Is special monitoring required for these medications?
It is important that people with diabetes who are taking an ACE inhibitor or ARB have their serum creatinine and potassium levels checked within one to two weeks of starting the medication, when the dosage is increased, or during times of acute illness. (Creatinine is a waste product in your blood. It tells how well your kidneys are working.)
This is important because your healthcare team needs to check your eGFR (short for estimated glomerular filtration rate). Your eGFR is a number based on your blood test for creatinine.
If there is a greater drop in eGFR than expected at initiation of these medications, other kidney tests sometimes need to be done. It is interesting that there is an expected slight drop in eGFR when these medications are started but over time people on these medications will have a higher eGFR. The drop in eGFR means that the pressure in the kidney has decreased, which ultimately will prolong the life of the kidney. During times of illness or dehydration eGFR can also decrease and potassium levels can increase, especially if people have known kidney disease.
High potassium levels can be dangerous and ways to prevent this must be undertaken. This might involve a change in diet or addition of another medication (for example, a diuretic), a decrease in dose of the ACE inhibitor or ARB, or even discontinuation of these medications altogether. However, because these medications are so helpful for the heart and kidneys, many things are tried first before discontinuing them.
Key point: Adults with diabetes and kidney disease with either hypertension or albuminuria should receive an ACE inhibitor or an ARB to delay the progression of kidney disease.
Sodium-glucose co-transporter-2 inhibitors (these usually end in ‘flozin’)
Sodium-glucose co-transporter-2 (SGLT2) inhibitors are a newer class of blood sugar lowering medications, with two important influences on risk factors for kidney disease in diabetes: improvement in glycemic control and reduction in blood pressure. This class of medication works by preventing the kidneys from reabsorbing glucose and sodium from the urine back into the blood. Glucose is therefore removed from the body through urine. As a result, glucose in the blood decreases.
