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Having kidney disorder and diabetes, taking januvia, ace-inhibitor and metformin. Have goitre. Right medication?

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Im borderline stage two kidney disorder and a diabetic was on Januvia not have 3 goiters in rt lobe of thyroid wont take Januvia any more loking for kidney friendly meds for diabetes blood pressure in control and should I cont to take ace inhibitor and metformin
Posted Wed, 29 May 2013 in Kidney Conditions
 
 
Answered by Dr. Ravi Bansal 2 hours later
Hi, XXXXXX
You have diabetes with early kidney disease and goiter.

Your kidney disease is not so bad. In-fact you can continue ACE-Inhibitors and metformin.

Kidney friendly diabetes medicines would include-- glimiperide, gliclazide, metformin can be used till 1.5 mg/dl serum creatinine levels. Januvia is actually pretty safe for the kidneys. Some trials have shown it to be drug of choice in post renal transplant patients.

Goitre is not a common side effect of januvia, though you can discuss with endocrinologist regarding the same.

Being on ACE-I you should monitor your Serum creatinine and potassium levels every month initially for 3 months and then 2 monthly- just to keep an eye on kidney functions. If they deteriorate then consider stopping ACE-I under guidance of your doctor.

Once GFR falls below 25 ml/min, insulin is best for sugar control.

Hope this answers your queries,
If any more questions please write-in.

Best wishes.
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Follow-up: Having kidney disorder and diabetes, taking januvia, ace-inhibitor and metformin. Have goitre. Right medication? 20 hours later
is nateglinide safer for kidney than januvia
or would prandin be a better drug I also take levimer
 
 
Answered by Dr. Ravi Bansal 2 hours later
Hi XXXXXX

Nateglinide and Prandin (Ripaglinide) both are safe for kidney patients and are same group drugs. These are short acting medicines and role is in postprandial sugar control only. They do not have a longer effect to control fasting sugars. They are insufficient if the fasting sugars are high. they can be combined with other medications. Januvia on the other had has slightly more effect on fasting sugars as well.

Levemir is a long acting insulin and mainly used to control fasting premeal sugars.

So a combination of Levemir with januvia or with prandin is quite a good way to control sugars.

The best way is let your doctor start with any one treatment combination. Monitor your sugars with glucometer and fine tune the drug doses to achieve good control. All these medicines are safe for the kidneys.

Hope this helps,
Bye
Above answer was peer-reviewed by
 
Follow-up: Having kidney disorder and diabetes, taking januvia, ace-inhibitor and metformin. Have goitre. Right medication? 21 hours later
nateglinide is a cheaper co pay than another drug recently discussed how kidney friendly is it with levemir
dly is it
 
 
Answered by Dr. Ravi Bansal 19 minutes later
Hi ,

Nateglinide metabolite, N-[trans-4-(1-hydroxy-1methylethyl)-cyclohexanecarbonyl]-D-phenylalanine levels can remain elevated in advanced renal failure patients. but in early kidney disease like your they are completely safe if used under guidance of doctor. It is also safe with levemir .

hope this clarifies the issue.
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