How Does Diabetes Cause Kidney Disease
High blood glucose, also called blood sugar, can damage the blood vessels in your kidneys. When the blood vessels are damaged, they dont work as well. Many people with diabetes also develop high blood pressure, which can also damage your kidneys. Learn more about high blood pressure and kidney disease.
Kidney Disease In People With Diabetes
People with diabetes have an increased risk of developing kidney disease, especially if they have consistently high blood sugar and high blood pressure levels. This is because high blood sugar and high blood pressure levels can cause the nephrons in the kidneys to become damaged. Nephrons are filtering units in the kidneys that contain many blood vessels when they are impaired, they cannot filter blood and waste products properly. This in turn leads to diabetic kidney disease.
Because it is common in people with diabetes, the Diabetes Canada guidelines recommend that adults with type 2 diabetes should first be tested for kidney disease when they are diagnosed, and adults with type 1 diabetes should be tested 5 years after their diagnosis. After that, people with either type 1 or type 2 diabetes should be tested every year.
How Diabetes Can Damage Kidneys
Diabetes is the leading cause of CKD: Approximately 1 in 3 people who have diabetes also have kidney disease, according to the Centers for Disease Control and Prevention . People with diabetes often have elevated levels of sugar in the blood, which can cause damage to many tissues in the body over time, including in the kidneys.
The working units of the kidneys, called nephrons, contain networks of tiny blood vessels that filter waste products from the blood.
When sugar is high in the blood, the sugars can bind to different proteins in the nephrons and change the structure of those proteins, says Staci Leisman, MD, a nephrologist and associate professor of medicine and medical education at Icahn School of Medicine at Mount Sinai in New York City. This can make the nephrons less effective at filtering and lead to protein in your urine a key sign of CKD.
Lowering blood sugar levels, which is the number one goal of diabetes management and treatment, can help prevent or slow kidney damage.
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Healthier Kidneys For Longer
- Keep your blood pressure below 140/90 mm Hg .
- Stay in your target blood sugar range as much as possible.
- Get activephysical activity helps control blood pressure and blood sugar levels.
- Lose weight if youre overweight.
- Get your kidneys tested every year.
- If you have CKD, meet with a dietitian to create a kidney-healthy eating plan. Ask your doctor for a referral.
Its smart to keep your hard-working kidneys in mind as part of your overall health. Take care of them, and theyll help take care of you.
Tests For Kidney Disease
The two tests for kidney disease are included in your annual review. You should normally have these tests every year but they might be happening differently at the moment because of the coronavirus pandemic. weâve got more advice about what care you can expect during this time.
As part of your 15 Healthcare Essentials, you should have both of the tests for kidney disease every year.
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Diabetes can be managed through oral medications. In addition to insulin, metformin, which is a sugar-reducing agent, is also a common treatment for diabetes. It is considered a first-line therapy for diabetes treatment and is often added to insulin. It is important to know the risks of taking diabetes medications. Some drugs can be addictive, so you must consult your doctor before taking any medication. Your physician can prescribe you an appropriate treatment plan based on your medical history.
Your doctor will prescribe medication and check your blood glucose levels on a regular basis. Your A1c level will be checked every six months and your cholesterol levels will be tested regularly. Your doctor will also look for any signs of retinopathy, which is damage to the nerves in the eye caused by diabetes. You will also be examined for any foot problems. It is important to see a foot specialist regularly. Your feet should be thoroughly inspected for damage to the nerves.
While the first two types of insulin are the most common treatments, diabetes can be treated in a variety of ways. Your doctor may prescribe medications to control high blood pressure, which can protect the kidneys. Other types of medication include aspirin and other types of anti-platelet drugs. If your doctor is concerned about your blood sugar level, you may need to try a different medication. Some medications can cause side effects. Your treatment will depend on what type of insulin you need.
Brain And Nervous System
When you have diabetes, your cells must work harder to use glucose. That may tire your muscles and leave you feeling spent.
Studies tie diabetes to proteins in your brain that are linked to dementia. Because of narrowed, hardened arteries, your chances of stroke are also higher. Your brain needs sugar to do its job. Repeated bouts of low blood sugar can damage the brain.
Nerve damage happens to almost everyone with diabetes. Some parts of your body may go numb or have other problems. All organs, including your heart, rely on healthy nerves. Pain in your feet and legs is a common sign that something isnt right.
You may not notice small cuts or sores at first. Those small injuries can grow into big wounds.
Since diabetes affects your blood flow and immune system, a small sore may not get what it needs to heal. In severe cases, doctors may need to amputate a foot or other affected areas.
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Control Your Blood Pressure
Blood pressure is the force of your blood against the wall of your blood vessels. High blood pressure makes your heart work too hard. It can cause heart attack, stroke, and kidney disease.
Your health care team will also work with you to help you set and reach your blood pressure goal. The blood pressure goal for most people with diabetes is below 140/90 mm Hg. Ask your health care team what your goal should be.
Medicines that lower blood pressure can also help slow kidney damage. Two types of blood pressure medicines, ACE inhibitors and ARBs, play a special role in protecting your kidneys. Each has been found to slow kidney damage in people with diabetes who have high blood pressure and DKD. The names of these medicines end in pril or sartan. ACE inhibitors and ARBs are not safe for women who are pregnant.
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.
Today, more and more research dollars are spent on diabetes research. Hopefully, the prevention and cure of diabetes are in the 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.
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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 dietitian. 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 dietitian can plan your diet together.
How Can Diabetic Nephropathy Be Prevented
The best way to prevent kidney damage is to keep your blood sugar in your target range and your blood pressure at a target of less than 130/80. You do this by eating healthy foods, staying at a healthy weight, exercising regularly, and taking your medicines as directed.
At the first sign of protein in your urine, you can take high blood pressure medicines to keep kidney damage from getting worse.
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How Is Diabetic Nephropathy Treated
Lowering blood pressure and maintaining blood sugar control are absolutely necessary to slow the progression of diabetic nephropathy. There are medications available which have been found to slow down the progression of kidney damage. They include:
- SGLT2 inhibitors including dapagliflozin , which helps control high blood sugar.Ã
- Angiotensin converting enzyme inhibitors can help slow down the progression of kidney damage. Although ACE inhibitorsâ including ramipril , quinapril , and lisinoprilâ are usually used to treat high blood pressure and other medical problems, they are often given to people with diabetes to prevent complications, even if their blood pressure is normal.
- Angiotensin receptor blockers can often be given insteadÃ if you have side effects from taking ACE inhibitors
If not treated, the kidneys will continue to fail and larger amounts of proteins can be detected in the urine. Advanced kidney failure requires treatment with dialysis or a kidney transplant.
How Diabetes Affects Your Kidneys
With diabetes being the leading cause of kidney disease, one may ask, how does diabetes affect your kidneys?
It is estimated that about a quarter of the people that have diabetes experience kidney disease. High blood sugar caused by diabetes can damage the blood vessels in the kidneys. The damage done to the blood vessels can lead to diabetic kidney disease. Over time, high blood sugar can cause the blood vessels to become narrowed and potentially blocked. Therefore, there is a lack of blood flow to the kidneys, leading to damage.
Another way diabetes affects your kidneys is through nerve damage. Nerves are essential for transmitting messages between the brain to other parts of the body, including the bladder. Your bladder will signal to the brain when the bladder is full. However, if nerves are damaged, then the signal will not reach your brain, and you may not feel that your bladder is full. When your bladder is continuously full, it can place pressure on your kidneys. The pressure placed on the kidneys can cause damage to them.
In addition to the pressure on the kidneys, a urinary tract infection is more likely to occur if ones bladder is full for too long. Bacteria will grow quickly in urine, especially if the urine has a high sugar level. The bacteria has the potential to affect the kidneys if it spreads.
September 30, 2020 by Diabetes Care
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Reach Your Blood Glucose Goals
Your health care professional will test your A1C. The A1C is a blood test that shows your average blood glucose level over the past 3 months. This is different from the blood glucose checks that you may do yourself. The higher your A1C number, the higher your blood glucose levels have been during the past 3 months.
The A1C goal for many people with diabetes is below 7 percent. Ask your health care team what your goal should be. Reaching your goal numbers will help you protect your kidneys.
To reach your A1C goal, your health care professional may ask you to check your blood glucose levels. Work with your health care team to use the results to guide decisions about food, physical activity, and medicines. Ask your health care team how often you should check your blood glucose level.
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What Are The Early Signs Of Kidney Disease In Patients With Diabetes
The earliest sign of diabetic kidney disease is 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.
Where Can I Get More Information
The National Kidney Foundation has free booklets that provide more information about diabetes and kidney disease. Call the national toll-free number 855.653.2273 and ask for free booklets. You can see these and other titles at www.kidney.org/store.
If you would like more information, please contact us.
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Can You Have Diabetes And Kidney Disease At The Same Time
One meal plan for diabetes, another for chronic kidney disease . Find out how you can eat well for both. If you have diabetes and CKD, youre definitely not aloneabout 1 in 3 American adults with diabetes also has CKD. The right diet helps your body function at its best, but figuring out what to eat can be a major challenge.
Stages Of Kidney Disease
Early treatment can help slow down the progression of kidney disease. There are five stages of kidney disease. Stage 1 is the mildest stage and kidney functionality can be restored with treatment. Stage 5 is the most severe form of kidney failure. At stage 5, the kidney is no longer functional, and you will need to have dialysis or a kidney transplant.
Your glomerular filtration rate can be used to help your doctor determine the stage of your kidney disease. Knowing your stage is important because that will affect your treatment plan. To calculate your GFR, your doctor will use the results from a creatinine blood test along with your age, gender, and physique.
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How Is Diabetic Kidney Disease Diagnosed And Assessed
Diabetic kidney disease is diagnosed when the level of albumin in the urine is raised and there is no other obvious cause for this. Urine tests are part of the routine checks that are offered to people with diabetes from time to time. Urine tests can detect albumin and measure how much is present in the urine.
The standard routine urine test is to compare the amount of albumin with the amount of creatinine in a urine sample. This is called the albumin:creatinine ratio . Creatinine is a breakdown product of muscle.
A blood test can show how well the kidneys are working. The blood test measures the level of creatinine, which is normally cleared from the blood by the kidneys. If your kidneys are not working properly, the level of creatinine in the blood goes up. An estimate of how well your kidneys are working can be made by taking into account the blood level of creatinine, your age and your sex. This estimate of kidney function is called the estimated glomerular filtration rate .
What Is Gastroparesis
Gastroparesis, also called delayed gastric emptying, is a disorder that affects digestion. With gastroparesis, the movement of food from the stomach to the small intestine is slowed or stopped even though nothing is blocking the stomach or small intestine.
In gastroparesis, the vagus nerve, which controls muscles of the stomach and small intestine, is damaged, resulting in slowed or stopped movement of food. Other cells in the stomach can also be damaged and cause the stomach to stop emptying its contents.
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What Is The Outlook
- If you have microalbuminuria , this may clear away, especially with treatment.
- If you have proteinuria , over time the disease tends to become worse and progress to end-stage kidney failure. However, the length of time this takes can vary and it may take years. If your kidneys do begin to fail you should be referred to a kidney specialist.
- Once the kidney function goes below a certain level then you will need kidney dialysis or a kidney transplant.
- A main concern is the increased risk of developing cardiovascular diseases. Cardiovascular diseases, such as heart attack and stroke, are the main causes of death in people with diabetic kidney disease. The treatments outlined above will reduce the risk of these occurring.