Diabetes and Chronic Kidney Disease

Contributed by Elaine M. Koontz, RD, LD/N Review Date 8/13D-0674

Provided Courtesy of Nutrition411.com

Definitions

• Diabetes: In diabetes the body either cannot make enough insulin or the cells are unable to use the insulin that is produced. Insulin is a hormone that helps the cells to pick up glucose from the blood and use it for energy.

• Chronic kidney disease: Chronic kidney disease is diagnosed when kidney damage is present for more than 3 months or a glomerular filtration rate of <60 mL/minute exists for 3 months with or without evidence of kidney damage.

• Hypertension (high blood pressure): Hypertension occurs when the force of the blood against your artery wall increases.

2mL=milliliters

What Do the Kidneys Do for You?

• Remove waste• Remove excess fluid• Remove drugs from the body• Secrete erythropoietin to make red blood

cells• Regulate bone metabolism• Regulate blood pressure• Maintain electrolyte and acid balance

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Stages of Chronic Kidney Disease

Stage DescriptionGFR

(mL/min/1.73m2)

1 Slight kidney damage with increased or normal filtration

>90

2 Mild decrease in kidney function 60-89

3 Moderate decrease in kidney function

30-59

4 Severe decrease in kidney function 15-29

5 Kidney failure requiring dialysis or transplantation

<15

GFR=glomerular filtration rate, m2=square meters, min=minutes, mL=milliliters 4

Urine Albumin andChronic Kidney Disease

• Albumin is a protein found in the blood:– A healthy kidney does not let albumin pass into

the urine– A damaged kidney lets some albumin pass into

the urine– The less albumin in your urine, the better

• A urine albumin result below 30 is normal• A urine albumin result above 30 may mean

kidney disease

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Chronic Kidney Disease Risk

• The following increase your risk:– Older age– Diabetes– Hypertension– Smoking– High cholesterol– Exposure to certain drugs that can damage the

kidneys– A family history of chronic kidney disease– African American, Hispanic American, Asian, Pacific

Islander, or American Indian ethnic heritage

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Diabetes and the Kidneys

• Diabetes injures the small blood vessels in the body• If the blood vessels in the kidneys are

damaged, the kidneys are unable to remove wastes and excess water from the body• This can result in fluid retention, protein

spilling in the urine, and the buildup of waste products in the blood

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Statistics

• 30% of patients with type 1 diabetes and 10% to 40% of those with type 2 diabetes will develop kidney failure• Diabetes is the leading cause of chronic

kidney disease in the United States

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Signs and Symptoms of Diabetes

• Type 1:– Frequent urination– Excessive thirst– Excessive irritability– Extreme hunger accompanied by loss of weight– Nausea and vomiting– Weakness and fatigue

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Signs and Symptoms of Diabetes (cont’d)

• Type 2:– Any of the type 1 symptoms, but not necessarily

weight loss– Tingling or numbness in hands or feet– Recurring or hard-to-heal skin, gum, or bladder

infections– Fatigue– Blurred vision

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Signs and Symptoms of Kidney Disease

• Early stages:– Increased excretion of albumin in the urine– Weight gain and ankle swelling– Increased urination at night– High blood pressure

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Signs and Symptoms of Kidney Disease (cont’d)

• Late stages:– Rising blood urea nitrogen and creatinine levels– Nausea and vomiting– Loss of appetite– Itching – Weakness and fatigue– Muscle cramps– Anemia– Less need for insulin or antidiabetic medications

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End-Stage Kidney Disease

• End-stage kidney disease is diagnosed when only 10% to 15% of kidney function is present• The average person develops end-stage

kidney disease within 5 to 7 years after the occurrence of a diabetic kidney injury• End-stage kidney disease is treated with

dialysis or kidney transplant

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Delaying the Progression of Kidney Disease

• Having good blood glucose control• Controlling blood pressure—often requires

two or more medications• Promptly treating urinary tract infections• Correcting any problems in the urinary

system• Avoiding medications that can damage the

kidneys• Following your renal diet as prescribed—a

low-protein diet seems to slow progression14

Understanding A1c Level

• The A1c test determines what your average blood glucose was for the last 3 months• Each 1% reduction in A1c reduces your risk of

microvascular complications (nephropathy, neuropathy, and retinopathy) by 40%• In general, the American Diabetes Association

recommends a goal of 7% for all people with diabetes, and the American Association of Clinical Endocrinologists recommends a goal of 6.5% (however, this varies by individual)

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A1c Level and Average Blood Glucose

A1c Level

Average BG Over the Last 2-3 Months

6% 126 mg/dL

7% 154 mg/dL

8% 183 mg/dL

9% 212 mg/dL

10% 269 mg/dL

BG=blood glucose, dL=deciliters, mg=milligrams 16

Diet Tips for People With Diabetes

• Eat three meals and snacks each day as recommended by your registered dietitian • Eat recommended low-potassium fruits and

vegetables to increase fiber intake• Limit intake of concentrated sweets• Practice sensible portion control• Test and record your blood glucose often• Take all medications as prescribed• Exercise as much as physically possible

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Hypoglycemia

• Hypoglycemia can result from:– Too little food– Too much insulin or diabetes medication– An increase in physical activity

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Hypoglycemia (cont’d)

• Hypoglycemia symptoms include:– Blurry or double vision– Fast heartbeat– Anxiety or irritability– Headache– Shakiness or trembling– Insomnia– Sweating– Numbness—often around mouth– Weakness – Fainting

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Treating Hypoglycemia

• If left untreated, hypoglycemia can result in seizures, coma, and death• Treatment (consume 15 grams of carbohydrate):– Glucose tablet or glucose gel– ½ cup of apple juice or grape juice (no orange juice—

high in potassium)– ½ cup regular clear soda (no colas—high in

phosphorus)– Two to four hard candies• Wait 15 minutes; if glucose is still low, repeat• If blood glucose does not normalize after

repeating three times, call 911 • If it does normalize, test again in 1 hour

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Hyperglycemia

• Hyperglycemia can result from:– Eating too much carbohydrate– Not getting enough insulin– Not taking enough diabetes medication– Having an illness or injury– Experiencing stress– Doing too little physical activity

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Hyperglycemia (cont’d)

• Symptoms of hyperglycemia include:– Dry skin– Hunger– Drowsiness– Nausea– Thirst– Blurry vision

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Hyperglycemia (cont’d)

• If untreated, ketoacidosis can develop—this is life threatening• Ketoacidosis has the following symptoms:– Shortness of breath– Fruity-smelling breath– Nausea and vomiting– Very dry mouth

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Treating Hyperglycemia

• Exercise can bring blood glucose down, but if blood glucose is >240, you must test for ketones—do not exercise if positive• You may need to change your diet—meet

with a registered dietitian regularly to help plan an appropriate meal plan • You may need to increase your insulin or

medication or alter the timing of when you take these

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SourcesDiabetes and kidney disease. National Kidney Foundation Web site. http://www.kidney.org/atoz/content/diabetes.cfm?utm_source=nkfhome&utm_medium=static&utm_campaign=KnowAboutDiabetes. Accessed August 15, 2013.

Diabetes: definitions, signs & symptoms. WakeMed Health & Hospitals Web site. http://www.wakemed.org/body.cfm?id=604. Accessed August 15, 2013.

How your kidneys work: why are the kidneys so important? National Kidney Foundation Web site. http://www.kidney.org/kidneydisease/howkidneyswrk.cfm. Accessed August 15, 2013.

Hyperglycemia (high blood glucose). American Diabetes Association® Web site. http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hyperglycemia.html. Updated August 5, 2013. Accessed August 15, 2013.

National Kidney Disease Education Program. Explaining your kidney test results. National Institutes of Health Web site. http://nkdep.nih.gov/resources/explaining-kidney-test-results.shtml. Accessed August 15, 2013.

NFK KDOQI guidelines. National Kidney Foundation Web site. http://www.kidney.org/professionals/kdoqi/guidelines_ckd/toc.htm. Accessed August 15, 2013.

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