Diabetes: Check your kidneys too

There are two main types of diabetes. These are called type 1 and type 2 diabetes.

People with type 1 diabetes are usually younger when diagnosed and must have insulin injections for life. People with type 2 diabetes are usually adults when diagnosed.

When diagnosed early people with type 2 diabetes can often manage their diabetes for a while with increased activity and a healthy diet. However over time the body will need help to keep the blood glucose levels in a safe range so tablets and possibly insulin may be needed.

People with all types of diabetes are at risk for long term health problems called complications. One of these complications is a type of kidney damage, called diabetic nephropathy.

It is known that up to 30 per cent of people with diabetes develop kidney problems. In the future as people improve their diabetes care by managing their BGLs, having regular kidney and blood pressure checks there will be fewer people with this serious problem.

Where are the Kidneys?

The kidneys are two small bean shaped organs. Each kidney weighs about 150gms. They lie above the waist toward the back on both sides of the spine. The lower ribs and muscles on both sides protect them.

What do the kidneys do?

The main functions of the kidneys are:

• To filter the blood to remove waste products.
• To regulate the body’s balance of salt, water and other chemicals.
• To produce hormones and chemicals, which help regulate blood pressure, maintain calcium balance and red blood cell production.

Who’s at risk for kidney problems?

There are some people with diabetes who may be more likely to develop kidney problems:

• People with diabetes for more than 10 years
• People with a history of high blood glucose levels for a long time
• People with a history of high blood pressure for a long time
• People with a history of high blood fats (cholesterol) for a long time
• People who smoke or have smoked for a long time
• People with a family history of high blood pressure or kidney disease
• Indigenous Australians

What is diabetic nephropathy?

In people with diabetes, damage to the filtering units, or the strainer, of the kidneys may occur. These filters are called glomeruli. Damage to them can lead to problems such as the loss of a protein called albumin in the urine and high blood pressure.

If picked up early and cared for, serious kidney problems can be prevented. But if not looked after the kidneys will begin to fail.

How to detect nephropathy early

Finding out early that the kidneys are beginning to have a problem is simple and painless. Care at this time can prevent more damage. Nephropathy is easily detected in a urine sample. The urine is checked for the presence of tiny microscopic amounts of albumin.

There are several ways to check for it:

• Untimed samples (random or morning samples) can be sent for laboratory testing.
• A micro-albumin dipstick test is sometimes used.
• Timed collections, usually of either 12 or 24 hours can sometimes be used, especially if an abnormal urine albumin result has been found previously.

How often to check

• Children are checked for the first time 5 years after diagnosis – then yearly.
• Adolescents are checked for the first time 2 years after diagnosis - then yearly
• Adults are checked every year following diagnosis.

How to prevent or reduce the risks for nephropathy

• Urine test for microalbumin yearly.
• Test your own blood glucose levels to know the pattern and what affects them.
• Make sure your doctor or clinic arranges a blood test every 3 –6months to show the average of your blood glucose levels. This test is called a glycated haemoglobin or HbA1c
• Make sure your doctor or clinic checks your blood pressure at every visit. Keep a written record. (The ideal without kidney problems is less than 130/85 but with kidney problems the ideal is 125/75 or less)
• Have your doctor check your cholesterol regularly
• Follow a healthy eating plan
• Drink plenty of water - especially when being active and in hot weather
• Be active 30 – 40mins most days
• Quit smoking (QUIT line 131848)
• Maintain a healthy weight
• Drink alcohol in moderation

Contact Australian Diabetes Council for more Information Sheets

Infections of the Bladder and Kidneys

Infections of the bladder, kidneys, ureters and urethra (urinary tract) can be a problem for people with diabetes. Infections are more likely in people:

• with high blood glucose levels.
• with poor mobility
• with an inability to completely empty their bladder.
• Older people
• Women

Suspecting kidney damage

Signs and symptoms do not appear until serious damage has occurred.

Classic Signs and Symptoms:

• Increased tiredness
• Retaining fluid – often seen in feet and ankles
• Trouble breathing at rest
• Loss of appetite
• Nausea
• Vomiting
• Protein in urine (not microalbumin)

Less medication or insulin for blood glucose control may be needed.

What happens if the kidneys fail?

Toxic waste products stay in the body, fluids build up and the chemical balance is upset. Dialysis treatments or a kidney transplant will be needed.

 

For more information phone Australian Diabetes Council on 1300 342 238.