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What Causes Raised Serum Creatinine When Suffering From Type 1 Diabetes?
Question: Hello Dr. Grief,
I am type 1 diabetic and have been for 44 years. My hemoglobin A1C on my last visit was 6.3. I did notice that after review my blood work, it showed a reading of 1.6 for creatine. I am very concerned and having it checked on Friday. I have always had very limited protein showing but everything has remained the same. I have decreased my protein intake and stuck mostly to a plant based diet with carbs. For years, I have followed the heart smart diet with a great deal of grains, veggies and fish. Should I be concerned and what will happen next? I am on multiple meds, plus 6-8 insulin shots daily.
I am type 1 diabetic and have been for 44 years. My hemoglobin A1C on my last visit was 6.3. I did notice that after review my blood work, it showed a reading of 1.6 for creatine. I am very concerned and having it checked on Friday. I have always had very limited protein showing but everything has remained the same. I have decreased my protein intake and stuck mostly to a plant based diet with carbs. For years, I have followed the heart smart diet with a great deal of grains, veggies and fish. Should I be concerned and what will happen next? I am on multiple meds, plus 6-8 insulin shots daily.
Brief Answer:
?Diabetic Nephropathy
Detailed Answer:
Hello
Thanks for the query
Type 1 Diabetes is known to cause nephropathy however since your Hba1C is under good control I would want to rule out any reversible cause for raised serum creatinine before jumping into the obvious diagnosis of diabetic nephropathy
1. Please approach an opthalmologist to rule out diabetic retinopathy, usually retinopathy precedes nephropathy
2. The other tests to confirm DN are uric acid, calcium, phosphorus and 24 hour urine protein. It will be usually altered in diabetic nephropathy
3. Please get your s creat checked once again after 15 days to know for any change
The most important things to do now are
1. Avoid smoking and use of pain killers
2. Always mention to your GP before prescribing any medication that you have a rasied s creat as dosages have to be altered
3. Insulin requirement might come down so watch for hypoglycemic episodes
4. Strict diabetic and low protein diet
5. Continue exercising 30 min a day
6. Avoid de hydration
If diabetes is under good control most patients do well. We think of dialysing a patient only when the s creat is beyond 6 mg/dl
I hope I was of help, if you have any further queries please get back to me
I wish you good health
Regards
?Diabetic Nephropathy
Detailed Answer:
Hello
Thanks for the query
Type 1 Diabetes is known to cause nephropathy however since your Hba1C is under good control I would want to rule out any reversible cause for raised serum creatinine before jumping into the obvious diagnosis of diabetic nephropathy
1. Please approach an opthalmologist to rule out diabetic retinopathy, usually retinopathy precedes nephropathy
2. The other tests to confirm DN are uric acid, calcium, phosphorus and 24 hour urine protein. It will be usually altered in diabetic nephropathy
3. Please get your s creat checked once again after 15 days to know for any change
The most important things to do now are
1. Avoid smoking and use of pain killers
2. Always mention to your GP before prescribing any medication that you have a rasied s creat as dosages have to be altered
3. Insulin requirement might come down so watch for hypoglycemic episodes
4. Strict diabetic and low protein diet
5. Continue exercising 30 min a day
6. Avoid de hydration
If diabetes is under good control most patients do well. We think of dialysing a patient only when the s creat is beyond 6 mg/dl
I hope I was of help, if you have any further queries please get back to me
I wish you good health
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Dr. Madhyasthia,
I appreciate all the medical advice. I since my eye specialist ever year and have no eye problems - thankfully. Since the elevated creatine levels occurred, I have limited my protein intake and continue with my gluten free carbs (yes have celiac disease) as well, plus more vegetables but have also limited fruit as this does spike my sugars. I am having my blood work done tomorrow so have a follow-up appointment with my GP next week.
On another note, with reaching my late 40's can early menopause play a factor in elevated creatine or increase stress/workload. My hormones seem to be out of whack so wondering if this could be a factor.
I thank you for your time and look forward to your response.
Regards,
XXXXXXX
I appreciate all the medical advice. I since my eye specialist ever year and have no eye problems - thankfully. Since the elevated creatine levels occurred, I have limited my protein intake and continue with my gluten free carbs (yes have celiac disease) as well, plus more vegetables but have also limited fruit as this does spike my sugars. I am having my blood work done tomorrow so have a follow-up appointment with my GP next week.
On another note, with reaching my late 40's can early menopause play a factor in elevated creatine or increase stress/workload. My hormones seem to be out of whack so wondering if this could be a factor.
I thank you for your time and look forward to your response.
Regards,
XXXXXXX
Brief Answer:
Diabetic nephropathy
Detailed Answer:
Hello
Thanks for the query
I am very happy that you do not have retinopathy, but since retinopathy comes before nephropathy is most of the diabetics you will need further work up of the nephropathy as there is a possibility that it might be secondary to some other issue like a urinary tract infection, etc
Here is what I suggest
1. Get a urine routine to check for RBC and pus cells
2. If there are no pus cells I suggest you to quantify your protein loss with a 24 hour urine protein test
3. Get an USG abdomen and pelvis to rule out obstructive cause for nephropathy like renal stones
4. I would have suggested a renal biopsy to my patient if there was a strong suspicion of a non diabetic cause, even more so because your diabetes is under beautiful control
5. Menopause will not cause raised creatinine and those hormones have no affect on the kidneys
I hope I was of help, please get back to me if you have further doubts
Regards
Diabetic nephropathy
Detailed Answer:
Hello
Thanks for the query
I am very happy that you do not have retinopathy, but since retinopathy comes before nephropathy is most of the diabetics you will need further work up of the nephropathy as there is a possibility that it might be secondary to some other issue like a urinary tract infection, etc
Here is what I suggest
1. Get a urine routine to check for RBC and pus cells
2. If there are no pus cells I suggest you to quantify your protein loss with a 24 hour urine protein test
3. Get an USG abdomen and pelvis to rule out obstructive cause for nephropathy like renal stones
4. I would have suggested a renal biopsy to my patient if there was a strong suspicion of a non diabetic cause, even more so because your diabetes is under beautiful control
5. Menopause will not cause raised creatinine and those hormones have no affect on the kidneys
I hope I was of help, please get back to me if you have further doubts
Regards
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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