Diabetes and Kidney Disease Q-A

What is diabetes?

Diabetes mellitus, usually called diabetes, is a disease that happens when your body does not make enough insulin or when your body cannot use normal amounts of insulin properly. Insulin is a hormone that regulates the amount of sugar in your blood. A high blood sugar level can cause problems in many parts of your body.

 

Are there different types of diabetes?

Yes. The most common one are Type I and Type II. Type I diabetes usually happens in children. It is also called "juvenile onset" diabetes mellitus or insulin dependent diabetes mellitus. In this type, your pancreas does not make enough insulin and you have to take insulin injections.

Type II diabetes (the most common type of diabetes) usually happens in people over 40 and is called "adult onset" diabetes mellitus. It is also called noninsulin dependent diabetes mellitus. In this type, your pancreas makes insulin, but your body does not use it properly. The high blood sugar level often can be controlled by following a diet and/or taking pills, although some patients must take insulin. Type II diabetes is particularly prevalent among African Americans Native-Americans, Latin Americans and Asian-Americans.

 How does diabetes affect your body?

When you have diabetes, the small blood vessels in your body are injured. This can affect your kidneys, eyes, nerves, muscles, intestines and heart. High blood pressure and hardening of the arteries (arteriosclerosis) can develop, which can lead to heart disease.

 

What does diabetes do to the kidneys?

When the blood vessels in the kidneys are injured, your kidneys cannot clean your blood properly. Your body will retain more water and salt than it should, which can result in weight gain and ankle swelling. You may have protein in your urine. Also, waste materials will build up in your blood.

Diabetes also may cause damage to nerves in your body. This can cause difficulty in emptying your bladder. The pressure that results from your full bladder can backup and injure the kidneys. Also, if urine stays in your bladder for a long time, you may get an infection. This is because bacteria grow rapidly in urine with a high sugar level.

 

How many diabetic patients will get kidney disease?

About 30 percent with Type I (juvenile onset) diabetes and 10 to 40 percent of those with Type II (adult onset) diabetes will eventually have kidney failure. Certain groups, such as African-Americans, Native-Americans and Asian-Americans may have a higher risk of getting this complication.

 

What are the early signs of kidney disease in patients with diabetes?

The earliest sign of diabetic kidney disease is an increased excretion of albumin in the urine. This is present long before there is evidence of kidney disease by the usual tests done in your doctor's office. Thus, it is important for you to have this test on a yearly basis. Weight gain and ankle swelling may occur. You will will use the bathroom more at night. Your blood pressure may get too high. As a person with diabetes, you should have your blood, urine and blood pressure checked at least once a year by your doctor. this will lead to  better control of your disease and early treatment of high blood pressure and kidney disease.

 

What are the late signs of kidney disease in patients with diabetes?

As your kidneys fail, you will have a rise in your BUN and creatine blood tests. You may also have nausea, vomiting, a loss of appetite, weakness,  increasing tiredness, itching, muscle cramps (especially in your legs) and a low blood count (anemia). You may find you need to use less insulin. This is because diseased kidneys cause less breakdown of insulin. If you have any of these signs, call our doctor.

 

Early and Late Signs of Kidney Disease in Patients with Diabetes

  • Albumin / protein in the urine
  • High blood pressure
  • Ankle and leg swelling, leg cramps
  • Going to the bathroom more often at night
  • High levels of BUN and creatinine in blood
  • Less need for insulin or antidiabetic pills
  • Morning sickness, nausea and vomiting
  • Weakness, paleness and anemia
  • Itching
What can patients with diabetes do to prevent kidney damage?

Keeping good control of your diabetes can lower your risk of having severe kidney disease. This means having your blood pressure and urine albumin excretion checked at lest once a year and taking blood pressure medicine if your doctor orders it for you. You need to get enough sleep (usually about eight hours), follow your diabetic diet and get regular exercise. Avoid alcohol and cigarettes. See your doctor as often as you are told.

Many people with diabetes do not get kidney disease, and having diabetes does not always mean your kidneys will fail. Talk to your doctor about your chances of getting kidney damage.

 

If diabetes has affected the kidneys, what can be done?

If you have any of the signs of kidney disease listed earlier, you need to call your doctor. With blood and urine tests, your doctor can tell how your kidneys are working. This will help you doctor to order the best treatment for you.

 

What will happen if your kidney function has been damaged?

First, the doctor needs to find out if your diabetes has caused the injury. Other diseases can cause kidney injury. The following things can help your kidneys work better and last longer:

  • Controlling your diabetes
  • Controlling high blood pressure
  • Treatment of urinary tract infections
  • Correction of any problems in your urinary system
  • Avoiding any medicines that may damage the kidneys (especially pain medicines)

If no other problems are found, your doctor will try to keep your kidneys working as long as possible. The use of high blood pressure medicines called angiotensin converting enzyme (ACE) inhibitors has been shown to help slow the loss of kidney function.

 

How are the kidneys kept working as long as possible?

The kidney doctor (nephrologist) will plan your treatment with you, your family and dietician. The two best things to keep your kidneys working are controlling high blood pressure in conjunction with an ACE inhibitor and following your renal diabetic diet. Restriction of protein in your diet may be helpful. You and the dietitian will plan your diet together. (See National Kidney Foundation brochure Nutrition and Changing Kidney Function.)

 

What is end stage kidney failure in patients with diabetes?

End stage kidney failure is the time when your kidneys are no longer able to support you in a reasonably healthy state and dialysis or transplantation is is needed. This happens when your kidney function is about 10 to 15 percent of normal. The usual time between the beginning of diabetic kidney injury and end stage kidney failure is about five to seven years.

 

How is end stage kidney failure treated in diabetic patients?

Three types of treatment can be used once your kidneys have failed: kidney transplantation, hemodialysis and peritoneal dialysis. The type of treatment for you will be chosen by your general health and medical condition, your lifestyle and by what you would like. The success rate of each treatment type is very important in this planning. These decisions are not final. Many people have used each one of these treatments at different times. Your health care team will discuss these different treatments with you and answer your questions.

 

Can a patient with diabetes have a kidney transplant?

Yes, a kidney transplant can come from one of your relatives (living-related transplant) or from a dead person (cadaver transplant). Once you get a new kidney, you may need to use a higher dose of insulin. This is because you will be eating more, your new kidney will break down insulin better than your injured one, and you will be using steroids to keep your body from rejecting your new kidney. If your new kidney fails, dialysis treatment can be started and you can wait for another new kidney. (See National Kidney Foundation brochure Kidney Transplant: A New Lease on Life.)

 

What about pancreas transplants?

Sometimes, it is possible to do a pancreas transplant along with a kidney transplant. Your doctor can advise you about this possibility.

 

What does hemodialysis involve?

Hemodialysis is the most common form of treatment for end stage kidney failure. In order to have hemodialysis, you will need to have surgery to join one your arteries to a vein in your arm. This will make a bigger vein called a fistula. Needles are put into this fistula and joined to the artificial kidney machine. This machine cleans the blood and takes away waste materials that build up in your body. The treatments last about four hours and usually need to be done three times a week. This dialysis can be done in a hospital, an outpatient dialysis clinic or at home (after training). (See National Kidney Foundation brochure Dialysis.)

 

What does peritoneal dialysis involve?

Peritoneal dialysis is used often in patients with diabetes. In this type of dialysis, the patient's blood is not cleaned outside the body as with hemodialysis. The blood stays in the blood vessels that line your own abdominal (peritoneal) space. The lining of this space acts like a filter.

A plastic tube called a catheter is placed into your abdomen during surgery to create an access. During the treatment your abdomen (through the catheter) is slowly filled with fluid called dialysate. Your blood is cleaned and waste materials are taken away in the dialysate. Once the process is finished, the used dialysate is drained out through the catheter and thrown away; this process is then repeated (usually three to five times a day or night). Three kinds of peritoneal dialysis can be done. (See National Kidney Foundation brochure Peritoneal Dialysis: An Alternative to Hemodialysis.)

 

What about a low-protein diet?

Research suggests that lowering the protein in your diet can slow the advance of kidney damage. You should talk to your doctor about this. If you need to go on a low-protein diet, you need to plan this with a dietician. Do not go on this type of diet without talking to a dietician as it could make you sicker. 

 

What is the outlook for patients with diabetes?

More research dollars are being used for diabetes research. Hopefully, prevention and cure of diabetes will be possible in the future. In the meantime, you can manage your diabetes better with:

  • home monitoring of you blood glucose levels
  • knowing he importance of controlling your blood pressure, and possibly monitoring your pressure at home
  • following your special diet

If you do get kidney failure, know that the success rates of diabetic patients on dialysis or with transplantation are almost equal to those of non-diabetic kidney patients. Pancreas transplants are being done more often and their success rates are increasing. Thus, the future looks bright in terms of the understanding and management of diabetes. 

 

What important points should the patient remember about diabetes and the kidneys?
  • Severe kidney failure occurs in about 30 percent of people with Type I (juvenile onset) diabetes and in 10 to 40 percent of those with Type II (adult onset) diabetes.
  • Because diabetes may injure the blood vessels in the body, it can cause permanent kidney damage and kidney failure. The earliest sign of kidney damage is the presence of increased albumin excretion in the urine.
  • Keeping the blood pressure in the normal range with the help of ACE inhibitors is the most effective way of slowing the loss of kidney function.
  • Other factors can cause kidney injury and failure. These are: blocking of urine flow, urinary tract infections and certain medicines (especially pain medicines).
  • Early kidney injury by diabetes can be found by a urine test. The best way to check the condition of the kidneys is with blood (BUN and creatinine) tests.
  • Ankle and leg swelling (edema), going to the bathroom more often at night, high blood pressure and a drop in the amount of insulin needed to control diabetes may all be signs of kidney damage.
  • End stage kidney failure can be treated by kidney transplantation, hemodialysis and/or peritoneal dialysis. The type of treatment is chosen individually for every patient depending on overall health, lifestyle and personal preference. A treatment plan may use each of these forms of therapy at one time or another.
  • The diabetic diet is a very important part of the treatment of all diabetic patients.