Diabetes Health Center

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If you take other medicines, avoid ones that damage or stress the kidneys, especially nonsteroidal anti-inflammatory drugs (NSAIDs).

It is also important to keep your blood sugar within a target range to prevent damage to the small blood vessels in the kidneys. The American Diabetes Association recommends that you keep your blood sugar levels at:¹

• 70 mg/dL to 130 mg/dL before meals and 110 mg/dL to 150 mg/dL at bedtime.
• Less than 180 mg/dL 1 to 2 hours after meals.

Ongoing treatment

As diabetic nephropathy progresses, blood pressure usually rises, making it necessary to add more medicine to control blood pressure and keep it less than 130/80 mm Hg.

Your doctor may advise you to take the following medicines that lower blood pressure. You may need to take different combinations of these medicines to best control your blood pressure. By lowering your blood pressure, you may reduce your risk of kidney damage. Medicines include:

• A combination of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). A combination of these medicines may be more effective in controlling blood pressure than either used alone.
• Calcium channel blockers lower blood pressure by making it easier for blood to flow through the vessels. Examples include diltiazem (such as Cardizem SR, Dilacor XR, or Tiazac), verapamil (such as Calan SR or Isoptin SR), amlodipine (such as Norvasc), and nifedipine (such as Adalat or Procardia XL).
• Diuretics. Medicines such as chlorthalidone, hydrochlorothiazide, or spironolactone help lower blood pressure by removing sodium and water from the body.
• Beta-blockers lower blood pressure by slowing down your heartbeat and reducing the amount of blood pumped with each heartbeat. Examples include atenolol (Tenormin), carvedilol (Coreg), or metoprolol (such as Lopressor).

Continue to avoid other medicines that may damage or stress the kidneys, especially nonsteroidal anti-inflammatory drugs (NSAIDs). And it is still important to keep your blood sugar within your target range, limit salt in your diet, restrict the amount of protein you eat, keep your cholesterol at a healthy level, eat a low-fat diet, get regular exercise, and not smoke.

Treatment if the condition gets worse

If damage to the blood vessels in the kidneys continues, kidney failure eventually develops. When that occurs, it is likely that you will need dialysis treatment (renal replacement therapy)-an artificial method of filtering the blood-or a kidney transplant to survive. For more information, see the topic Chronic Kidney Disease.

What to think about

Diabetic nephropathy can get worse during pregnancy and can affect the growth and development of the fetus. If your nephropathy is not severe, your kidney function may return to its prepregnancy level after the baby is born. If you have severe nephropathy, pregnancy may lead to permanent worsening of your kidney function.⁴