Suggest Treatment For Elevated Serum Creatinine Levels While Having Diabetes

Posted on Thu, 21 Apr 2016

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Thu, 21 Apr 2016 Answered on

Mon, 13 Jun 2016 Last reviewed on

Question : Hello doctor,
I am 46 year old male with a history of diabetes for the past 14 years. I have been on metformin throughout this period and have started on Insulin ( huminsulin 30/70) for the past 5 years. However the blood sugar control has been poor. My recent test reports revealed an elevated serum creatinine (1.9). My doctor has asked me to stop metformin and increase the insulin dosage. My insulin dosage has now increased to 30+ two times a day and I have also started on basal insulin ( 15 units) at bedtime.
My blood sugar reading ( fasting) is at 219.

I have started intensive weight training since the past one month.

I have some questions:

1. Does a SC of 1.9 with a GFR of 41 warrant stoppage of metformin?
2. Can the elevated SC levels be attributed to my intensive weight traning?
3. In case I need to discontinue metformin, how do I control my blood sugar ?
4. Is there any medication that I need to take for elevated SC.

THE GENDER IS MALE

Answered by Dr. Pavan Kumar Gupta (2 hours later)

Brief answer.....explained below
Detailed answer....
Hello,
Thanks for the query.
I have read your query and understand your concern.
I will reply your query one by one.
1.....Yes. Protocol says that metformin should be stopped if SC goes above 1.4 or GFR comes below 60
2....yes. Intensive weight training or exercises can cause rise in SC levels
3....your blood sugar control will not be affected by stoppage of metformin as you are already on inj. Insulin.
4...adopt following measures to control and reduce your SC levels....
Tight control of blood sugar and blood pressure
Avoidance of painkillers and other nephrotoxic drugs
Avoiding urinary tract infection.

I would advise you to consult a nephrologist to accurately assess your kidneys and their function. I would further advise you to consult your treating doctor and think of getting a GLIPTIN like SITAGLIPTIN and alpha glucosidase inhibitor like VOGLIBOSE to be added to your current treatment to have better control of your blood sugar levels.

I hope it helps,however you are most welcome to revert to me for any further query.
Best of luck
Thanks

Above answer was peer-reviewed by : Dr. Deepak

Follow up: Dr. Pavan Kumar Gupta (19 hours later)

I have also been taking galvus 50 ( twice a day)..My doctor has advised me to stop this also. Pls. suggest whether this is a right course.

Secondly I would like to know whether I need to discontinue my weight training.

Thirdly do I restrict protien intake and if so, how would the body be able to meet the protien requirements.

Answered by Dr. Pavan Kumar Gupta (3 hours later)

Hello,
Had I been your doctor,I would have continued with GALVUS 50.
Although no harm in continuing your weight training but aerobic exercises like brisk walking,jogging,swimming etc would be much better for you.
Protein is restricted if you are suffering from diabetic kidney disease ( diabetic nephropathy ). That is why I advised you to consult a nephrologist and get your kidneys and their functions assessed properly.
A mere increase in SC levels doesn't mean that your kidneys are involved or affected.
Thanks

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar