Hi, In your daughter case there is high possibility of CKD (chronic kidney disease). Chronic Kidney Disease (CKD) is due to persistent underlying disease like diabetes, uncontrolled high blood pressure. Staging of CKD is done by estimating glomerular filtration rate (GFR). For calculation of GFR following factors taken into consideration- 1) Age and gender. 2) Weight. 3) Serum creatinine level. I want to know- 1) Her age. 2) Height & weight. 3) Duration of diabetes. 4) Any heart disease. 5) Habits like smoking, alcohol. 6) Her diabetes control (fasting, postprandial blood sugar level, HbA1c). 7) Her blood pressure control for her blood pressure target is below or equal to 125/75. 8) Lipid profile. 9) Current kidney function test profile (serum creatinine, blood urea, electrolytes, calcium, phosphorus, uric acid, urinary protein level, ultrasonography of kidneys - size, shape, echo, cortico-medullary differentiation). 10) Blood acid levels by doing - Arterial blood gas (ABG). 11) 24 hours urine volume. 12) Symptoms like breathing difficulties, puffiness of face, swelling over body. Treatment of CKD is to prevent or to slow the process of deterioration of kidney function. It requires- 1) Diet with adequate vegetarian proteins. 2) Control of Diabetes, blood pressure, cholesterol. 3) Avoidance of nephrotoxic food and medicines like pain killers 4) Water intake needs to restrict if there is tenancy to retain water. 5) Low Potassium intake (avoid intake of fruit and fruit juices, coconut water) in case there is potassium retention in body. 6) Maintain calcium, phosphorus, uric acid levels under control. 7) Avoid smoking, alcohol. 8) Screening for complication on heart. 9) Proper treatment of acute illness using medicines safe drugs for kidney, prevention of undue dehydration or over hydration. 10) Avoidance of smoking, alcohol. She needs to have regular follow up with diabetologist and nephrologist and screening for other diabetic and hyepertensive complications like neuropathy, retinopathy. In her case worsening of kidney function may be indicated by- 1) Signs of water retention like breathing difficulties, puffiness of face, swelling over body, decreased urine volume. 2) Symptoms like generalized weakness, nausea, vomiting, decreased apatite. 3) Recurrent episodes of hypoglycemia (low blood sugar) on insulin doses which are suitable for her earlier that is decreasing insulin requirement. It is usually not possible to revert kidney function to normal in CKD, but we can definitely halt or slows the progression of deterioration. I hope this may helpful for her. If found helpful please do vote.