Diabetes and Kidney Disease
Diabetes mellitus, usually called
diabetes, is a disease in which your body does not make enough
insulin or cannot use normal amounts of insulin properly.
Insulin is a hormone that regulates the amount of sugar in your
blood. A high blood sugar level can cause problems in many parts
of your body.
Are there different types of diabetes?
The most common ones are Type 1 and Type
2. Type 1 diabetes usually occurs in children. It is also called
juvenile onset diabetes mellitus or insulin-dependent diabetes
mellitus. In this type, your pancreas does not make enough
insulin and you have to take insulin injections for the rest of
your life.
Type 2 diabetes, which is more common,
usually occurs in people over 40 and is called adult onset
diabetes mellitus. It is also called non insulin-dependent
diabetes mellitus. In Type 2, your pancreas makes insulin, but
your body does not use it properly. The high blood sugar level
often can be controlled by following a diet and/or taking
medication, although some patients must take insulin. Type 2
diabetes is particularly prevalent among African Americans,
American Indians, Latin Americans and Asian Americans.
What does diabetes do to the kidneys?
With diabetes, the small blood vessels in
the body are injured. When the blood vessels in the kidneys are
injured, your kidneys cannot clean your blood properly. Your
body will retain more water and salt than it should, which can
result in weight gain and ankle swelling. You may have protein
in your urine. Also, waste materials will build up in your
blood.
Diabetes also may cause damage to nerves
in your body. This can cause difficulty in emptying your
bladder. The pressure resulting from your full bladder can back
up and injure the kidneys. Also, if urine remains in your
bladder for a long time, you can develop an infection from the
rapid growth of bacteria in urine that has a high sugar level.
How many diabetic patients will develop
kidney disease?
About 30 percent of patients with Type 1
(juvenile onset) diabetes and 10 to 40 percent of those with
Type 2 (adult onset) diabetes eventually will suffer from kidney
failure.
What are the early signs of kidney
disease in patients with diabetes?
The earliest sign of diabetic kidney
disease is an increased excretion of albumin in the urine. This
is present long before the usual tests done in your doctor's
office show evidence of kidney disease, so it is important for
you to have this test on a yearly basis. Weight gain and ankle
swelling may occur. You will use the bathroom more at night.
Your blood pressure may get too high. As a person with diabetes,
you should have your blood, urine and blood pressure checked at
least once a year. This will lead to better control of your
disease and early treatment of high blood pressure and kidney
disease. Maintaining control of your diabetes can lower your
risk of developing severe kidney disease.
What are the late signs of kidney disease
in patients with diabetes?
As your kidneys fail, your blood urea
nitrogen (BUN) levels will rise as well as the level of
creatinine in your blood. You may also experience nausea,
vomiting, a loss of appetite, weakness, increasing fatigue,
itching, muscle cramps (especially in your legs) and anaemia (a
low blood count). You may find you need less insulin. This is
because diseased kidneys cause less breakdown of insulin. If you
develop any of these signs, call your doctor.
TABLE 1
Signs of Kidney Disease in Patients with
Diabetes
- Albumin/protein in the urine
- High blood pressure
- Ankle and leg swelling, leg cramps
- Going to the bathroom more often at
night
- High levels of BUN and creatinine in
blood
- Less need for insulin or antidiabetic
medications
- Morning sickness, nausea and vomiting
- Weakness, paleness and anaemia
- Itching
What will happen if my kidneys have been
damaged?
First, the doctor needs to find out if
your diabetes has caused the injury. Other diseases can cause
kidney damage. Your kidneys will work better and last longer if
you:
- Control your diabetes
- Control high blood pressure
- Get treatment for urinary tract
infections
- Correct any problems in your urinary
system
- Avoid any medicines that may damage the
kidneys (especially over-the-counter pain medications)
If no other problems are found, your
doctor will try to keep your kidneys working as long as
possible. The use of high blood pressure medicines called
angiotensin converting enzyme (ACE) inhibitors has been shown to
help slow the loss of kidney function.
How are the kidneys kept working as long
as possible?
The kidney doctor, called a nephrologist,
will plan your treatment with you, your family and your
dietician. Two things to keep in mind for keeping your kidneys
healthy are controlling high blood pressure in conjunction with
an ACE inhibitor and following your renal diabetic diet.
Restricting protein in your diet also might be helpful. You and
your dietician can plan your diet together.
What is end stage renal failure in
patients with diabetes?
End stage renal failure, or kidney
failure, occurs when your kidneys are no longer able to support
you in a reasonably healthy state, and dialysis or
transplantation is needed. This happens when your kidneys
function at only 10 to 15 percent. The usual span of time
between the onset of diabetic kidney injury and kidney failure
is about five to seven years.
How is kidney failure treated in diabetic
patients?
Three types of treatment can be used once
your kidneys have failed: kidney transplantation, haemodialysis
and peritoneal dialysis.
Can a patient with diabetes have a kidney
transplant?
Yes. Once you get a new kidney, you may
need a higher dose of insulin. Your appetite will improve so
your new kidney will break down insulin better than your injured
one. You will use steroids to keep your body from rejecting your
new kidney. If your new kidney fails, dialysis treatment can be
started while you wait for another kidney.
What about pancreas transplants?
Sometimes it is possible to perform a
pancreas transplant along with a kidney transplant. Your doctor
can advise you about this possibility.
What about a low-protein diet?
Research suggests that a low-protein diet
can slow the advance of kidney damage.
What is the future outlook for patients
with diabetes?
Today, more and more research dollars are
spent on diabetes research. Hopefully, the prevention and cure
of diabetes is in our future. In the meantime, you can manage
your diabetes better with:
- home monitoring of your blood glucose
levels
- maintaining an awareness of controlling
your blood pressure, and possibly monitoring your pressure at
home
- following your special diet.
Updated: 05/18/05
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See also in this A-Z guide:
- Hemodialysis
- Dialysis
- Kidney Transplant
- Nutrition and Chronic Kidney Disease
- Phosphorus and Your CKD Diet
- Potassium and Your CKD Diet
- Spice Up Your Diet
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