't know how to count them or to even count them. I hadn't been trained in any area of diabetic management outside of very fundamental knowledge. I'm learning so much more now. For me, reading and these forums are key. I wished I had this type of information before my father passed of a heart attack in 1997. He was type 2 also and he, like I, was a struggling diabetic...

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jwags

I have been eating 30-50 for the past 9 years. Now I am trying to aim for about 60-75 a day. So far the only time my bgs stayed high is when I ate rice and Naan at an Indian restrauant over the holidays. Most mornings I am 90-110 and at 2 hours I Like to be 120-130. cutting back csrbs will help you but because of your kidney problems you will probably need to see a special dietician. Your doctor may need to take you off the oral drugs and add insulin instead.

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strugglinDiabetic

wow... really...? After researching over the last few days, I have discovered that my carb intake is what's causing my high levels. About 2 weeks ago, I was getting reading like 86 - 130...  I wasn't actually counting carbs but I wasn't eating large amounts of food. I stop eating after 7:00pm and I had not touched sweets during that period. However, the week of Christmas is when I went a little south and ate all the wrong things... I didn't get my numbers to lower until this morning... I don't want to do that again and so that's when I located this forum to be a sort of encouragement to keep moving forward with my goals.

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moneymeister

Hi and welcome Strugglindiabetic. Don't have much to offer to the conversation on kidneys, but glad you are here and hope this helps you find the best solutions to manage your health. Jwags is on target: Corah is definitely one of our friends with so much knowledge on the subject.

 

Again, welcome !

 

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Kit

What you need to figure out is how many carbs you can eat given your current treatment methods.

I personally have given up on grains, most root vegetables, most fruits (except for some occasional berries), and all forms of sugar.  This right there tends to limit you down to a much lower amount.

 

I am tempted to recommend starting at 100g a day.  Its not too much lower than your current estimate, so should be easier to adjust to.

After that, well we;ll see how you react from there.

 

I am concerned about your chronic kidney disease.  Have they had any discussions with you about a kidney diet?  There are further things you will need to limit that are common in a low carb diet.  Its a difficult line to walk.  If you haven't already, I recommend asking for an appointment with a nutritionist with experience dealing with diabetics with renal issues.

 

I also recommend discussing your diabetes meds with your doctor.  Given your range, you are spiking quite high, which means your body is unable to cover the carb load of the foods you are eating.  In most situations I would say low carb full steam a head.  But the kidney diet limitations makes that difficult.  Januvia pushes you to make more insulin, but obviously it can't push enough for your load.

 

So, I would personally want to do two thing.

1)  Become more stringent on diet.  Keep a carb budget in mind and try to stick to it.

2(  Discus with your doctor about a fast acting insulin for meals.  (and drop the Januvia)

 

Anyway, I wish you luck.

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strugglinDiabetic

Thank you moneymeister for the welcome. Kit, thank you so much for the suggestions. My next primary care doctor's appointment is on the 14th of January. I will ask her about the fast acting insulin and Januvia. I also have a appointment with my nephrologist in that same week. I'll know by my blood work if my kidney function has worsen, requiring me to go on dialysis (which I really don't want to do and I want to avoid it as long as possible). However, I knows I can't live without functioning kidney, thus why I am striving to keep my blood pressure close to normal and my blood glucose close to target range. Unfortunately, I never go the seriousness of this issue from ANY of the doctors I went to. Yes, they said certain things about my condition, but never really stressed what I should have been doing and should not have been doing. I had to find out through trial and error. That's one of the MAIN reasons I am loving this forum. I have noticed that it's a community of individuals who share a common challenge and who truly care about one another's situation(s).... and for that, I TRULY thank you ALL!

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Kit

You aren't the only one.  The doctors said absolutely nothing about the state of my brother's kidneys other than "its all fine" until he landed in the ER with congestive heart failure.  His kidneys were struggling so badly that they could no longer filter enough liquid out of his system which stressed out his heart.  He's not on dialysis, but he has to watch sodium, potassium, and phosphates.  Makes planning his diet quite a challenge.

 

Any more, you have to be your own advocate.  Insist on getting copies of all of your lab reports.  Look for items that seem out of the standard range, and then research what would cause it to go out of range.  That way you are better armed when you speak to your doctor about your lab results.

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strugglinDiabetic

Geezsh...! So sorry to hear that about your brother. How is it that he's NOT on dialysis, if his kidneys aren't moving the waste out of his body...? I'm very interested in this knowledge as I am worried because my nephrologist keeps attempting to push me in that direction...  :(

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strugglinDiabetic

So..., this morning I was able to locate a nutritionist/dietitian who specializes in diabetes and renal. I pray that she's able to share 'life saving (pro-longing)' information to assist me in my walk with this dreaded combination I carry of diabetes and ckd. I will definitely keep this forum posted with the information I receive, in the hopes that it will help someone else (also). Last night, I checked my numbers and my blood sugar was 117 and this was before I ate anything. I prepared cabbage with lots of bell pepper and white onions. I ate a cup full and drank 32 ounces of water. I also had a handful of almonds and 2 "sugar-free" cookies. I checked my numbers about 2.5 hours later and my blood sugar was 218. hmmm...????

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Bishop

So..., this morning I was able to locate a nutritionist/dietitian who specializes in diabetes and renal. I pray that she's able to share 'life saving (pro-longing)' information to assist me in my walk with this dreaded combination I carry of diabetes and ckd. I will definitely keep this forum posted with the information I receive, in the hopes that it will help someone else (also). Last night, I checked my numbers and my blood sugar was 117 and this was before I ate anything. I prepared cabbage with lots of bell pepper and white onions. I ate a cup full and drank 32 ounces of water. I also had a handful of almonds and 2 "sugar-free" cookies. I checked my numbers about 2.5 hours later and my blood sugar was 218. hmmm...????

 

Without knowing more (ingredients, portion size, and of course, your actual diabetes situation) I'd like to think it was those sugar free cookies.   =)   I'm sure I could make a bunch of folks hit 300+ with sugar free cookies of my choosing.  Easily.

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Kit

I don't know his current state as far as what stage he is in.  As little sister, I only get second, and some times third, hand information.

I do know he happily blindly trusts whatever his doctors say.

 

As far as your meal, take a closer look at those cookies.  It might surprise you just how high in carbs those can be.  Look around at the recipe section.  There are a ton of dessert recipes and links to sites with tons of them.  You should be able to find something that works for you.

 

Onions and bell peppers can be somewhat high in carbs if eaten in large quantities, so be careful there.  Both are staples in my diet, but I keep the quantity in moderation and don't have any problems with them.

 

Good luck with the dietician.  Hope he can help you find a path through these two conditions.

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strugglinDiabetic

Wow..., just found out there was 40 grams of carbs in those "sugar-free" cookies. The almonds were 4.74 grams. The cabbage was 1.3 grams. So, after investigating, I see it was the COOKIES!!!!  lol.... Ok, they're OUT the window...  I'm going to look in the recipe section for my cookies (smiles)... Thanks, all of you... this has become very encouraging for me.

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predb4

Wow..., just found out there was 40 grams of carbs in those "sugar-free" cookies. The almonds were 4.74 grams. The cabbage was 1.3 grams. So, after investigating, I see it was the COOKIES!!!!  lol.... Ok, they're OUT the window...  I'm going to look in the recipe section for my cookies (smiles)... Thanks, all of you... this has become very encouraging for me.

 

well you could have 1 cup of sugar free icecream instead of the cookies.

 

whne you see the dietician, tell her what your low carb is.  many think low carb is 240 g per day.

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ronmesnard

Most of the Metformin you take is excreted through your kidneys.  It tends to block them.  If you are taking metformin your Drs are supposed to check your kidney function every 6 months so you don't have the problem you have now.  You Dr screwed up.  He was right to drop the metformin since that stresses your kidneys but your kidneys are still under attack from the diabetes.  Much more so now that you are not taking the metformin.  Even though metformin stresses your kidneys by blocking them it suppresses the destruction cause by diabetes, 

 

You have gotten expert diet advice now I will give you what I your do it I were in your shoes.  I have been a D for 15 yrs so I am familiar with what you are going through.  You have a huge problem!  You are only taking 1 very weak anti - diabetic drug.  You need a strong one.  I suggest taking a long acting GLP1 injection before bed with your Januvia.  That does the same as metformin except it is stronger and doesn't hurt you kidneys.  Metformin raises all your GLP1s.  These proteins counter the diabetes.  You should be concerned with your kidneys and liver dumps at night.  Taking those 2 drugs at night will prevent nightly liver dump.  Diabetic hormones are still damaging your kidneys as you read this! 

 

 I would suggest you also take a minimal dose of a BP med ACE inhibitor is best ARB is next best.  You just barely meet the new criteria for BP meds.  Your highest reading of the day should not be above 120. Diabetic kidney damage is mostly caused by a Insulin Resistance IR hormone angiotensin II.Those BP meds reduce the level of Ang II.  You are unfortunate that the Ang II didn't raise your BP enough for treatment.  That hormone at normal IR levels damages your circulatory system.  It is the most dangerous of all the diabetic hormones.  You need to lower it even if it makes you dizzy.

 

I suggest you make an appointment to see your Dr.  Print out this post as well as the linked articles.  Maybe you can keep your kidneys.  

 

You need to eat right, exercise and take better meds.

 

Angiotensin II, nitric oxide, and end-organ damage in hypertension

http://www.nature.com/ki/journal/v54/n68s/full/4490541a.html

Angiotensin II, nitric oxide, and end-organ damage in hypertension. The adaptive changes that accompany hypertension and involve the kidney, heart, and vessels, namely, muscle hypertrophy/hyperplasia, endothelial dysfunction and extracellular matrix increase can, in fact, be maladaptive and eventually lead to end- organ disease, such as renal failure, heart failure, and coronary disease. However, these changes vary markedly between individuals with similar levels of hypertension. (Genes?)

 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3223326/

http://www.hindawi.com/journals/ijhy/2013/230868/

Nitric oxide, angiotensin II, and hypertension.

http://www.ncbi.nlm.nih.gov/pubmed/15252776

 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1483155/

In conclusion

GLP-1 receptor agonists and dipeptidyl peptidase–4 (DDP-4) inhibitors (16) and thiazolidinediones (125) show the most promise at present of being disease modifying rather than simply directed at normalization of hyperglycemia.

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strugglinDiabetic

(Ronmesnard)... Thank you for your advice. A few things... Everyone keeps suggesting that I "eat right" and believe me..., that is exactly what I am so desperately striving to do, however, my challenge is, every time I think I got it right and I'm eating what I've read or what was suggested that will work for me, someone else says it's "not good" for me. So, I strive to move towards something else. This is so difficult. Many times (lately) I find myself in the ilse of the store, standing, almost to tears falling down my face because I "just don't know" what to purchase to eat, even after reading labels. Sooooooo...., I am truly trying and striving to eat right. I exercise daily by walking at least 1 mile per day... I drink tons of water... and I try to read all I can concerning this problem I have with diabetes and chronic kidney disease.

 

I am going to ask my primary care physician to refer me to an endochronoligist... It's so terrible, since I've been with this doctor she hasn't already sent me to one. I JUST found out that I NEEDED one. At one point, I was seeing one a couple of years ago... Sooooo..., I will ask (at your suggestion) about 

 

1) taking a long acting GLP1 injection

2) a minimal dose of a BP med ACE inhibitor

 

Thank you so Ronmesnard much for your input. My Primary Care Doctor's appointment is on the 14th and my Kidney Doctor's appointment is on the 14th also. I will keep you posted....

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