Diabetes is a disease in which the body does not produce or properly utilize insulin. Insulin is a hormone produced by the pancreas and functions to regulate blood glucose (blood sugar).
There are two types of diabetes. Type 1 diabetes usually occurs in childhood and requires insulin to control blood sugar levels. Type 2 diabetes is the most common type of diabetes and usually occurs in adults over 45 but younger people may also be affected.
In Type 2 diabetes the pancreas produces insulin but it is not utilize properly by the body. Blood sugar levels may be controlled by diet, exercise and hypoglycemic medications (diabetic pills); however, some people may require insulin.
Uncontrolled diabetes may result in chronic kidney disease which, over time, can eventually lead to kidney failure or end stage renal disease. Diabetes is the leading cause of kidney failure accounting for almost 40 per cent of patients who develop end stage renal disease requiring dialysis or transplantation.
The long term effects of uncontrolled diabetes on the kidneys result in damage to the blood vessels that supply the kidneys leading to a decrease in the kidney’s ability to remove waste from the body. This build up of waste over time can lead to complications such as high blood pressure, anemia (low blood count), weak bones, poor nutritional health and nerve damage.
Kidney disease also increases the risk of having heart and blood vessel disease. There are five stages of chronic kidney disease and are determined by the glomerular filtration rate (GFR), which is a measure of kidney function. The lower the GFR the worst the kidney functions.
Chronic disease
In the early stages of chronic kidney disease, progression to permanent kidney failure can be delayed. However, in stage five or end stage renal disease (GFR less than 15 per cent), dialysis or kidney transplantation is necessary to sustain life. Early detection and treatment can often keep chronic kidney disease from getting worse.
Chronic kidney disease is a silent disease and symptoms are usually not present until the advanced stage of the disease, some of which include fatigue, poor appetite, difficulty sleeping, swollen feet and ankles, puffiness around the eyes, especially in the morning, and dry, itchy skin.
The earliest sign is the presence of albumin (protein) in the urine. In a normal functioning kidney albumin is usually reabsorbed by the kidneys’ filtering system. In the very early stages of kidney disease, small amounts of albumin are filtered out in the urine (microalbuminuria). This may also be an early sign of blood vessel abnormality that may lead to heart disease. As kidney disease progresses the amount of protein that is filtered out increases (macroalbuminuria).
People who are at risk for kidney disease – such as having a history of diabetes, hypertension, or a family history of kidney disease – should have regular check ups to test for protein in the urine and creatinine levels in the blood (elevated in the presence of kidney disease).
High blood pressure can cause kidney disease (second leading cause of kidney failure), and kidney disease can cause high blood pressure, so regular blood pressure monitoring is also important.
Good control of diabetes and high blood pressure is important in preventing or delaying the progression of kidney disease. People at risk for kidney disease should maintain a blood pressure of 130/80.
Certain types of blood pressure medication called angiotensin converting enzyme (ACE) inhibitor, e.g. lisinopril and enalapril and angiotensin receptor blocker (ARB) e.g. cozaar and diovan can help protect the kidneys.
Restricting the amount of salt in the diet helps to control high blood pressure and reduce swelling. For good blood sugar control, fasting levels (first check in the mornings before a meal) should be between 70-120 mg/dl and hemoglobin A1C levels (average blood glucose levels over three months) should be less than 7 per cent.
Dietary protein restriction may also be helpful as protein breaks down into toxic waste product that may be harmful to the kidneys, especially if they are already compromised. Consultation with a dietician is necessary in planning a low protein diet.
Not everyone with diabetes will develop chronic kidney disease; however, diabetes is a high risk factor. It is therefore important to prevent the complications of diabetes through early detection and prevention.
Urine and blood tests should be done annually, as well as regular blood pressure checks. Maintaining good control of blood pressure and blood sugar with diet, exercise, and medication, and maintaining a low protein diet will help to protect the kidneys and prevent or slow the progression of chronic kidney disease.
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