Tuesday, 27 September 2011

Preventing Diabetic Kidney Disease

Disclaimer: This following information is not provided to you by a medical profession but by a non-medical third party and does not in any well replace any advice given to you by such professionals.

In October 2010, I attended a presentation given by Dr. Ray O’Connor on Diabetic Kidney Disease. I’m getting to the stage in my life where I don’t want to rely on luck alone to stave off the complications of diabetes and even though I trust my endo; I want to know more about the medical side of things myself. I am passing along the information that he provided.

Dr. O’Connor is a full time general practitioner (GP) who has a special interest in diabetes and he is also, among other things, the chairperson of a task force in the mid-west of Ireland to co-ordinate diabetes care in the region.

He introduced his topic by stating that most people who have kidney disease do not have any symptoms and feel well. In the image to the right, the part of the iceberg we see above water represents the number of people who know they have kidney disease and the part of the iceberg represents the people who do not know they have kidney disease.

What is Diabetic Kidney Disease?

Diabetic kidney disease affects 20-30% of people with diabetes (Type 1 & Type 2).
When the kidneys are working well, tiny filters in your kidneys, the glomeruli, keep blood proteins inside your body. You need these proteins to stay healthy. High blood glucose and high blood pressure damage the kidneys' filters. When the kidneys are damaged, proteins leak out of the kidneys into the urine. Damaged kidneys do not do a good job of filtering out wastes and extra fluid. Waste and fluid build-up in your blood instead of leaving the body in urine. With more damage, the kidneys leak more and more protein. More and more wastes build up in the blood. This damage gets worse until the kidneys fail.

What’s that Microalbuminuria all about?

The first sign of Kidney disease will appear when the blood vessels start to leak Microalbuminuria (little bits of protein) in the urine. A normal level of Microalbuminuria is less than 2.5. The test to detect if any microalbuminuria is present is called a Albumin:Creatinine Ratio (ACR) and is done through a urine sample and should be done once a year in all people who have diabetes.

How does your doctor screen for Diabetic Kidney Disease?

Your doctor should take a urine sample once a year to have it tested for the Albumin:Creatinine Ratio. A result of less than 2.5 is normal. A result of between 2.5 and 25 is stage 1 kidney disease and a result greater than 25 is stage 2.

How should we prevention Kidney Disease?

Keeping our blood vessels healthy will help keep your kidneys healthy. We do this by;
  • Keeping our Blood Pressure under control, using ACE (angiotensin converting enzyme) inhibitors or ARBs (angiotensin receptor blocker), if necessary. Simply reducing our Blood Pressure with other medicines is effective also,
·         Good glucose control,

·         Restriction of dietary protein may be helpful,

·         Stop smoking will relieve the pressure on our blood vessels,

·         Cholesterol control,

·         Lifestyle modifications are helpful too. 

¾     Weight loss

¾     Exercise

¾     Reduction of protein

¾     Reduction of salt

¾     Reduction of alcohol


Dr. O’Connor summed up his presentation with these few points below that were easy to remember.

·         Get your urine tested for the Albumin : Creatinine Ratio (A:C Ration) at least once a year and Blood Pressure checked regularly

·         Keep your sugars controlled

·         Take your medication

·         Don’t smoke

·         Work on your lifestyle

I think it's safe to say that I have not done his presentation justice; you kinda had to be there to absorb the full impact and everyone who did attend walked out with more knowledge and more motivation to take control of their diabetes.

Monday, 19 September 2011

What should I eat now I have diabetes?

I was at a diabetes information evening last week and we listened to an extremely eloquent and knowledgeable dietitian give a presentation on the most commonly asked questions from people with diabetes.

I started to think about how much focus there is on food when you have diabetes and why this question is always asked, in multiple forms, so many times.

It’s one of the first questions a person asks themselves, irrelevant to what type of diabetes they have, when they get home from the hospital or doctor’s office after being told they have diabetes is “What should I be eating now?”

The answer to this question is different for everyone because each one of us lives very different lives. Some of us work outside the home, some of us don’t, some of us have children and some of us don’t.

So when you ask a dietitian “what should I eat?” The answer will be very general, long and contain a huge amount of information. (S)he loses our attention on sentence three because  it’s not the quick fix/easy answer we were hoping for.

My point is that I don’t think asking this question benefits anyone with diabetes. I think we should be asking “what am I eating every day and how do I modify it?’ Thus, taking control of the situation ourselves and not looking to others for answers. AND not believing that we are going to lose all of our treats.

To find out what we eat every day, we need to keep a food and blood sugar diary for, at least, two weeks. We should do this because when you sit down at the end of the day and list try to remember what we ate we inevitably forget a number of things.

And we shouldn’t just record what we eat but how much of it! This is hugely important because we could be eating all the right things but if you eat more food (healthy or unhealthy) than your body uses up in the form of energy, you will gain weight or be overweight.

Once we have our two week diary, then we can take it to a dietitian and go through it together. (S)he will help us figure out where we fall down on our healthy eating plan and decide what small changes we can make that will benefit us most and smooth out the troughs and peeks in our blood sugars.