Diabetes: The Leading Cause of Chronic Kidney Disease

How diabetes damages the kidneys

Diabetes is a disease that affects the body’s ability to produce or use insulin. When the body turns the food eaten into energy (also called sugar or glucose), insulin is used to move this sugar into the cells. If someone produces little or no insulin, or if the body cannot use the insulin (insulin resistant), the sugar remains in the bloodstream instead of going into the cells. Over time, high levels of sugar in the blood damage tiny blood vessels throughout the body including the filters of the kidneys. As more damage occurs to the kidneys, more fluid and waste remain in the bloodstream instead of being removed.

What is diabetic kidney disease?

Diabetic kidney disease is a type of kidney disease caused by diabetes. Diabetes is the leading cause of kidney disease. About 1 out of 4 adults with diabetes has kidney disease. The main job of the kidneys is to filter wastes and extra water out of your blood to make urine. Your kidneys also help control blood pressure and make hormones that your body needs to stay healthy.

When your kidneys are damaged, they can’t filter blood like they should, which can cause wastes to build up in your body. Kidney damage can also cause other health problems.

Kidney damage caused by diabetes usually occurs slowly, over many years. You can take steps to protect your kidneys and to prevent or delay kidney damage.

How does diabetes cause kidney disease?

High blood glucose, also called blood sugar, can damage the blood vessels in your kidneys. When the blood vessels are damaged, they don’t work as well. Many people with diabetes also develop high blood pressure, which can also damage your kidneys.

What increases my chances of developing diabetic kidney disease?

Having diabetes for a longer time increases the chances that you will have kidney damage. If you have diabetes, you are more likely to develop kidney disease if your

  • blood glucose is too high
  • blood pressure is too high

African Americans, American Indians, and Hispanics/Latinos develop diabetes, kidney disease, and kidney failure at a higher rate than Caucasians.

You are also more likely to develop kidney disease if you have diabetes and

  • smoke
  • don’t follow your diabetes eating plan
  • eat foods high in salt
  • are not active
  • are overweight
  • have heart disease
  • have a family history of kidney failure

Symptoms of diabetes

The American Diabetes Association lists the symptoms of diabetes as:

  • Frequent urination
  • Excessive thirst
  • Extreme hunger
  • Unusual weight loss
  • Excessive fatigue
  • Irritability
  • Blurry vision

How can I tell if I have diabetic kidney disease?

Most people with diabetic kidney disease do not have symptoms. The only way to know if you have diabetic kidney disease is to get your kidneys checked.

Health care professionals use blood and urine tests to check for diabetic kidney disease. Your health care professional will check your urine for albumin and will also do a blood test to see how well your kidneys are filtering your blood.

You should get tested every year for kidney disease if you

  • have type 2 diabetes
  • have had type 1 diabetes for more than 5 years

Lack of an early diagnosis compounds the problem

Type 1 diabetes (also known as juvenile diabetes or insulin-dependent diabetes) is typically diagnosed early because its symptoms are severe and rapid. A treatment plan can then be put in place and continued. Unfortunately, Type 2 diabetes often goes undiagnosed for many years because early symptoms are not severe.

It is estimated that by the time someone is diagnosed with Type 2 diabetes, the disease has been present for four to seven years. Since diabetes may have been present for some time, the chances for kidney damage increase. Type 2 diabetes (also known as adult-onset diabetes or non-insulin dependent diabetes) accounts for approximately 90% of diabetes cases. Of new patients diagnosed with Type 2 diabetes, 8% have nephropathy, or kidney damage.

Obesity is on the rise

Obesity is linked to insulin resistance, which is a factor in developing Type 2 diabetes. If someone is insulin resistant, their body is unable to use the insulin. High glucose levels may be a sign someone is pre-diabetic. If their blood glucose level is persistently high, they may eventually develop Type 2 diabetes.

As more people become obese, cases of Type 2 diabetes rise. Since many people with Type 2 diabetes are diagnosed in a later stage of the disease, chances are higher their kidneys are already damaged.

High blood pressure can accompany Type 2 diabetes

Patients with Type 2 diabetes sometimes develop high blood pressure. High blood pressure damages tiny blood vessels in the body (called capillaries). These capillaries are responsible for transporting oxygen and energy to the body’s cells. They also transport blood to the filters of the kidneys, where waste and fluid are removed and clean blood is returned to the body.

High glucose levels coupled with high blood pressure can accelerate the damage to the blood vessels in the kidneys. This can lead to a drop in kidney function. If left untreated, the kidneys will lose function over time to the point where dialysis becomes necessary.

Chronic kidney disease is progressive

Chronic kidney disease is a progressive condition — this means damage occurs over time. It is a slow process. Someone may not even realize anything is wrong. In fact, most people do not show any symptoms or discomfort from kidney damage until the kidneys can no longer work well enough to support their vital life functions.

The good news is that with an early diagnosis of diabetes, steps can be taken to help prevent kidney damage. Even if tests indicate a person has slight kidney damage, there are still treatment options that may help prevent further damage and preserve remaining kidney function.

What are your risks for diabetes?

Becoming aware of your risk for diabetes is important. One or more of the following factors may put you at a higher than normal risk for diabetes:

  • Obesity
  • Family history of diabetes
  • Member of the following ethnic groups: Native American, African American, Hispanic, Asian American, Pacific Islander

Regular check ups give you important information about your health. If you have any of the above risk factors for diabetes, your doctor can test your blood glucose levels and make recommendations for any treatment you may need.

How can I keep my kidneys healthy if I have diabetes?

The best way to slow or prevent diabetes-related kidney disease is to try to reach your blood glucose and blood pressure goals. Healthy lifestyle habits and taking your medicines as prescribed can help you achieve these goals and improve your health overall.

Reach your blood glucose goals

Your health care professional will test your A1C. The A1C is a blood test that shows your average blood glucose level over the past 3 months. This is different from the blood glucose checks that you may do yourself. The higher your A1C number, the higher your blood glucose levels have been during the past 3 months.

The A1C goal for many people with diabetes is below 7 percent. Ask your health care team what your goal should be. Reaching your goal numbers will help you protect your kidneys.

To reach your A1C goal, your health care professional may ask you to check your blood glucose levels. Work with your health care team to use the results to guide decisions about food, physical activity, and medicines. Ask your health care team how often you should check your blood glucose level.

Control your blood pressure

Blood pressure is the force of your blood against the wall of your blood vessels. High blood pressure makes your heart work too hard. It can cause heart attack, stroke, and kidney disease.

Your health care team will also work with you to help you set and reach your blood pressure goal. The blood pressure goal for most people with diabetes is below 140/90 mm Hg. Ask your health care team what your goal should be.

Medicines that lower blood pressure can also help slow kidney damage. Two types of blood pressure medicines, ACE inhibitors and ARBs, play a special role in protecting your kidneys. Each has been found to slow kidney damage in people with diabetes who have high blood pressure and DKD. The names of these medicines end in –pril or –sartan. ACE inhibitors and ARBs are not safe for women who are pregnant.

Develop or maintain healthy lifestyle habits

Healthy lifestyle habits can help you reach your blood glucose and blood pressure goals. Following the steps below will also help you keep your kidneys healthy:

  • Stop smoking.
  • Work with a dietitian to develop a diabetes meal plan and limit salt and sodium.
  • Make physical activity part of your routine.
  • Stay at or get to a healthy weight.
  • Get enough sleep. Aim for 7 to 8 hours of sleep each night.

Take medicines as prescribed

Medicines may be an important part of your treatment plan. Your health care professional will prescribe medicine based on your specific needs. Medicine can help you meet your blood glucose and blood pressure goals. You may need to take more than one kind of medicine to control your blood pressure.

How can I cope with the stress of managing my diabetes?

Managing diabetes isn’t always easy. Feeling stressed, sad, or angry is common when you are living with diabetes. You may know what to do to stay healthy but may have trouble sticking with your plan over time. Long-term stress can raise your blood glucose and blood pressure, but you can learn ways to lower your stress. Try deep breathing, gardening, taking a walk, doing yoga, meditating, doing a hobby, or listening to your favorite music. Learn more about healthy ways to cope with stress.

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