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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.

Stages G1 and G2

In short

At G1 and G2 your kidneys still filter well (eGFR 60 or more), but there are signs of damage. With type 1 diabetes the usual sign is albumin leaking into the urine. Most people feel nothing at this stage, so the blood and urine tests are the only way to know (NIDDK). This is the stage where treatment does the most good: blood pressure, glucose in range, a kidney-protecting medicine if albumin is raised, activity and no smoking. You do not need a low-potassium or low-phosphorus diet unless your blood tests say so.

Your numbers

Starting points, not your prescription

These numbers are typical starting points from guidelines. Your nephrologist, diabetes team and renal dietitian set your own numbers from your blood tests, urine output and medicines, and change them as your labs change. If your lab report or your team says something different, they win.

What Typical goal or limit Why
eGFR G1: 90 or more; G2: 60–89 mL/min/1.73 m² how well the kidneys filter
UACR A1 under 30 mg/g; A2 30–300; A3 over 300 how much albumin leaks
Blood pressure under 130/80 mmHg; systolic under 120 (measured the standard way in clinic) if you feel well on it protects kidneys and heart
A1c your own goal between under 6.5 % and under 8.0 % slows kidney damage, avoids lows
CGM time in range (70–180 mg/dL) more than 70 % the same goal as without CKD
Sodium under 2,000 mg a day lowers blood pressure and albumin leak
Protein 0.8–1.0 g/kg a day (56–70 g at 70 kg); not more than 1.3 g/kg enough, but not a high-protein diet
Potassium, phosphorus no limit unless your blood levels run high the kidneys still clear them
Activity 150 minutes a week of moderate activity, or what you can manage heart and kidney health
What Typical goal or limit Why
eGFR G1: 90 or more; G2: 60–89 mL/min/1.73 m² how well the kidneys filter
UACR A1 under 3 mg/mmol; A2 3–30; A3 over 30 how much albumin leaks
Blood pressure under 130/80 mmHg; systolic under 120 (measured the standard way in clinic) if you feel well on it protects kidneys and heart
HbA1c your own goal between under 48 and under 64 mmol/mol slows kidney damage, avoids lows
CGM time in range (3.9–10.0 mmol/L) more than 70 % the same goal as without CKD
Sodium under 2,000 mg a day (about 5 g of salt) lowers blood pressure and albumin leak
Protein 0.8–1.0 g/kg a day (56–70 g at 70 kg); not more than 1.3 g/kg enough, but not a high-protein diet
Potassium, phosphorus no limit unless your blood levels run high the kidneys still clear them
Activity 150 minutes a week of moderate activity, or what you can manage heart and kidney health

Sources for the table: blood pressure (ADA 2026 §11, recommendation 11.5; KDIGO 2024, recommendation 3.4.1); A1c (KDIGO 2022, recommendation 2.2.1); time in range (ADA 2026 §6); sodium (KDIGO 2024, recommendation 3.3.2.1); protein (about 0.8 g/kg with diabetes and CKD, KDIGO 2022, recommendation 3.1.1; not more than 1.3 g/kg, KDIGO 2024, practice point 3.3.1.1; 0.8–1.0 g/kg is the app's G1–G2 starting range); activity (KDIGO 2024, recommendation 3.2.2.1). The app's starting values for G1–G2 are in Targets and warnings.

Tests to expect

Test How often
UACR and eGFR at least once a year; 1–4 times a year once CKD is found, depending on your stage (ADA 2026 §11, recommendations 11.1a–b; KDIGO 2024, practice point 2.1.1)
Potassium, creatinine and blood pressure within 2–4 weeks of starting or raising an ACE inhibitor or ARB (KDIGO 2024, practice point 3.6.2)
A1c or a CGM report at your diabetes visits

What changes now

Medicines. If your UACR is in A2 or A3, KDIGO recommends an ACE inhibitor or an ARB (strong recommendation, 1B), whatever your blood pressure (KDIGO 2024, recommendation 3.6.3). Your prescriber aims for the highest approved amount you tolerate, because that is what protected kidneys in the trials (practice point 3.6.1). An ACE inhibitor and an ARB are never combined (recommendation 3.6.4). If you could become pregnant, ask about each medicine's safety in pregnancy and about contraception before you start; KDIGO asks prescribers to review this every time (practice point 4.1.4). Pregnancy planning is for your specialists: see Sex, fertility and pregnancy.

Finerenone (Kerendia) was approved in the US in September 2026 to lower UACR in adults with CKD and type 1 diabetes. It is not started if blood potassium is above 5.0 mmol/L, and grapefruit must be avoided while taking it (Kerendia label). Ask whether it fits you. See Kidney-protecting medicines.

SGLT2 inhibitors (such as dapagliflozin or empagliflozin) protect the kidneys in type 2 diabetes, but none is approved for type 1 diabetes in the US, because they raise the risk of diabetic ketoacidosis (DKA) (ADA 2026 §9). If one is ever prescribed for you, ask for a written plan for checking ketones and for sick days before you start.

Pain medicines. The National Kidney Foundation says people with CKD should avoid NSAIDs such as ibuprofen and naproxen, because they cut blood flow to the kidneys (NKF). Acetaminophen at the dose on the label is usually safer for the kidneys, but ask first.

Food. Eat more plants and fewer ultra-processed foods (KDIGO 2024, practice point 3.3.1). Keep sodium under 2,000 mg. Potassium and phosphorus limits are not needed unless your blood levels are high.

Diabetes. Insulin needs fall as eGFR falls, so that matters more from G3 on (JBDS–Renal Association). For now, keeping glucose in range is one of the main ways to slow kidney damage (KDIGO 2022).

What to do

  • Get your latest UACR and eGFR and write them down with the date.
  • Check your blood pressure at home and bring the readings to your next visit.
  • If your UACR is 30 mg/g (3 mg/mmol) or more, ask whether you should take an ACE inhibitor or ARB, and whether you are on the full amount you can tolerate.
  • Ask whether finerenone is right for you.
  • Read labels and keep sodium under 2,000 mg a day (Sodium).
  • Move for 150 minutes a week, for example 30 minutes on 5 days (Exercise).
  • Do not take ibuprofen or naproxen as a habit. Ask the pharmacist before any pain or cold medicine.
  • Stop smoking, and ask for help to do it (KDIGO 2024, practice point 3.2.1).
  • Never eat star fruit or drink its juice (NKF).
  • Set your stage in the app and use "Suggest targets" (First setup).

Examples

A sandwich and the sodium budget. Two slices of white bread have about 284 mg of sodium and a tablespoon of mayonnaise about 88 mg. One ounce of processed American cheese adds about 470 mg. That one sandwich is over 840 mg, more than 40 % of a 2,000 mg day (USDA FoodData Central). Swap the cheese for home-roasted turkey or chicken and you save over 400 mg.

Breakfast without a potassium rule. A cup of cooked oatmeal (about 164 mg potassium) and a banana are fine at G1–G2 if your blood potassium is normal (USDA). Count the carbohydrate for your insulin as usual.

A sore back on a Saturday. Reach for acetaminophen at the label dose, not ibuprofen, and ask the pharmacist if you are not sure (NKF).

Ask your care team

  1. What is my UACR, and is it A1, A2 or A3? Is it going up or down?
  2. Should I be on an ACE inhibitor or an ARB? Am I on the amount that protects the kidneys?
  3. Am I a candidate for finerenone?
  4. What blood pressure goal should I aim for at home, and how often should I check it?
  5. How often will you check my eGFR and UACR?
  6. Do I need any change in what I eat?

Get help now if…

Call 911 (or your local emergency number)

Chest pain, severe breathlessness, a low the person cannot treat themselves (give glucagon, then call), or possible DKA: blood ketones of 3.0 mmol/L or more, or any ketones with vomiting, deep fast breathing or fruity breath (2024 consensus). Full list: Get help now.

Call your care team today

You feel faint or dizzy when you stand after starting a blood pressure medicine (KDIGO 2024, practice point 3.6.5), you have new swelling of the legs or face, or you are vomiting or cannot eat (start your sick-day plan).

Sources

Not yet reviewed by a clinician. Facts and sources last checked 2026-10-06.