By Dr SUNITA BAVANANDAN
Managing your diabetes properly can prevent or slow down kidney disease.
ANDY, a diabetic, is a well-educated man with a demanding job. He thought he had things under control when he decided to turn to self-medication for his condition since he was so busy.
So, he defaulted on his follow-up visit to the doctor and decided to buy over-the-counter medications. He continued this for many years until he experienced increasing lethargy and early morning nausea. A check-up confirmed he had kidney failure and his diabetes control was poor.
In hindsight he wished he had taken the time to seek professional help for his diabetes management.
Anna is a 40-year-old who had everything; a wonderful husband, a high-paying job and a house to call her own. Fifteen years ago, she developed diabetes during her pregnancy and was treated for it. She thought she was alright after that so she subsequently never went for any tests, and never saw a doctor except for minor ailments like the flu.
Little did she know, many years after this episode of diabetes during pregnancy, her blood sugar levels had started to rise and she had become pre-diabetic. Only after her elder brother was diagnosed to have diabetes did she go for a medical check-up herself. By then she was diagnosed to already have type 2 diabetes..
Anna and Andy are just a few out of the many people suffering from diabetes and kidney disease. Some do not even realise that they are at risk of having diabetes or that their kidneys are failing.
Here is what you need to know about diabetes and kidney problems.
How diabetes affects kidneys
The kidneys function to cleanse blood from any waste products and excess fluid by filtering blood to produce urine. When the kidneys are unable to filter normally, dangerous accumulation of fluid and wastes occurs in the body.
It usually takes 10 to 20 years for diabetic patients with kidney disease to develop kidney failure. This provides a big window of opportunity for kidney failure to be prevented.
However, in many instances, diabetes has already been present many years before it is detected, and organ damage may already exist at the time of diagnosis. This is why early detection of diabetes is important. Early preventive measures must be taken to control your diabetes and prevent kidney failure.
What is diabetes mellitus?
Diabetes mellitus is a condition where there is insufficient insulin produced by the pancreas or the body is unable to respond to the insulin normally. Blood glucose levels will then rise and cause damage to organs, including the kidneys.
Did you know that diabetes mellitus is the leading cause of end stage kidney failure in Malaysia? According to the 14th Report of the Malaysian Dialysis and Transplant Registry 2006, 57% of kidney failure patients had diabetes mellitus.
Kidney care for people with diabetes
Manage your diabetes
Managing your diabetes well can prevent or slow down the progress of your kidney disease, especially if your diabetes was detected early.
Achieve and maintain your targeted blood glucose and blood pressure. High levels of these are the main factors that contribute to kidney damage. In addition, if there is already kidney damage with protein leaking into urine, it is important to minimise this protein leak because it will cause further injury to the kidneys. This is usually achieved with good blood pressure control and appropriate medication.
Patients with diabetes and kidney disease are at an increased risk of heart attacks and strokes so it is also important to achieve good control of lipid levels, exercise and control weight, as well as stop unhealthy habits such as smoking. The following shows the targets to achieve:
Blood glucose: 4.0mmol/L to 6.0 mmol/L (fasting); and less than 7-8 mmol/L after food
HbA1c: Less than or equal to 6.5%
LDL cholesterol: Less than 2.6 mmol/L
Triglycerides: Less than 1.7 mmol/L
HDL cholesterol: More than 1.02 mmol/L
Blood pressure: 130/80 mmHg or lower
Don’t default on follow-ups
As tempting as it is, defaulting follow-ups can lead to further deterioration of your diabetes and diabetic complications, which include kidney disease. The problem is that complications such as diabetic eye and kidney disease are usually silent until in advanced stages. Because of this lack of early physical signs or symptoms, you may not be convinced of the need to see a doctor.
However, your doctor would be able to monitor your condition and help you control the disease. You would also have the opportunity for your kidneys to be checked routinely. To screen for kidney complications, the doctor only needs to check your blood pressure and do some simple urine and blood tests.
Remember – diabetes has the potential to damage many different organs in your body, not just the kidneys. Regular follow-up helps protect your heart and blood vessels, brain and nerves, eyes and skin also.
Medications help, not make you worse
Medications are prescribed to you by your doctor to help in controlling your diabetes, blood pressure and also other conditions.
Many patients worry that taking too many medications may be harmful but they need to understand that the probability of any permanent serious harm from medications is exceedingly low.
It is far more dangerous to allow their diseases to go untreated or uncontrolled. Avoid drugs other than the ones prescribed to you. Do also avoid traditional medications and certain types of pain-killers as these may damage your kidneys further.
If you are diabetic, you need to watch your diet. You can eat normally but control your carbohydrate and fat intake. If you already have kidney damage due to diabetes, controlling what you eat can avoid excessive accumulation of wastes in your kidneys since your kidneys are not able to function normally.
Control your intake of protein, sodium, potassium and phosphorus according to your doctor or dietitian’s dietary plan.
People with pre-diabetes have blood glucose levels higher than normal but not high enough to be classified as type 2 diabetes. The Diabetes Prevention Programme (DPP) was a landmark study conducted in the United States more than five years ago. It showed that about 11% of pre-diabetics may develop type 2 diabetes each year. Therefore, it is important to detect pre-diabetes early.
Like Anna, there are many out there going about their daily lives, not knowing they are suffering from pre-diabetes as the symptoms may develop gradually or not surface at all.
If you are in the high-risk group of getting diabetes, you should go for screening to check whether you have pre-diabetes or diabetes. Those who should go for screening are:
·Those with a family history of diabetes
·Age over 40 years old
·Those with high blood pressure
·Those with high cholesterol
·Women who had diabetes during pregnancy
Embark on a healthy lifestyle
Leading a healthy lifestyle can prevent pre-diabetes from developing into type 2 diabetes. This in turn helps prevent end stage kidney failure. The Diabetes Prevention Program found that people with pre-diabetes can prevent or delay type 2 diabetes by losing just 5 to 10% of excessive body weight through exercise, and a lower calorie and fat diet. It is recommended that you exercise 30 minutes a day, 5 days a week.
Chronic kidney disease and diabetes are common and harmful. However, most importantly, they are treatable, especially when detected early. It is important for you to work together with your doctor to prevent or manage diabetes appropriately.
> Dr Sunita Bavanandan is a consultant nephrologist. This article is courtesy of NKF Kidney Care, a community education programme by National Kidney Foundation of Malaysia. For more details, please call NKF at the NKF Hotline: 1-300-88-3110 or log on to www.nkf.org.my.