Diabetes

Diabetes is the most common cause of kidney disease in the United States accounting for more than 45 percent of new cases. Diabetes is diagnosed when there are high levels of glucose (sugar) in the blood. High blood sugar levels from poorly controlled diabetes damage the blood vessels and nephrons (filtering units) of the kidneys.

Who is at risk?

Heredity, diet and certain medical conditions like high blood pressure and/or uncontrolled blood sugar increase the risk of diabetes and potentially kidney failure. African Americans, American Indians, and Hispanics/Latinos develop diabetes and kidney failure at rates higher than Caucasians.

What are the types of diabetes?

Diabetes occurs when the body does not properly process sugar. The body normally converts food to glucose, the simple sugar that is the main source of energy for the body’s cells. To enter cells, glucose needs the help of insulin, a hormone produced by the pancreas. If the body does not make enough insulin or does not respond to the insulin that is present, glucose builds up in the blood stream. High levels of glucose in the blood lead to a diagnosis of diabetes. There are two types of diabetes:

• Type 1 Diabetes - Approximately five to ten percent of people diagnosed with diabetes have type 1 diabetes which most often occurs in young adults and children. In type 1 diabetes, the body stops producing insulin requiring daily insulin injections or use of an insulin pump. Type 1 diabetes is more likely to lead to kidney failure. Twenty to forty percent of people with type 1 diabetes develop kidney failure by the age of 50 and some develop kidney failure before the age of 30.
• Type 2 Diabetes - About 90 to 95 percent of people diagnosed with diabetes have type 2 diabetes which generally occurs in people over the age of 40 but can occur at any age. People with type 2 diabetes do not respond properly to insulin – a condition called insulin resistance. Many aren’t even aware they have diabetes. Type 2 diabetics can control their glucose with meal planning, exercise, medications and/or insulin injections.

Diabetes, High Blood Pressure and Kidney Disease

High blood pressure (hypertension) is a major factor in the development of kidney problems in people with diabetes. Hypertension also accelerates the progress of kidney disease when it already exists.

The American Diabetes Association and the National Heart, Lung and Blood Institute recommend that people with diabetes keep their blood pressure below 130/80. The top number refers to pressure in the arteries during contraction of the heart (systolic) and the bottom number refers to the pressure in the arteries between heartbeats (diastolic).

High blood pressure is not only a cause of kidney disease, but is also a result of kidney disease. As kidney disease progresses, physical changes in the kidneys lead to increased blood pressure. Early detection and treatment of even mild hypertension are essential for people with diabetes.

Diabetic Kidney Disease

Diabetic kidney disease takes many years to develop. Most kidney damage rarely occurs in the first 10 years of diabetes, and usually 15 to 20 years will pass before kidney failure occurs.

If You Have Diabetes

• Have your doctor measure your A1C level at least twice a year. Aim to keep it at less than seven percent.
• Work with your doctor regarding insulin injections, medicines, meal planning, physical activity, and blood glucose monitoring.
• Have your blood pressure checked several times a year. Aim to keep it at less than 130/80.
• Ask your doctor if you might benefit from taking an ACE inhibitor or ARB.
• Have your urine checked yearly for microalbumin and protein.
• Have your blood checked for elevated amounts of waste products such as creatinine. A doctor should provide you with an estimate of your kidney’s filtration based on the blood creatinine level.
• Ask your doctor if you should reduce the amount of protein in your diet and consult a dietitian to help with meal planning.