Recently, the Swedish Society of Endocrinology and Diabetes published recommendations for the treatment of diabetic patients with renal disease, suggesting that the pharmacokinetic profile of glucose-lowering drugs may change once the glomerular filtration rate (GFR) falls below 60 ml/min. The panel noted that diabetic patients are inherently at risk of reduced renal function and should therefore receive renal function tests at least once a year. The risk of hypoglycemia with sulfonylureas and glinides is increased when renal function is impaired. Most sulfonylureas should be discontinued when GFR is below 60 ml/min. Some glinides are not affected by renal function, and repaglinide can even be used in dialysis patients. In the absence of comorbidities, metformin can be applied in small doses when GFR is above 45 ml/min, but should be discontinued when dehydration occurs or when nephrotoxic drugs (including contrast agents) are applied. Glitazones may aggravate water and sodium retention in patients with renal insufficiency. The pharmacokinetics of all DPP4 inhibitors are altered by impaired renal function except for ligliptin. only selegiline, saxagliptin and ligliptin can be used in patients with progressive renal disease, but current experience is extremely limited. gLP-1 agonists are contraindicated in patients with moderate to severe renal disease.