Kidney disease a complication of Diabetes-by Harold Gunatillake
Let us discuss today why kidneys get damaged in people having uncontrolled diabetes.
Diabetes is a leading cause of kidney disease, and sometimes referred to such kidneys as ‘Diabetic
kidneys or diabetic nephropathy
It is estimated that 40% of people living with type 2 diabetes may develop kidney disease.
Sri Lanka too is seeing an increase in the cases of diabetes and the risk of getting kidney disease is extremely high, in addition to the risk through pollutants and germicides used in rice cultivations.
How does uncontrolled diabetes affect your kidneys?
High blood sugar damages blood vessels in the body, that includes blood vessels in your kidneys The sugar that is present in the blood vessels being glucose derived from the dietary carbs is the culprit that cause the damage to the inner lining of the blood vessels.
Normal fasting range of blood sugar varies from about 85mg/dl (5.6 mmol/L) to 100 mg /dl.
A level from 100 mg/dl to 125mg/dl (5.6 to 6.9 mmol/L) is considered prediabetic.
In uncontrolled diabetes the sugar level can rise even more than 200mg/dl. The blood vessels tend to thicken, and plaques are formed causing blockage to the blood flow to the organs, including kidneys, extremities, and your brain.
When the blood supply to the kidneys get diminished due to arterial blockage, they cannot filter blood like they should, which results in waste products build up in your body. The kidneys make hormones and controls your blood pressure.
The damage to the kidneys is a slow process, and unless your doctor does some blood tests and urine analysis during the early stages it will not be detected for a long time.
Invariably, if you suffer from diabetes, you may be having high blood pressure and that too will cause kidney damage.
The earliest test that detects kidney failure is an increase of creatinine in your blood. It is a waste product of creatine, which is a chemical that the body uses to supply the muscles with energy.
Body builders seem to take creatine powder as a supplement for the same purpose of building
Breakdown of creatine in your muscles produce the waste product creatinine which is filtered
through your kidneys into the urine.
Elevated levels of creatinine level signify impaired kidney function or kidney disease.
Normal creatinine levels in your blood can vary depending on age, race, and body size. Normal range is for women 1.2and 1.4 mg per deciliter for men. The greater figures may be an early sign that the kidneys are not working properly.
If your blood creatinine is getting high cut down on your protein intake in such as red meat,
including dairy products. It is better to switch onto a more vegetable-based dishes.
Another essential test done to find out kidney damage is eGFR -Estimated Glomerular Filtration Rate Test. This test is based on the amount of creatinine in your blood.
A normal eGFR for adults is greater than 90 mL, according to the National Kidney
This is the best test to measure your level of kidney function and determine your stage of
eGFR seem to decrease progressively after the age of 40 years.
For older people it should read over 60 or higher. Below 60 may mean kidney disease.
An eGFR of 15 or lower may mean kidney failure and needs dialysis.
It is also observed that increased water intake can decrease eGFR.
Among Sri Lankans having diabetes in most cases the eGFR starts decreasing and quick
action needs to be taken to arrest the drop and improve kidney function.
This is something that most Sri Lankans are not aware of, and the doctors too do not stress
the importance of improving your eGFR.
Your diabetes needs to be tightly controlled by going on a low GI diet, controlling your weight, treating high blood pressure with medication, and walking over 10,000 steps daily.
When your diabetes is under control dropping of your eGFR seems to get arrested or
Most patients are ignorant of how to manage their diabetes control. Seeing your family
doctor, and adjusting your anti-diabetic management alone is insufficient. There are certain
lifestyle changes that are required too. Most doctors in Sri Lanka do not have the time to
explain proper overall management of diabetes.
I have observed in Sri Lanka my friends taking their metformin with a drink of alcohol. If you
tell them that alcohol and metformin do not seem to agree, they will say, “We have been
doing it for 10 years, we are okay”
Metformin does not cause kidney damage. If your kidneys do not function well, metformin
can build up in your system and cause a condition called lactic acidosis- a serious state you
need to get admitted to the hospital.
Metformin is a common first-line treatment for type 2 diabetes, can lower your risk of
cardiovascular events like heart attacks.
If your eGFR drops to 60, you should stop taking metformin.
People with diabetes should get regular screenings for kidney diseases. Tests include a
urine test to detect protein in your urine.
Filters in your kidney are called glomeruli. Due to the damage to the blood capillaries, and
narrowing and clogging, there is leakage of protein from the blood into the urine.
This is referred to as proteinuria. Under normal situation kidneys do not excrete the precious
proteins that are required to build the body.
The protein that leaks in albumin.
You can stop your protein leakage by increasing fresh vegetable and fibre intake. You
should avoid foods that are high in potassium and magnesium if you have proteinuria.
A diet rich in red bell peppers, cabbage, cauliflower, garlic, onions, apples, blueberries,
raspberries, egg white are recommended.
You could always detect protein loss in your urine- if you see foamy, frothy or bubbly-looking
urine when you use the toilet, that would be a sign you are losing albumen in your urine.
Temporary rise in the levels of protein in urine could be due to dehydration and emotional
The early stage of protein leakage from your kidneys is referred to as Microalbuminuria.
Persistent microalbuminuria indicates a high probability of damage to the glomerular filtration
capacity of the kidneys
Your doctor will start you on ACE inhibitor or ARB therapy if you have microalbuminuria.
During this early stage small amounts of albumin leaks into the urine.
Early symptoms of diabetic kidneys appearing quite late with severe damage are:
Swelling of the hands, feet, and face.
Trouble sleeping or concentrating.
Towards the end-stage kidney disease your skin becomes itchy and dry, and you become
If you have diabetes, it is important to take steps to control with strict dietary and lifestyle
changes described. If neglected, you are bound to get complications, and kidney damage is
quite common. Take all steps to tightly control your diabetes to avoid kidney disease.
Hope this video talk was useful.
Stay safe and Goodbye for now
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