Susan B. Sloane, BS, RPh, CDE, has been a registered pharmacist for more than 20 years and a Certified Diabetes Educator for more than 15 years. Her two sons were diagnosed with diabetes, and since then, she has been dedicated to promoting wellness and optimal outcomes as a patient advocate, information expert, educator, and corporate partner.
I am always hesitant to write an article that addresses bad things that can happen in patients with diabetes. I consider myself a pretty positive person, and I like to take a positive spin on my subject matter. Sometimes though, as with any chronic disease, it’s best to just grab the bull by the horn and remember that although there is risk, there are also opportunities for prevention. So let’s dig in and learn how to take care of those precious kidneys!
Studies have shown that kidney disease, also called diabetic nephropathy, is a potential long-term consequence of diabetes. It presents in approximately 20 to 40 percent of patients with diabetes. There may be several causes, but one of the main issues that can aggravate kidney function is hyperglycemia, especially long-standing hyperglycemia.
High blood sugars seem to cause injury to the glomerulus of the kidney directly. The glomerulus helps to filter out toxic substances from the body. When the glomerulus gets damaged, plasma proteins such as albumin start to escape or leak out of the body into the urine. With continued high blood sugars, glucose binds to proteins in the kidney over time, causing further damage.
When there is an insult to the kidneys, a substance in the kidneys called renin is also activated, causing additional problems such as increases in blood pressure. There is a delicate balance between blood pressure and healthy kidneys that needs to be maintained in patients with diabetes where nephropathy is a very real risk.
Now for the good news: healthy habits can prevent kidney disease in many cases. Lifestyle interventions such as weight loss, regular exercise and, of course, smoking cessation can optimize glucose and blood sugar control. Bringing your A1C down even one point can significantly reduce one’s risk for getting kidney disease. This is another good reason to try to keep your blood sugars within acceptable limits as prescribed by your healthcare team.
Your doctor will generally assess your kidney function when you’re first diagnosed with diabetes and then yearly thereafter. You may see a test to check your glomerular filtration rate or levels of protein in the urine. A normal GFR is generally about 90, although these values vary person to person. Normal protein (albumin) excretion is around 30-300mg/d. Always check your test values against laboratory norms as tests measuring kidney function are often given in different ways.
Blood pressure and cholesterol are important parameters to watch in order to help prevent or stop the progression of kidney damage. Your doctor may have already started you on a common blood pressure medication even if you don’t have high blood pressure or kidney damage. This class of medications are known as ACE inhibitors, an example being Altace®, or ramipril. They have been studied and found to have some protective effects on preventing kidney damage in patients with diabetes.
Remember my favorite quote by Elliot Joslin: “The diabetic that knows the most lives the longest.” I think this holds true for anything and any disease; knowledge is a powerful tool, keep it with you always!
Have you had experience with kidney complications as a result of your diabetes? Or, if not, how does your doctor recommend preventing them? Share your thoughts and experiences in the comment section below.