Diabetes & Chronic Kidney Disease
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Diabetes is a serious disease that with poor control can lead to many complications. It’s also the leading cause of chronic kidney disease. That’s why it’s important to:
- Understand the connection between diabetes and chronic kidney disease
- Keep diabetes well controlled. This means keeping your blood sugar under control.
- Get tests that check kidney function.
- Follow the prescribed treatment plan from your doctor, which may help preserve kidney function for as long as possible
Glomerular filtration rate (GFR) is a measure of how well your kidneys are working. It helps your doctor diagnose kidney disease by determining how well your kidneys are cleaning your blood.
Types of diabetes
If you have diabetes, it means your blood sugar (or glucose) is too high. If your diabetes is not kept under control, it can lead to kidney failure. It can also cause problems in many other parts of your body, including your eyes, nerves, blood vessels, and heart.
Type 1 diabetes
- In type 1 diabetes, the pancreas stops producing insulin. Insulin is a hormone that helps the body convert blood sugar into energy.
- Type 1 diabetes is usually diagnosed in children and young people, but it can appear at any age.
- Type 1 diabetes accounts for about 5 to 10 percent of diagnosed diabetes in the US.
- People with type 1 diabetes must take insulin to live
Type 2 diabetes
- In type 2 diabetes, the body may still make some insulin, but not enough. Also, the body may not use insulin in the normal way.
- Type 2 diabetes is ten times more common than type 1, and many people who have it do not know it.
- It’s the most common cause of kidney disease.
- Type 2 diabetes has all the same long-term problems as type 1 diabetes if blood sugar levels are not controlled.
- Diet, exercise, pills and sometimes insulin are used to treat type 2 diabetes.
- This type of diabetes occurs only during pregnancy and usually goes away after pregnancy. Women who have had gestational diabetes are at higher risk for type 2 diabetes later in life.
No matter what type of diabetes you have, it is important to follow your doctor’s treatment recommendations to keep your diabetes under control. What does that mean?
Your doctor will test your blood during office visits. But it is still important for you to test your blood sugar levels at home.
Test yourself often. You will need a glucose meter, test strips and a special needle, called a lancet. Ask your doctor for a blood sugar test demonstration. He or she should also walk through your meter instructions with you.
When and how often to test is different for every person
- You may need to test several times a day or several times a week. This depends on your diabetes control and treatment plan.
- Blood sugar levels are usually tested before breakfast, lunch, supper and at bedtime.
- For patients who take insulin, it is important to test before taking your medication.
- Testing two hours after a meal is recommended. It will let you see if blood sugar levels are under control after you eat.
- Your diabetes may be well controlled without diabetes medicines. If this is the case, you will not need to test as often as people who take insulin.
Remember: testing should be done more often when:
- Your blood sugar is high, or low.
- You are sick.
- Your diabetes medicine has changed.
Your A1C test
This blood test (called a hemoglobin A1C) is performed at your doctor’s office. It shows how well you have controlled your blood sugar over the past two to three months. The A1C test does not take the place of doing your own regular blood sugar checks. It is a helpful tool to use with the daily blood sugar results you get.
Goals for your A1C
You should try for a result of 7 percent or less. This means that on average, your blood sugar test is within the normal range. If your results are more than 7 percent, then it’s time to make some changes in your diabetes plan.
Remember the American Diabetes Association goals for blood sugar:
- Before a meal: 90-130mg/dL
- 1-2 hours after the start of a meal: less than 180 mg/dL
- Hemoglobin AIC (3 month average blood sugar): less than 7%
- Get your A1C checked three to four times a year
Goals can sometimes change. Ask your doctor for the current goal.
Maintain a daily health routine
Testing regularly and reviewing blood sugar results over time can help you and your doctor monitor and track how you are managing your diabetes. For instance, you may notice that you have high blood sugar each day before lunch. This information can help you and your doctor better manage your diabetes.
As part of your daily health routine, be sure to:
- Test your blood sugar
- Take your medicines for diabetes
- Eat according to a healthy nutrition plan
- Check your feet daily
- Take good care of your eyes and mouth
- Stay active
If you follow these tips, you will be on your way to meeting your target blood sugar level.
Keep your feet healthy
When you have diabetes, good foot care is important.
Follow these helpful tips to keep your feet healthy.
Take your diabetes medicines
Some people with diabetes take shots or diabetes pills, or have both to help control their blood sugar levels. If you have diabetes, it is good to know how your diabetes medicines work.
Understanding hypoglycemia and hyperglycemia
Hypoglycemia = low blood sugar1
Low blood sugar happens when there is not enough sugar in your blood (below 70mg/dL). It can happen quickly to people who take insulin or diabetes pills. Severe low blood sugar can potentially lead to accidents, injuries, coma and even death.
If you have low blood sugar, eat or drink something with sugar in it right away, such as fruit juice or hard candies.
Hyperglycemia = high blood sugar2
High blood sugar happens when the body has too little insulin or when the body cannot use insulin properly. It is a reading of more than 130mg/dL before meals, more than 180mg/dL after meals, or more than 140 mg/dL at bedtime. Not keeping blood sugar in control will lead to complications over time, such as chronic kidney disease.
In some cases, if you don’t treat high blood sugar, it can lead to a very serious condition called ketoacidosis where ketones are present in the blood. Ketone is produced when there is a shortage of insulin in the blood and the body breaks down body fat for energy.
High blood sugar is usually treated with insulin and exercise (as long as ketones are not detected).
Remember to follow your meal plan, paying attention to the kinds of food you eat, and the serving sizes. Take diabetes medicine as ordered and check your blood sugar more often. Your best bet is to practice good diabetes management and learn to detect hyperglycemia so you can treat it early— before it gets worse.
Talk to your doctor about the signs and symptoms for low and high blood sugar, and talk about the right treatment plan for you. Share this information with family and friends so that they can help you recognize and treat these conditions.
Ask your doctor for the following tests to monitor possible chronic kidney disease:
- A blood test to measure GFR (glomerular filtration rate) to determine how well your kidneys are working.
- A urine test to measure protein levels, and to check red and white blood cell levels.
- 1.American Diabetes Association. Hypoglycemia (Low blood glucose) webpage. http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hypoglycemia-low-blood.html accessed on February 1, 2014.
- 2. American Diabetes Association. Hyperglycemia (High blood glucose) webpage. http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hyperglycemia.html accessed on February 1, 2014.