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Draft: not yet reviewed by a clinician

Use this page to prepare questions for your care team. It does not replace their advice. Your own targets and doses come from your nephrologist, diabetes team and renal dietitian.

Get help now

In an emergency, call 911 now

In the US and Canada call 911. Elsewhere call 112 (across the EU), 999 (UK) or 000 (Australia). If you are not sure whether it is an emergency, call. While you wait, treat a low blood glucose straight away: potassium never delays treating a low (Treating a low).

In short

This page sorts warning signs into three groups: call 911 now, call your care team today, and mention at your next visit. Kidney disease and type 1 diabetes share a few dangers that can turn serious within hours: very high potassium, a severe low, diabetic ketoacidosis (DKA), fluid on the lungs and serious infection. Print the wallet card and write in your own numbers. If your team has given you a written plan that differs from this page, follow your team's plan.

Call 911 now

Call 911 (or your local emergency number) for any of these. Do not drive yourself.

  • Chest pain or pressure. Also call for sudden breathlessness or fainting with no clear cause: in people with kidney disease, heart trouble often shows up that way instead of as classic chest pain (KDIGO 2024, section 3.15).
  • Severe breathlessness, being unable to lie flat, gurgling breathing, or coughing up pink or bloody froth. These are signs of fluid on the lungs, and kidney failure is one cause (MedlinePlus).
  • Fainting or collapse, a very slow, weak or irregular pulse, or sudden severe weakness, especially if your potassium has been high (MedlinePlus). If a lab or your team tells you your potassium is 6.5 mmol/L or more, go now: KDIGO calls this "severe" and says to "take immediate action to assess and treat" (KDIGO 2024, Table 28).
  • A low the person cannot treat themselves: they cannot swallow safely, are very drowsy or confused, or are having a seizure. Give glucagon if you have it, turn them on their side (they may vomit as they wake), and call 911. Give food or drink only once they are awake and able to swallow (NIDDK; ADA 2026 §6; glucagon instructions).
  • Signs of a stroke: the face droops on one side, an arm or leg is weak or numb, speech is slurred or hard to understand, or there is sudden trouble seeing or walking or a sudden severe headache. Note the time the signs started (CDC).
  • A blood pressure of 180/120 or higher with a sudden severe headache, trouble breathing, sudden severe pain in the chest, belly or back, numbness or weakness, a sudden change in vision or problems talking. Call even if you have not measured again, and do not wait to see if it comes down on its own (MedlinePlus; NHLBI).
  • New confusion, a seizure, or someone you cannot wake up. Check glucose if you can and treat a low first (ADA 2026 §6). In kidney failure, confusion can also come from waste building up in the blood, which KDIGO lists as a reason to start dialysis (KDIGO 2024, Table 41).
  • Possible DKA: blood ketones 3.0 mmol/L or more (urine ketones 2+ or more); or any ketones with vomiting so you cannot keep fluids down, deep or fast breathing, fruity-smelling breath or confusion; or glucose that stays at 300 mg/dL (16.7 mmol/L) or above (NHS; CDC; 2024 consensus). People with kidney failure often have lower ketone numbers in DKA than other people, so symptoms count even if the meter reads under 3.0 (2024 consensus, Table 4).
  • Bleeding from a fistula or graft that is heavy or spurting, or has not stopped after 10–15 minutes of firm pressure. Press hard on gauze with two fingers and keep pressing while you call (AKF; NKF).
  • Signs of a serious infection (sepsis): fever, shivering or feeling very cold, together with confusion, a fast heartbeat or weak pulse, shortness of breath, clammy skin or extreme pain. Sepsis is a life-threatening emergency (CDC). After a transplant, anti-rejection medicines raise the risk of infection (NIDDK), so fever with shaking chills is enough: do not wait for other signs.
  • Thoughts of harming yourself: call or text 988 in the US (988 Lifeline). If you are in immediate danger, call 911.

Call your care team today

Use the number your team gave you, including the after-hours line. If you cannot reach anyone and you feel worse, go to urgent care or the emergency department.

Blood tests

  • A lab potassium of 6.0–6.4 mmol/L. KDIGO says: if you feel unwell, get checked and treated in hospital; if you feel well and the result was unexpected, repeat the test within 24 hours (KDIGO 2024, Table 28). See Blood potassium.

Diabetes

  • Blood ketones 1.6–2.9 mmol/L: call your diabetes team now, not later in the day (NHS). If you cannot reach them quickly, or you are vomiting, go to the emergency department: the American Diabetes Association advises emergency care at 1.6 mmol/L or more (ADA).
  • Blood ketones 0.6–1.5 mmol/L: follow your sick-day plan and test again in 2 hours. If you are also ill, call your team (NHS).
  • Check ketones whenever you are ill, have missed insulin or have symptoms, especially if glucose is above 200 mg/dL (11.1 mmol/L) (ADA 2026 §6).
  • High glucose that does not come down after the correction your plan tells you to take: check ketones and call your diabetes team (NHS).
  • Vomiting, diarrhea or not eating: start your written sick-day plan and call. Ask which of your medicines to pause and exactly when to restart them (KDIGO 2024, practice points 4.3.2–4.3.3; Sick days).
  • Lows that keep coming back, lows at night, or lows you no longer feel coming (ADA 2026 §6).

Dialysis and transplant

  • On peritoneal dialysis: cloudy fluid, belly pain, fever, or redness or pain around the catheter. Call your PD unit the same day and keep the bag, so the fluid can be tested (NIDDK; ISPD 2022).
  • Fistula or graft: the buzz (thrill) stops, feels much weaker or changes. Call right away; do not wait for your next session (NKF).
  • Redness, warmth, swelling, pain or pus at an access site or a catheter exit site (NKF; NIDDK).
  • A missed or shortened dialysis session: call the unit to make it up (KDOQI hemodialysis adequacy). Risk of death and hospital stays is highest after the long two-day gap in a three-times-a-week schedule (Foley 2011).
  • After a transplant: a temperature over 100 °F (37.8 °C), feeling unwell, drainage from the scar, burning when you pass urine, or a cold or cough that will not go away. Call your transplant center right away (NIDDK).

Blood pressure

  • A blood pressure of 180/120 or higher that is still that high when you check again after resting 5 minutes, and none of the signs in the 911 list above. If a reading is that high, sit quietly for 5 minutes and check again before you call (NHLBI).

Fluid

  • Much less urine than usual, new swelling of the legs, ankles or face, or weight gain above the alarm number your team gave you. On hemodialysis, large gains between sessions are linked with more heart problems (Cabrera 2015); fluid that cannot be controlled is a reason to start or change dialysis (KDIGO 2024, Table 41).

Mention at your next visit

Itch, tiredness, poor appetite or nausea, muscle cramps, restless legs, low mood, poor sleep, or problems with sex. These are common and often treatable. KDIGO asks clinicians to ask about poor appetite, nausea and tiredness at every visit as kidney disease progresses, and lists ways to manage itch, restless legs, poor sleep, low mood and other common symptoms (KDIGO 2024, practice point 5.2.2.1 and Table 38). Also mention high glucose readings that keep happening, a medicine you are struggling to take or pay for, and any new medicine, supplement or scan that another doctor suggests (Medicines to avoid).

If any of these get worse quickly, do not wait: call today.

Get ready before you need help

  • Save your care team's numbers, including the after-hours line, in your phone and on the card below.
  • Keep glucose tablets and glucagon where you and your family can reach them, and show your family how to give glucagon. ADA says glucagon should be prescribed for everyone who takes insulin (ADA 2026 §6, recommendation 6.16).
  • Keep in-date blood ketone strips. In a trial, blood ketone checks halved hospital and emergency visits compared with urine strips (ADA 2026 §6).
  • Ask for a written sick-day plan that says which medicines to pause and when to restart them (KDIGO 2024, practice point 4.3.2).
  • Wear a medical ID (NIDDK) and fill in the wallet cards.
  • With a fistula or graft, keep clean gauze and tape at home (AKF).
  • Know your own potassium and fluid rules (Potassium; Fluid).

What to tell the 911 call-taker

  1. "I have type 1 diabetes and kidney disease", plus "I am on dialysis" or "I have a kidney transplant" if that is true.
  2. What is happening, and when it started (CDC).
  3. Your latest glucose and ketone readings, and whether glucagon was given.
  4. If you can, take your medicine list, glucose meter, wallet card and, on PD, the cloudy bag.

Printable wallet card

Print this page and cut out the card (it prints at credit-card width). Write in your own numbers. More cards, including one for paramedics and one for your own targets, are on Wallet cards.

Kidney disease + type 1 diabetes: get help

Call 911 (112 EU · 999 UK · 000 Australia): chest pain · can't breathe or lie flat · fainting, very slow or irregular pulse · lab potassium 6.5 mmol/L or more · stroke signs (note the time) · a low I can't treat: glucagon, turn me on my side, call 911 · blood ketones 3.0 mmol/L or more, or ketones with vomiting · fistula bleeding not stopped after 10–15 min of firm pressure · fever with confusion or a racing pulse · after a transplant, fever with shaking chills · blood pressure 180/120 or higher with a sudden severe headache, trouble breathing, chest, belly or back pain, numbness or weakness, a sudden vision change or trouble talking (call, do not wait to measure again)

Call my team now or today: potassium 6.0–6.4 mmol/L · ketones 1.6–2.9 mmol/L (now; emergency room if no answer) · vomiting, diarrhea or not eating · cloudy PD fluid (keep the bag) · no fistula buzz · missed dialysis · fever over 100 °F (37.8 °C) after a transplant · lows that keep coming back · blood pressure 180/120 or higher after resting 5 minutes · weight gain above my alarm weight

Kidney team: ____ Diabetes team: ____

Dialysis unit or transplant center: ____

My fluid limit: __ My alarm weight: __

Outside the US

  • Emergency numbers: 112 works across the EU, 999 in the UK, 000 in Australia, 111 in New Zealand. In England, NHS 111 gives urgent advice when it is not an emergency (NHS).
  • National kidney charities, such as Kidney Care UK (Kidney Care UK), and your national diabetes charity list local help lines.

Treating a low · Sick days · Blood potassium · Fluid · Dialysis access · Questions to ask · in the app, warnings link back here: Targets and warnings.

Sources

Not yet reviewed by a clinician. Facts and sources last checked 2026-10-22.