November is National Diabetes Month, and World Diabetes Day falls on November 14. This year's World Diabetes Day theme is "Early action on diabetes" [1].
Here's a thought we hear a lot from people living with type 2 diabetes: "My A1C is fine, so I'm fine."
But the A1C is a blood sugar test. It shows your average blood sugar over the past three months [3]. It doesn't tell you how your kidneys are doing.
And the kidneys are the part people tend to forget. About 1 in 3 adults with diabetes has chronic kidney disease [2]. Most of them feel nothing early on.
If you've ever looked up diabetes kidney disease early signs, here's the honest answer. In the early stages, there usually aren't any [2]. So for your kidneys, early action doesn't mean waiting for something to feel wrong. It means getting tested.
How diabetes wears down the kidneys' tiny filters
Every day, all of your blood passes through them about 40 times to be cleaned [4]. They remove waste and extra fluid, balance salt and minerals, and help keep blood pressure steady [4].
Each kidney is made of millions of tiny filters called nephrons [2]. Picture a very fine coffee filter. It lets waste pass through while holding on to things your body needs, like protein [5].
Over time, high blood sugar can damage the small blood vessels in the kidneys and those filters [2]. Early on, high blood sugar and high blood pressure make the kidneys work harder than they should. That extra strain slowly wears the filters down [4].
High blood pressure adds damage of its own. Many people with diabetes also have it, and it can hurt the kidneys too [2].
As the filters weaken, a small amount of a protein called albumin starts leaking into the urine. Later, the kidneys have a harder time cleaning the blood [4].
Diabetes kidney disease early signs: why you usually won't feel them
Most people with diabetic kidney disease have no symptoms [3]. Many don't realize they have kidney disease until it's advanced [2].
Early damage may not even show up on a standard blood test [4]. You can feel completely normal while albumin is quietly leaking into your urine.
As kidney disease gets worse, some people do notice changes. The National Kidney Foundation lists these among the signs common in advanced kidney disease [5]:
- Foamy or bubbly urine that keeps happening, which can be a sign of protein in the urine
- Swelling in the ankles, feet or lower legs, or puffiness around the eyes
- Feeling tired all the time, even after a good night's sleep
These symptoms can have other causes too. Leg swelling, for example, can also come from heart or liver problems [5].
Here's the key point: if you wait for symptoms, you're waiting too long. By the time many people feel something, the disease may already be advanced [2]. If you notice any of these changes, don't try to sort it out on your own. Talk to your doctor.
The two yearly tests that check your kidneys
Checking your kidneys is simple. It takes one urine test and one blood test, and both can happen at a regular visit [4].
The urine test: UACR
UACR stands for urine albumin-to-creatinine ratio. It checks for albumin, a protein that can leak into urine when the kidneys are damaged. Albumin in the urine is one of the first signs to show up on screening tests [4].
The blood test: eGFR
eGFR stands for estimated glomerular filtration rate. This blood test shows how well your kidneys are filtering [4].
Why you need both
Each test answers a different question. UACR looks for signs of damage. eGFR shows how well your kidneys are doing their job. Together, they give a general picture of your kidney health [4].
Because early damage may not show up on blood tests, skipping the urine test can leave out an important part of the story [4]. The National Kidney Foundation recommends that people with diabetes get both tests [5].
The American Diabetes Association says most people with type 2 diabetes should have these tests every year [4]. If your results change, your doctor may want to check more often [4]. Your doctor will explain what your numbers mean.
What early action looks like
Bring these questions to your next appointment
Appointments go by fast, so it helps to write your questions down ahead of time [6]. Here are a few to start with:
- Have I had both a urine albumin test and an eGFR this year?
- What were my results, and what do they mean?
- Have my numbers changed since last time?
- Is my blood pressure where it needs to be?
- What can I do to protect my kidneys?
- Should I see a nephrologist (a kidney specialist)?
Consider bringing a family member along. They can take notes and ask questions you might not think of [6].
Keep blood sugar and blood pressure in range
The best way to slow or prevent diabetes-related kidney disease is to reach your blood sugar and blood pressure goals [3]. Ask your health care team what your goals should be.
Everyday habits help too. That includes eating less sodium, staying active, not smoking and taking your medicines as prescribed [2][3].
One more thing to watch: some common over-the-counter pain relievers, called NSAIDs, can damage the kidneys. The risk is higher for people with diabetes or high blood pressure [6]. Ask your pharmacist or doctor which pain relievers are safe for you.
Ask whether you should see a nephrologist
A nephrologist is a doctor who specializes in the kidneys. Your primary care provider may refer you to one if your kidney disease is complicated, advanced or getting worse quickly [6].
Who should pay extra attention
Everyone with type 2 diabetes should have their kidneys checked every year [3]. Some people have extra reasons to stay on top of it:
- You've had diabetes for a long time. The longer you've had diabetes, the higher the chance of kidney damage [3].
- You have high blood pressure. People with diabetes are more likely to develop kidney disease if their blood pressure is high [3].
- Kidney disease runs in your family. A family history of kidney failure raises your risk [3]. The National Kidney Foundation lists family history as a reason to get tested [5].
African Americans, American Indians and Hispanics/Latinos also develop diabetes, kidney disease and kidney failure at higher rates [3].
Kidney research at Prolato
Prolato Clinical Research Center conducts kidney research here in Houston, including research studies in diabetic kidney disease. Research studies help the medical community learn more about kidney disease, and some involve investigational medications.
If you have diabetes and kidney disease and want to learn more, visit our study listings page. Taking part in a research study is always voluntary.
Medical disclaimer: This post is for education only and isn't medical advice. Please talk with your doctor about your own health, symptoms and test results.
Sources
- World Health Organization. World Diabetes Day 2026: Early action on diabetes.
- Centers for Disease Control and Prevention. Chronic Kidney Disease (Diabetes complications).
- National Institute of Diabetes and Digestive and Kidney Diseases. Diabetic Kidney Disease.
- American Diabetes Association. Keeping Your Kidneys Healthy.
- National Kidney Foundation. Signs and Symptoms of Kidney Disease.
- National Institute of Diabetes and Digestive and Kidney Diseases. Managing Chronic Kidney Disease.