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Health Blog :: Diabetes and Kidney Disease

November 23, 2022

What is diabetes?

Having high blood sugars all the time can cause a disease called Diabetes which happens when your body does not make enough of a hormone called insulin or cannot use insulin properly to use up or store the extra sugar. High blood sugar can give you symptoms of being hungry all the time, thirsty all the time and urinating frequently. A high blood sugar can lead to problems in many parts of your body, including your eyes, blood vessels, heart, kidneys, feet, nerves, and brain. Over time, if left unchecked, with uncontrolled sugars, the body parts may fail, leading to blindness, nerve problems, heart failure, kidney disease, kidney failure and amputations.

The most common types of diabetes are Type 1, Type 2 and gestational diabetes. In type 1 diabetes, the body does not make insulin. It is usually diagnosed in children and young adults, although it can happen at any age. People with type 1 diabetes need to take insulin every day to stay alive. Type 2 diabetes, which is the most common type, the body makes insulin, but cannot use it well or is resistant to it. Type 2 Diabetes can happen at any age, even during the childhood. It can be associated with being overweight. It tends to run in families. Gestational diabetes happens in some pregnant women. This type of diabetes usually goes away after delivery. However, people with gestational diabetes have a greater chance of acquiring type 2 diabetes later in life.

Although diabetes has no cure, one can take charge and manage the diabetes to stay healthy. Sometimes people call diabetes “a touch of sugar” or “borderline” or “pre-diabetes.” These words suggest that someone doesn’t have full-blown diabetes or has a less serious case with borderline sugars, but every case of diabetes should be taken seriously.

As of 2019, 37.3 million people in the United States, or 11.3 percent of the population, had diabetes.

How does diabetes cause damage to my kidneys?

Uncontrolled high sugars can injure the kidneys over time by damaging the blood vessels inside your kidneys. The kidneys’ main role in the body are filtering the blood and removing waste products produced by food digestion and excess salt and water from the body. The filtering units of the kidney are filled with tiny blood vessels. Over time, high sugar levels in the blood can cause damage and the filter becomes leaky to albumin (a type of protein) that passes through the filter and ends up in the urine. This also starts a cascade of inflammation and scar formation in the kidney. These events plus the high blood pressure in the kidney, all contribute to the damage that will lead to chronic kidney disease and eventually kidney failure.

How do I know if I have kidney damage?

There are no symptoms to warn you in early kidney damage. The best way to find early kidney damage is to check for a urine protein called albuminuria at least once a year. It helps people with diabetes to show early kidney damage. The higher the albumin leakage the higher chance of progression of kidney disease. Not everyone with kidney disease gets kidney failure requiring dialysis if you can keep the albumin level under control. You can also find the level of kidney function by a blood test called creatinine. The higher the creatinine the lower the kidney function. With the right treatments, one can slow the advancement of kidney disease and buy time.

If I have diabetes and kidney damage, what should I do?

Your healthcare team will create a treatment plan for you. This may include your primary care provider, your kidney doctor or nephrologist, your dietitian or nutritionist. Here are some tips that can help you protect your kidneys from damage:

  • Lifestyle changes Changing your lifestyle can have a big effect on the health of your kidneys. Low salt diet, exercise, losing weight and quitting smoking are recommended for everyone, but are especially important if you have diabetic kidney disease.
  • Controlling your blood sugar The best way, early on, to prevent or slow kidney damage is to keep your blood sugar well controlled. This is usually done with a healthy diet, exercise, and, if needed, medicines to control sugar.
  • Controlling high blood pressure High blood pressure can increase your chances of getting kidney failure. Ask your doctor what your blood pressure target should be, usual goal is less than 130/80 with albumin in the urine.
  • Protecting kidney function by taking ACE inhibitors or ARBs Your doctor may prescribe high blood pressure medicines called ACE inhibitors or ARBs even if your blood pressure is normal to protect your kidneys. Remember to not to take these on sick days and resume them when you feel better. If you develop allergies to these medicines, ask your doctor for alternatives.
  • Limiting how much protein you eat Less animal protein and more protein from vegetable sources are better for kidney health. Research suggests that eating less protein can slow kidney damage. You should talk to a dietitian to get some help in this area.
  • Medications called SGLT2 inhibitors Some people with type 2 diabetes will benefit from a medication called a sodium-glucose co-transporter 2 (SGLT2) inhibitor. Your health care provider can talk to you about whether you are a candidate for this treatment or not. This will depend on your overall health, how advanced your kidney disease is and how much albumin is in your urine. This class of medicines not only slow the progression of kidney disease and decrease albuminuria but also may help with heart disease.
  • Medication called Kerendia While diabetes and high blood pressure medications may help control your glucose and blood pressure, KERENDIA is the only medication of its kind that reduces inflammation and scarring in the kidneys. Ask your doctor if you are a candidate for this medicine. You may have to watch high potassium foods if you are treated with Kerendia.
  • Not using medicines that may damage the kidneys Specially over the counter pain medicine called NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) such as ibuprofen and naproxen. Check with your doctor before taking any herbal supplements because some can harm the kidneys.
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