I have had type 2 diabetes for eleven years. For most of that time I looked at the columns of numbers on my clinic report and only paid attention to the blood sugar. The kidney figures meant nothing to me, so I ignored them, which is exactly the wrong way round. Kidneys damaged by diabetes usually give no warning until a lot of the function is already gone, and the only way to catch it early is to read those figures every visit.
What eGFR and creatinine actually tell you
Creatinine is a waste product your muscles make all the time. Your kidneys are supposed to clear it, so if it builds up, they are not clearing as well as they should. eGFR is a number worked out from your creatinine, your age and a few other details — it is an estimate of how much kidney function is left, expressed as a percentage. Your urine is also checked for protein, because protein leaking into urine is one of the earliest signs of kidney strain in diabetes.
I made a point of asking my doctor to explain my own numbers once, rather than only telling me they were fine. That ten-minute conversation changed how I read every report since.
| What is measured | What it shows | Why it matters in diabetes |
|---|---|---|
| Creatinine | Waste product cleared by the kidneys | Rising over time means the kidneys are working less well |
| eGFR | Estimated percentage of kidney function | The trend across visits matters more than any single number |
| Urine protein (ACR) | Protein leaking into urine | An early warning often before eGFR changes |
| Blood pressure | Pressure inside the kidney's filters | High pressure damages kidneys faster |
| HbA1c | Average blood sugar over about 3 months | Sustained high sugar is what damages the kidneys |
Salt and protein, without cutting too hard
The two things I got wrong were salt and protein. I underrated salt completely — most of it in my diet was not from the salt shaker but from sauces, instant noodles, salted fish, processed meat and eating out. Cutting back on those lowered my blood pressure, and lower blood pressure protects the kidneys.
Protein is the opposite mistake. Some people cut protein to nothing out of fear, which is not helpful and leaves them weak. What matters is the amount and the source, and that is a conversation to have with your doctor or dietitian rather than guessing. I kept protein in my meals, chose fish, beans and eggs alongside meat, and adjusted the portion rather than removing it.
Your blood pressure is doing more to your kidneys than salt alone
Diabetes and high blood pressure damage the kidneys together, and the combination is worse than either alone. That is why some of the tablets I take are not for sugar at all — they are to hold my blood pressure down and protect the kidneys directly. I used to wonder why a diabetes doctor cared so much about a blood pressure number. Now I understand that controlling both is what keeps the kidneys off the list of things going wrong.
The other habits matter too: not smoking, keeping active, and managing the blood sugar steadily rather than in dramatic swings. None of it is glamorous, and all of it showed up in my figures within a year of taking it seriously.
The kidney damage from diabetes is quiet. By the time you feel it, a lot of function is gone — so the reading on the report is the warning, and it comes years before your body gives you one.
Read next
- Eating out with diabetes at the kopitiam and hawker centre
The everyday decisions behind the numbers on the report.
- The health screenings actually worth paying for after 50
Where kidney testing sits in the short list worth doing.
- More in Health
Every condition, screening and prevention piece in one place.
Questions readers ask
- Can kidney damage from diabetes be reversed?
- It cannot usually be reversed once it has occurred, but the point of catching it early is that the decline can be slowed a great deal with blood sugar and blood pressure control and the right medication. That is why the routine tests matter even when you feel well.
- Should I cut protein if my kidney numbers are not good?
- Do not cut protein on your own. The right amount depends on your kidney function, your weight and your overall diet, and cutting too far can leave you weak. Ask your doctor or a dietitian for a target that fits you.
