Download Vol 5, Issue 2, Sept 2010 - The Kidney Foundation of Canada

living well
for kidney health
VOLUME 5
ISSUE 2
SEPTEMBER 2010
Diabetes Management =
Healthier Kidneys
Diabetes is the leading cause of kidney failure. The number
of at-risk Canadians predicted to increase by two million.
KIDNEY DISEASE DUE TO DIABETES is the number one cause of kidney failure in Canada. Two
million more Canadians are expected to develop diabetes in the next few years according to the Institute
for Clinical Evaluative Sciences. Nine percent of Canadians will have diabetes by 2017. Which puts
2,000,000 more Canadians at risk of developing kidney disease. But this does not mean that people
with diabetes have to develop kidney disease. Kidney disease from diabetes usually progresses slowly,
over a period of 10-20 years. If you have been diagnosed with diabetes, you can reduce the odds of
developing chronic kidney disease by eating a well balanced diet, exercising regularly, controlling your
blood pressure, quitting smoking and maintaining good blood glucose control. If you have diabetes, ask
your doctor immediately for the simple eGFR test to determine the health of your kidneys.
What is diabetes?
What do kidneys do?
Diabetes mellitus (DM), usually just called
diabetes, is a disease that occurs when the
body does not make enough insulin or
when the body cannot use normal amounts
of insulin properly. Insulin, a hormone
released by the pancreas (an organ in
the abdomen), regulates the amount of
sugar (glucose) in the blood. Glucose is a
primary energy source for the body, but a
blood sugar level that is too high can cause
serious life-threatening problems.
Kidneys do many things in the body. One of their most
important roles is to clear the blood of toxic waste
products. They also:
There are two types of diabetes: Type 1
and Type 2. Type 1 DM usually occurs in
childhood or young adulthood and is due
to a lack of insulin. Type 2 DM or “adult
onset” is much more common and usually
occurs in people over 40. Type 2 DM is
caused because the body does not properly
use the insulin that the pancreas creates.
Usually the high blood sugar level that
results can be controlled by following a
diet and/or taking medication.
• regulate the level of water needed for
normal body function
• produce hormones that control other
important body functions
• regulate blood pressure
• maintain bones by assisting with the
absorption of calcium
• produce red blood cells
• regulate the body’s levels of magnesium potassium, phosphorus, salt and other minerals
• control the chemical composition
(or electrolyte balance) of the blood
• help to maintain hemoglobin at normal levels
continued on page 2
Keep Your
Kidneys
Healthy!
Your kidneys are important to you.
They remove wastes from your
blood, regulate the levels of water
and minerals in your body and
produce hormones that control
important body functions.
Keep them healthy by
following these simple
guidelines:
• maintain a healthy body weight
• eat a well-balanced diet
• control your blood pressure
• maintain good blood glucose
control if you have diabetes
• be physically active
• quit smoking
www.kidney.bc.ca
Diabetes Management = Healthier Kidneys
continued from page 1
What are the complications
of diabetes?
Early signs of kidney disease
related to diabetes:
How diabetes damages the kidneys,
causing kidney failure
People with diabetes should have their blood, urine and
blood pressure checked at least once a year by their doctor
to ensure early detection and treatment of high blood
pressure and kidney disease. Because the kidneys have a
central role in controlling blood pressure, it is common for
people with kidney disease related to diabetes to have high
blood pressure. By lowering blood pressure, the progression
of kidney disease may be slowed down.
In addition, when the glomeruli are damaged, protein begins to leak
into the urine. At this time, the majority of patients develop high blood
pressure, which requires medical treatment.
Late signs of kidney disease
related to diabetes:
Diabetes may also cause damage to the nerves in the body. This can cause
difficulty in emptying the bladder. The pressure that results from a full
bladder can back up and injure the kidneys. Also, if urine stays in the
bladder for a long time, an infection can occur. This is because bacteria
grow rapidly in urine with a high sugar level.
•
•
•
•
•
Diabetes affects the whole body. It injures the small blood vessels, which
can have a negative effect on the kidneys, eyes, skin, nerves, muscles,
intestines and heart. High blood pressure and hardening of the arteries
(arteriosclerosis) can develop, possibly leading to heart disease, a
condition that also can lead to kidney disease.
Small blood vessels (glomeruli) in the kidneys clean the blood and remove
waste products. If these blood vessels have been damaged by diabetes,
they cannot function properly. The body then retains more water and salt
than it should, which can result in weight gain and ankle swelling. At the
same time waste materials start building up in the blood.
Over time, kidney function gradually worsens. Complete kidney
failure may occur and if this happens, the patient will need dialysis or
transplantation.
Many people with diabetes do not get kidney disease. Having
diabetes does not always mean kidneys will fail. Patients with
diabetes are encouraged to talk to their doctor about how to
prevent or minimize kidney damage.
For people with type 1 DM, it usually takes from 10 to 20 years for kidney
disease to progress to the point where they need renal replacement
therapy (dialysis or a transplant) but that timeline varies by person and
with the presence of other illnesses and complications. Kidney disease
in type 2 DM usually progresses more quickly. Often by the time type 2
DM has been diagnosed, the patient’s kidneys have already lost much of
their function.
• Increased level of protein in the urine
(only detected by medical tests.)
• Weight gain and swelling in ankles, limbs and/or
eyelids due to a buildup of fluid in the tissues
• Increased urination at night
• High blood pressure
All of the above, plus:
Less need for insulin or anti-diabetes pills
Morning sickness, nausea and vomiting
Weakness, paleness and anemia
Itchy skin
If any of the signs of kidney disease listed here are present,
see the doctor immediately. Blood and urine test results will
tell the doctor how the kidneys are working.
How to prevent or reduce kidney
damage related to diabetes
Unfortunately, researchers have not yet discovered
how to prevent this type of kidney disease. But
they do know that patients who follow the nine
steps below can delay or prevent the disease from
progressing:
•
•
•
•
•
•
•
•
•
Control blood glucose
Monitor protein levels in urine yearly
Take specific medications to decrease protein loss in urine
Control high blood pressure
Treat other cardiovascular risk factors
such as high cholesterol
Stop smoking
Exercise
Follow a diet appropriate to diabetes and kidney health
Avoid medicines that may damage the kidneys
(especially certain pain medicines)
“If only we had known.”
Eating guidelines for diabetes
and chronic kidney disease
If you have both diabetes and chronic kidney disease (CKD),
it may often seem that the diabetes and kidney diets don’t
fit well together. However, with careful planning, you can
follow your kidney diet and still control your blood sugar.
Controlling your blood sugar is an important first step to
slowing down the progression of kidney disease. It will also
help prevent or minimize other complications of diabetes
such as eye or nerve problems.
Controlling or preventing high blood pressure is another
critical part of your care. Avoid salt and high salt foods, and
take your blood pressure medication as prescribed.
Finally, eating a moderate amount of protein is another
change you can make to reduce the workload of your kidneys.
If you are on dialysis, you may need to eat extra protein.
Keys to success for controlling
your blood sugar
1
2
Eat three meals a day, no more than six hours apart.
3
Avoid simple sugars and sweets such as sugar,
regular pop (soda, soft drinks), sweet desserts,
candies, jam, and honey. Try using sugar substitutes
in your recipes.
4
5
Do some physical activity each day.
6
Maintain your blood sugar in the range
recommended by your doctor and/or diabetes team.
Try to eat at regular times (even on days when you
have dialysis). If you can’t eat a meal, make sure you
have suitable snacks available.
Use your glucose meter as directed by your
doctor or diabetes team to monitor how your diet
and medications affect your blood glucose level
throughout the day.
• With CKD, you are at increased risk of low blood sugar.
The doctor who takes care of your diabetes may need to
decrease your insulin (or other hypoglycemic agent) on a
regular basis. You should report repeated low blood sugar
reactions to your doctor.
• If you are on dialysis, controlling your blood sugar can
help to decrease thirst and control fluid intake.
• With a kidney transplant and anti-rejection medications, you may need higher doses of insulin (or other
hypoglycemic agent). Your doctor will help you adjust
these medications.
continued on page 4
Nanaimo couple deals with the life-changing complications
of diabetes and kidney disease.
For John and Sylvia Doctor, a little more knowledge
about how diabetes affects kidneys would have been really helpful. John was
diagnosed with diabetes in 1980. For years he and Sylvia did their best to
manage John’s condition. John quit smoking. They carefully watched his
diet and he took pills for his diabetes. But there was never any discussion
about the serious side effects that diabetes could lead to, such as kidney
failure, blindness etc.
Sylvia explains that their GP regularly tested John’s urine for protein, but
never told them why—what he was looking for. “It wasn’t until John’s lab
test came back with a high protein reading that the doctor said he had been
watching for kidney disease, and now had found it!”
At that time, John and Sylvia lived in a small community in Alberta. John
was sent to Edmonton, a 70 mile drive from their home, to see a kidney
specialist. The diagnosis was devastating. John had lost 85% of his kidney
function and would soon need to start dialysis. The various types of dialysis
were explained to him and he
decided to have a fistula made in
his arm at once for hemodialysis.
In addition to the emotional
stress this news brought, John
and Sylvia also realized they
could no longer stay on their
beloved acreage which was miles
from anywhere and was regularly
snowed in during Alberta’s long
winters. They had always liked
Vancouver Island, so that was
the natural choice for the move.
The next year proved to be quite
a time for John and Silvia. “There we were in the fall of 2003 house hunting
for a place that was close to a dialysis unit,” Sylvia says. After exploring a
few communities and seeing a number of houses, they flew back home with
nothing resolved. The following February Sylvia flew back to BC, looked at
16 houses in one day, put an offer on one and flew back home. The house
she found was in Nanaimo and close to the dialysis unit. They moved to BC
in July and by then John was so sick he could hardly stand up. “John had
not started dialysis because the fistula in his arm had not developed enough
yet,” Sylvia explains. Being newcomers to BC, they first had to register for
Medical Services, and then find a doctor whose first step was to refer them
to a kidney specialist in Victoria. It was October before all this was done and
the fistula was ready to use. By the winter of 2004, John was ready to start
dialysis. Unfortunately the nearby dialysis unit did not have a spot for him;
so began six weeks of driving to Victoria and back three days a week. Next
John was moved to Cumberland for dialysis and for another four weeks the
drive was up Island rather than down. “Thankfully,” says Sylvia, the family’s
chief driver, “by the New Year, 2005 a place became available in Nanaimo.”
With all that behind them, John is doing very well now. He’s even dieting
and losing some weight, and dialysis appointments are much more
convenient. But John and Sylvia still wonder what life would have been
like if they had known how to care for John’s diabetes. Maybe he wouldn’t
have had to dialyze. Or at least, they might have delayed it longer. They say
if they were better informed about the threat of kidney disease, they could
have done more. And their lives would not have been turned upside down
so much. “It would have made a big difference to us.” w
Eating guidelines for diabetes and chronic kidney disease
If you have both diabetes and kidney
disease, you can still eat well if you
remember to:
1 Choose low phosphorus and low
potassium foods if directed by your
doctor or dietitian.
2 Limit your milk and dairy intake.
3 Control blood sugar to help control
thirst and fluid gains (if you are on
hemodialysis).
4 Don’t cook with salt or salt substitutes, and don’t add salt at the table.
5 If in doubt about what to eat or
drink, it may be better to follow your
kidney diet until you can see a dietitian
who will make one complete diet just
for you.
continued from page 3
Frequently Asked Questions
Q My diabetes diet says to choose whole grains
more often, but my kidney diet tells me to eat
white bread–which one should I follow?
A Choose white bread in the amounts recommended in your diabetes diet. Whole grains are
higher in potassium and phosphorus. Research
shows that it is the total amount of carbohydrates
that matters most in controlling blood glucose.
Q I was taught to treat low blood sugar with
orange juice, but now I’m not allowed to drink
that anymore. What should I do if my sugar gets
too low?
A Any type of juice is effective in treating a low
blood sugar. Cranberry or apple juice will work
exactly the same way orange juice does. If you are
on a fluid restriction, the best way to treat a low is
with candies or glucose tablets so you don’t add
any extra fluids.
Q Should I continue to choose more
legumes as directed by my diabetes diet?
A Legumes are high in phosphorus and
potassium and should be avoided unless your
dietitian tells you how to safely include them
in your diet. If you are vegetarian, you should
see a registered dietitian as soon as possible
to make sure you are meeting all of your
nutritional needs.
Q I have several other medical conditions
and I don’t know how to make everything fit
together—what can I do?
A Ask your doctor for a referral to a
registered dietitian. The registered dietitian
will work with you to create an individualized
eating plan that takes all your medical
conditions into account. w
For further information, please contact The Kidney Foundation of Canada, BC Branch 1-800-567-8112
and ask for the Director of Programs. You can also visit our Web site at www.kidney.bc.ca.
living well
for kidney health
This is the tenth in a series of newsletters published by The Kidney Foundation of Canada, BC Branch. Its aim is
to provide health promotion information to people at risk of developing chronic kidney disease. Future issues will
address a variety of topics related to maintaining kidney health. For more information on kidney health, or to
view past issues of Living Well for Kidney Health visit www.kidney.bc.ca and click on Programs and Services.
You may also phone The Kidney Foundation of Canada, BC Branch, Toll Free at 1-800-567-8112. The
information contained in this publication is not intended to be a treatment guide. For specific information, please
consult your physician.
The Kidney Foundation of Canada is the national volunteer organization that is committed to reducing the burden of kidney disease through funding and
stimulating innovative research, providing education and support, promoting access to high quality healthcare, and increasing public awareness and commitment to advancing kidney health and organ donation.
We gratefully acknowledge the support of Amgen Canada Inc. and the Province of British Columbia. The
content is the sole responsibility of The Kidney Foundation of Canada, BC Branch.
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The Kidney Foundation of Canada, BC Branch
200 – 4940 Canada Way
Burnaby, BC V5G 4K6
Phone Toll Free: 1-800-567-8112
Fax Toll Free: 1-800-667-8871
www.kidney.bc.ca