Type 2 Diabetes Renal Failure

How Can I Tell If I Have Diabetic Kidney Disease

Most people with diabetic kidney disease do not have symptoms. The only way to know if you have diabetic kidney disease is to get your kidneys checked.

Health care professionals use blood and urine tests to check for diabetic kidney disease. Your health care professional will check your urine for albumin and will also do a blood test to see how well your kidneys are filtering your blood.

You should get tested every year for kidney disease if you

• have had type 1 diabetes for more than 5 years

Diet For Renal Failure

If you already have chronic renal failure, your doctor or dietician will want you to start on an eating plan called the Renal Diet.

Your kidneys are damaged therefore, your kidneys cannot handle a regular amount of protein as they could in the past. Your kidneys also cant handle excessive amount of salt or potassium, due to the kidneys role in regulating these electrolytes. If you choose not to decrease your protein, sodium, and potassium levels, it makes your kidneys work harder to filter waste, and you will experience ESRD sooner. A renal diet is lower in protein, fat, sodium or salt, and potassium. You will most likely be asked to:

• cut back on protein containing foods, especially animal products such as milk, eggs, and cheese
• eat a low fat diet that is also low in cholesterol, as your body cannot handle high cholesterol foods like it used to, and you will get plaque build-up in your arteries from all of the excessive cholesterol in your bloodstream
• avoid high salt or sodium in your diet, and keep sodium to 1500 mg/day to keep your blood pressure in a better range to protect your kidneys
• avoid excess potassium since your kidneys can no longer regulate this electrolyte. Potassium keeps your heart beating regularly and helps your muscles to work right, but kidney disease may result in high potassium levels, an irregular heartbeat, or even cardiac arrest. Avoid foods like apricots, oranges, potatoes and bananas, which are all high in potassium

Diabetic Kidney Disease: Diagnosis Treatment And Prevention

KATHRYN MCGRATH, MD, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania

RINA EDI, MD, University of California, San Diego, California

Am Fam Physician. 2019 Jun 15 99:751-759.

Patient information: A handout on this topic is available at .

• References

Globally, more than 400 million people have diabetes mellitus and almost 600 million may be affected by 2035.1 In the United States, approximately 12% of the population has diabetes, and up to 25% of these individuals may be undiagnosed.2 The disease affects patients across all age groups, sexes, racial or ethnic groups, education levels, and income levels.2 Diabetic kidney disease affects about 20% of patients with diabetes.3 DKD is associated with increased risks of morbidity and mortality and is the leading cause of end-stage renal disease in the United States.4,5

Prevention of diabetes in the general population is the most effective means of minimizing the impact of DKD understanding risk factors for DKD development can help with early identification and intervention. Effectively using screening guidelines, treatment strategies, and subspecialty referral can help prevent progression of DKD. The role of primary care physicians in the management of patients with DKD secondary to type 2 diabetes is reviewed.

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Antihyperglycemic Medication Selection And Dosing In Ckd

Many antihyperglycemic medications need to have their dose adjusted in the presence of low renal function, and some are contraindicated in people with significant disease. See Figure 1 in Pharmacologic Glycemic Management of Type 2 Diabetes in Adults chapter, p. S88 and Appendix 7. Therapeutic Considerations for Renal Impairment.

The Benefits Of The Kidney Disease Solution

With this program, here are the benefits you can expect to see with your kidneys and health:

• An integrated and comprehensive treatment for kidney disease.
• An all-natural treatment plan which doesnt rely on drugs, supplements or any other methods.
• Lowering kidney load and relieving the accumulation of toxin within the kidneys
• Better overall health by simple lifestyle changes
• Better diet through understanding the best foods to eat and what you should avoid to ensure healthy kidneys
• Reduced stress and improved sleeping through guided meditation and yoga exercises
• Greater energy throughout the day

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Other Clinical Features And Urinary Abnormalitieswhen To Consider Additional Testing Or Referral

Urinalysis findings of red or white blood cell casts or heme granular casts suggest a renal diagnosis other than diabetic kidney disease. Although persistent microscopic hematuria can occur in people with diabetic nephropathy, its presence should lead to the consideration of other urologic or nephrologic conditions. Table 2 lists other clinical clues that may point to a renal diagnosis other than kidney disease due to diabetes. Such individuals should undergo an appropriate assessment for the cause of their disease. Table 2 also lists some conditions whose presence would prompt a referral to a renal specialist.

Although 24-hour collections are not needed for routine screening in diabetes, they can be useful when there is doubt about the accuracy of an eGFR, when screening for non-albumin urinary proteins or when estimating daily sodium intake in an individual with refractory edema or hypertension. Individuals should be counseled to discard the first morning urine on the day of collection, and then collect all subsequent urine for a 24-hour period, including the first morning urine of the next day.

Medical Therapy In Diabetic Nephropathy

Medical therapy for diabetes is continually changing as new therapies become available for use and new updates are available that add to our knowledge of the safety profile of available medications. Please refer to Table for adjustments in dosing for diabetes medications used in CKD.

Table 1 Dose adjustment for insulin compounds and medications for diabetes in CKD

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Glycemic Control In Ckd

Glycemic control is essential to delay the onset of complications from diabetes, and it can be challenging for even the most experienced physician. Blood sugar control in those with CKD adds another level of complexity. It requires detailed knowledge of which medications can be safely used and how kidney disease affects metabolism of these medications. In addition, the glycemic target needs to be individualized for each patient, acknowledging that our ability to interpret the data can be altered in the setting of kidney disease.

How Diabetes Causes Kidney Disease

Each kidney is made up of millions of tiny filters called nephrons. Over time, high blood sugar from diabetes can damage blood vessels in the kidneys as well as nephrons so they dont work as well as they should. Many people with diabetes also develop high blood pressure, which can damage kidneys too.

CKD takes a long time to develop and usually doesnt have any signs or symptoms in the early stages. You wont know you have CKD unless your doctor checks you for it.

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Managing Blood Sugar Levels

This is crucial for lowering the risk of diabetes complications, such as kidney disease, cardiovascular disease, and diabetic neuropathy, which affects the nervous system.

These conditions, too, can lead to further complications. Managing blood sugar levels can also help prevent these from developing.

If diabetic nephropathy progresses to ESRD, a person will need either dialysis or a kidney transplant. They will usually need dialysis for the rest of their life or until a kidney transplant is available.

Prediabetes And Kidney Disease

If you have prediabetes, taking action to prevent type 2 diabetes is an important step in preventing kidney disease. Studies have shown that overweight people at higher risk for type 2 diabetes can prevent or delay developing it by losing 5% to 7% of their body weight, or 10 to 14 pounds for a 200-pound person. You can do that by eating healthier and getting 150 minutes of physical activity each week. CDCs National Diabetes Prevention Program lifestyle change program can help you create the healthy lifestyle habits needed to prevent type 2 diabetes. Find a program in your community or online.

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Symptoms Of Type 2 Diabetes:

In type 2 diabetes, symptoms happen slowly. Many people don’t notice any symptoms at all until their blood sugar has been too high for a long time. When they happen, symptoms include the general symptoms listed above and:

• Tingling, pain or feeling numb in your hands and feet
• Getting infections over and over

Diabetes And Kidney Disease: What To Eat

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. Whats good for you on one meal plan may not be good on the other.

Your first step: meet with a registered dietitianexternal icon whos trained in both diabetes and CKD nutrition. Together youll create a diet plan to keep blood sugar levels steady and reduce how much waste and fluid your kidneys have to handle.

Medicare and many private insurance plans may pay for your appointment. Ask if your policy covers medical nutrition therapy . MNT includes a nutrition plan designed just for you, which the dietitian will help you learn to follow.

Diabetes and CKD diets share a lot of the same foods, but there are some important differences. Read on for the basics.

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Importance Of Blood Glucose Control In Renal Failure Patients

Although the importance of tight glycemic control has been noted in several small studies, large studies found no significant relationship between tight glycemic control and survival of dialysis patients. Moreover, tight control of blood glucose may increase the risk of hypoglycemic attacks. According to studies, tight monitoring of blood glucose seems to be less important in diabetic dialysis patients than in those without renal failure because of the following reasons:

Therefore, based on the recent scientific evidence, it is recommended that glycemic control be considered as the main therapeutic goal in the treatment of diabetic patients with ESRD, too.

According to the studies, if patients with type 2 diabetes have a fasting blood sugar less than 120 and glycosylated hemoglobin of 5.6-7%, adequate control of glucose levels is required.

Data Source And Study Population

This study analyzed data from the nationally representative Korean National Health Insurance Claims Database. The National Health Insurance Corporation, a government agency that administers the medical service system in Korea, is a single insurer managed by the Korean government. The NHIS is an obligatory system, and approximately 97% of the Korean citizens are insured with this system. All Korean adults aged> 30 years are encouraged to undergo a biennial, standardized medical examination, which includes measurements of weight and height as well as laboratory tests including fasting blood glucose, lipid profiles, liver enzymes, urinalysis, and eGFR. In addition, a questionnaire on smoking, alcohol consumption status, and physical activity is administered.

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Role Of Antioxidants In Control Of Diabetes And Kidney Disease

Buffering the generation of ROS or consumption of these compounds might be a promising therapeutic approach to ameliorate diabetes and/or renal damage.

Antioxidants have been shown to be effective in a lot of ROS-induced diseases. The role of antioxidant therapy in diabetes and/or renal failure in humans is not clear, but there are a number of preclinical reports showing the effectiveness of antioxidants in the prevention and treatment of diabetes as well as renal failure.

Antioxidants with plant origins have been shown to be a better choice for this purpose and a lot of plants exhibit antioxidant activity. In this regard, it is better that we try using plants that have shown good results for controlling both DM and kidney disease.

The Evolving Presentation Of Dkd

The classic description of DKD involved progressive stages of glomerular hyperfiltration, microalbuminuria, overt proteinuria, and a decline in the GFR, eventually leading to dialysis . In recent years, this concept has been increasingly challenged as evidence suggests that DKD in the contemporary era presents in a more heterogeneous manner.

Large cross-sectional studies reveal that a large minority of patients with type 2 diabetes and reduced kidney function present with normal levels of albuminuria . In the Developing Education on Microalbuminuria for Awareness of Kidney and Cardiovascular Risk in Diabetes Study, 17% of this international cohort of 6072 individuals with type 2 diabetes of mean duration of 8 years and an eGFR< 60 ml/min per 1.73 m2 had normoalbuminuria . In one United States population-based study this number was reported to be as high as 33% . These findings are consistent with a recent report in which the prevalence of albuminuria in patients with type 2 diabetes decreased from about 21% in 1988â1994 to 16% in 2009â2014, despite a rise in the prevalence of reduced eGFR .

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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.

Strategy For Glycemic Control And Other Risk Factors

The primary goal of optimizing glycemic control to reduce the development of microvascular and macrovascular complications is universal. The medication regimen is based on the comfort of the patient and physician and should be individualized, especially as renal function changes.

For those who need insulin, MDI with an average of 4 daily injections is common. The closest approximation of physiologic insulin secretion can be achieved with an insulin pump delivering a continuous subcutaneous infusion. A single type of insulin is used in the pump such as a rapid-acting analog that serves as the basal, bolus and correction insulin. Insulin pumps require vigilance on the part of the patient and their use should be overseen by endocrinologists and experienced diabetes educators.

Continuous Glucose Monitoring Systems are available that can continually measure glucose levels. A small plastic catheter is inserted subcutaneously and measures glucose every 5 min. Patients can view this in real-time and detect upward and downward trends in glucose. The added benefit is that alarms for high and low readings can be set.

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The Effects Of Kidney Disease

Over time, high blood sugar levels can damage tiny blood vessels in your kidneys, which means they cannot filter your blood properly.

As a result, tiny particles of protein spill into the urine this is called microalbuminuria. As kidney disease progresses, larger amounts of protein spill into the urine this condition is called proteinuria.

As kidney disease progresses, waste products start to build up in your blood because your body can’t get rid of them. If left untreated, your kidneys will eventually fail and dialysis or a kidney transplant will be required.

Diabetes can also affect the nerves that tell you when your bladder is full. The pressure from a full bladder can damage the kidneys. If urine remains in the bladder for a long time, it can increase your risk of developing a urinary tract infection, which can spread to the bladder.

Who Created The Kidney Disease Solution Program

The Kidney Disease Solution was created by Duncan Capicchiano and his wife, Fiona Chin, from Melbourne, Australia. They established a wellness center in Melbourne with more than 13 health professionals who are natural.

Fully certified Naturopaths both have a common background in herbal and natural therapy.

The program started as an alternative treatment option for Fionas grandmother who was diagnosed with stage-4 renal disease. The couple put together an all-natural program which led to the improvement of her condition in just 12 weeks. After 6 months of treatment, she went from stage 4 to stage 1 and she was able to live a healthy life for another 10 years.

Due to the success they have had with Fionas grandmother They decided to start a company and share their approach to treatment to those suffering from kidney disease.

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What Are The Symptoms Of Diabetes

Symptoms of diabetes depend on how high your blood sugar is. In general, symptoms of type 1 and type 2 diabetes include:

• Feeling more thirsty or hungry than normal
• Urinating more than normal
• Blurry vision
• Having dry skin or sores that heal slowly

If you have any of these symptoms, talk with your doctor right away.

The Kidney Disease Solution Ebook

Its the main part of the program, which has 114 pages split into 13 chapters. Its a complete step-by-step guide to the entire program. It has all the information you will need on changing your lifestyle and healing your kidneys. The remedies found in the book are supported by the latest studies and research in the language that is easy to comprehend.

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