Diabetes: Metformin question

I had noticed my BG was getting worse, and assumed I was loosing control with Metformin (failure of the oral anti-glycemic after years of use is common). I got to feeling really bad and lost all appetite, loosing quite a few pounds. I finally got in to see the endo (actually the nurse practitioner) and was told I was in acute Kidney failure. My creatinine was 3 or so and my BUN was 60, I believe.

I originally assumed I was a rare case of Metformin induced lactic acidosis, but the endo has waiverd on an opinion as to cause (perhaps due to malpractice concerns). Maybe the ACE inhibitor I was taking in a rather large dose or maybe the HCTZ diuretic. It is frustrating not to understand exactly what happened since that understanding would help with decisions as to what drug cocktail to use now. All the docs want to talk about is congestive heart failure, but in fact I did not pick up a fluid load until the nurse practitioner insisted on cold tukeying on all diuretics. Eventually, I was put on megadoses of diuretics and have last in the neighborhood of 50 ponds of (mostly) water in the last two weeks (I say mostly because I am sure I lost some real weight on hospital food).

Now as to your situation. Ketones in your urine infers poor glycemic control, I believe. Blood in the urine can mean a number of things, generally not good. Find out your BUN and Creatinine numbers as these are good indicators of Kidney function. It is generally accepted that a creatinine of 1.7 or 1.8 indicate about 50% kidney function, though that is a subjective number. I am running 2.0 or a little less which is good enough to live with for at least awhile. Of couse my kidneys are being asked to deal with temporary huge doses of diuretic, and that may improve a bit more when that is over.