Everyone is aware that Diabetes Mellitus is a disease with increased blood sugar above and beyond normal levels as the defining feature. What many fail to realise is that Diabetic patients tend to develop different ailments in every part of the body from Eyes (retinopathy) to Toes (peripheral vascular disease) and everything between including but not limited to the Heart and Kidneys.
India is touted to be the Diabetic Capital of the world with estimated 80 million patients and with 40% of them being affected with Kidney issues we can expect many millions of Chronic Kidney disease (CKD) patients attributable to diabetes in our nation. While all of that may sound overwhelming, there is some good news; many of the steps you need to take to prevent one of those complications may help to prevent them all.
The kidneys play an important role in the body: they filter the blood, removing waste products and excess salt and water. If the kidneys become diseased, then these toxic wastes along with excess fluid build up in the body. CKD patients do not have any symptoms in the early stages and hence it is important to do tests to diagnose the condition early. When the kidneys are working normally, they prevent albumin from leaking into the urine, so finding albumin in the urine is a sign that the kidneys are in trouble. Urine tests are recommended once per year in people with type 1 diabetes, beginning about five years after diagnosis, and in people with type 2 diabetes, starting at the time of diagnosis and every six months thereafter.
Let us now look at some simple measures that can protect us from the scourge of Diabetes as well as CKD.
Lifestyle changes — changing your lifestyle can have a positive impact on the health of your kidneys. The changes that are strongly recommended are firstly to limit the amount of sodium (salt) you eat to less than 2 grams per day. In Goan diet context, this means reducing the salt used to cook by half and avoiding Pappad, Pickle and dried fish in diet. Smoking should also be avoided.
Blood sugar control — keeping blood sugars close to normal can help prevent the long-term complications of diabetes mellitus. The ideal target for fasting blood glucose and for blood glucose levels before each meal is 80 to 120 mg/dL; however, these targets may need to be individualised according to age and other associated conditions.
A blood test called A1C is also used to monitor blood sugar levels; the result provides an average of blood sugar levels over the last one to three months. An A1C of 7% or less is usually recommended; this corresponds to average blood glucose of 150 mg/dL. Even small decreases in the A1C lower the risk of diabetes-related complications to some degree. Self-home glucose monitoring and Continuous Glucose monitoring systems are now being employed and you should seek help from your physician to know if you can benefit from these.
Managing high blood pressure — Most people with diabetes have high blood pressure. While all people with diabetes are advised that it is important to control blood sugar; it should be noted that controlling blood pressure is at least as important. That’s because high blood sugar and high blood pressure work in tandem to damage the blood vessels and organ systems. High blood pressure causes few symptoms and often goes easily unnoticed. Persistently elevated Blood pressure stresses the cardiovascular system and speeds the development of diabetic complications of the kidney and eye. This is the basis for the practice of estimating Blood Pressure at every Clinic visit following certain prerequisites. A blood pressure reading below 130/80 is the recommended goal for most people with diabetic kidney disease, especially if you have more than 300 mg of albumin in your urine per day.
(The writer is Consultant Nephrologist, Manipal Hospitals Goa)
