Diabetes

Diabetes and kidney disease

If you have diabetes, you have a higher chance of kidney disease. The best way to prevent kidney disease caused by diabetes (diabetic kidney disease) is to work with your doctor to control your blood sugar and get tested for kidney disease. There are no symptoms of kidney disease until later stages, so getting tested is the only way to find it in the early stages, when there are ways to slow down kidney damage.

What is diabetes?

Diabetes is a disease that causes your blood sugar (glucose) to be too high because your body cannot make or use insulin the way it should. Insulin is a hormone your body makes that helps turn sugar from the food you eat into energy. When your body does not use insulin the way it should, too much sugar stays in your blood.

There are 3 different types of diabetes, each with a different cause: type 1, type 2 and gestational. 

Type 1 diabetes

Type 1 diabetes is an autoimmune disease. Autoimmune diseases happen when your immune system  mistakenly detects an infection, and then attacks your healthy cells and tissues. In type 1 diabetes, your immune system attacks the cells in your pancreas that make insulin, which means your pancreas makes little to no insulin. Your pancreas is an organ in your upper belly that makes insulin and juices to help you digest food. You cannot prevent or cure type 1 diabetes, but you can manage it with insulin shots and a healthy eating plan.

Type 2 diabetes

Type 2 diabetes is a chronic (long-lasting) disease. Type 2 diabetes happens when your body makes insulin, but does not use it the way it should. You are more likely to have type 2 diabetes if you are overweight or if someone else in your family has it. Type 2 diabetes is more common in adults, but more children have been getting it due to the rise of childhood obesity.

If your blood sugar is higher than normal, but not high enough to have type 2 diabetes, it is called prediabetes.

Gestational diabetes

Gestational diabetes is high blood sugar during pregnancy. In gestational diabetes, pregnancy hormones block your body from using insulin the way it should. For most women, blood sugar levels go back to normal after having their baby. 

If you have gestational diabetes, your doctor will do a test to check your blood sugar level six to 12 weeks after your baby is born. You may have a higher chance of getting type 2 diabetes later in life.

What are the symptoms of diabetes?

Symptoms of diabetes depend on how high your blood sugar is. In general, symptoms of type 1 and type 2 diabetes include:

• Feeling more thirsty or hungry than normal
• Urinating (peeing) more than normal
• Blurry vision
• Being easily irritated
• Feeling very tired
• Having dry skin or sores that heal slowly

If you have any of these symptoms, talk with your doctor right away.

Symptoms of type 1 diabetes:     

In type 1 diabetes, symptoms often happen suddenly and can be severe. Symptoms include the general symptoms listed above and:

• Feeling sick to your stomach or throwing up
• Weight loss that happens without a reason 
• Stomach pain

Symptoms of type 2 diabetes:

In type 2 diabetes, symptoms happen slowly. Many people don't notice any symptoms at all until their blood sugar has been too high for a long time. When they happen, symptoms include the general symptoms listed above and:

• Tingling, pain or feeling numb in your hands and feet
• Getting infections over and over

Symptoms of gestational diabetes:     

Most women don't have any symptoms. During pregnancy, a doctor tests for gestational diabetes between weeks 24 and 28 of pregnancy.

How will I know if I have diabetes?

If your doctor suspects you may have diabetes, they will do a blood test called hemoglobin A1C to check your blood sugar levels. This test tells your doctor how your blood sugar levels have been over the last two or three months. You have diabetes if you have a result of 6.5% or higher on two A1C tests.

How does diabetes cause kidney disease?

High blood sugar from diabetes damages the group of tiny blood vessels in your kidneys called glomeruli. These blood vessels clean your blood. When the glomeruli are damaged, they cannot filter out waste from your blood. Over time, this causes kidney disease. Kidney disease caused by diabetes is also called diabetic kidney disease or diabetic nephropathy.

If you have diabetes, you are more likely to get kidney disease if you: 

• Have had diabetes for a long time
• Often have high blood sugar levels
• Have high blood pressure or heart disease
• Smoke
• Have a family history of kidney disease
• Do not follow your diabetes eating plan every day, exactly as it says

Can I reverse kidney damage from diabetes?

After your kidneys have been damaged, you cannot reverse or fix the damage. However, if kidney disease is found early, there are often ways to slow down the damage and possibly avoid  kidney failure.      

Can diabetes cause kidney stones?

If you have type 2 diabetes, you have a higher chance of having kidney stones because of high levels of certain waste products in your urine, such as acid. 

Can kidney disease cause diabetes?

Recent research has found that kidney disease may cause high blood sugar and diabetes. When you have kidney disease, your kidneys cannot filter waste products from your blood as well as they should. This can cause diabetes because high blood levels of the waste product urea can prevent your pancreas from making insulin the way it should. Urea is a waste product that your body makes after it breaks down protein.

How will I know if I have diabetic kidney disease?

At first, you will not have any symptoms when diabetes has damaged your kidneys. Since kidney damage happens over time, there are no symptoms until later stages.

The only way to know if you have diabetic kidney disease is for doctors to do tests for kidney disease. Doctors use blood and urine tests to check how well your kidneys are filtering your blood. The earliest sign of diabetic kidney disease is a urine (pee) test that shows protein (albumin) in your urine. 

If you have diabetes, you should have blood and urine tests for kidney disease at least once a year.

Late symptoms of diabetic kidney disease

If your kidney damage gets worse, you may have these symptoms:

• High blood pressure
• Swelling of your legs or ankles
• Urinating (peeing) more than normal
• Less need for insulin or diabetes medicine
• Feeling sick to your stomach or throwing up
• Itchy skin

How do doctors treat diabetes?

The goal of treatment is to control your blood sugar and keep it in a healthy range. Doctors treat diabetes with medicines and a diabetes eating plan:

• For type 1 diabetes, insulin shots are the main treatment. They replace the hormone your body is not able to make.
• For type 2 diabetes, doctors use different medicines. These medicines work to lower your blood sugar. Sometimes is it possible to reverse type 2 diabetes by losing weight.     

• For both types, to control your blood sugar, doctors and dietitians help you create and follow a diabetes eating plan and be active.        

To know if your treatment is working, you will need to have tests to check your blood sugar often.

Tests to check blood sugar

There are two tests to check blood sugar:

Test of your current blood sugar level with a glucose meter (glucometer): You use a blood glucose meter at home to check your blood sugar level at certain times of the day. Ask your doctor how often to check your blood sugar and what your blood sugar level should be. 

Usually, you will aim for these blood sugar levels:

• Before eating: Between 80 mg/dL and 130 mg/dL 

• About 2 hours after eating: Less than 180 mg/dL 

Hemoglobin A1C: At your doctor visits, your doctor will do a blood test to check your hemoglobin A1C. Ask your doctor what your A1C number should be. Usually, you should have an A1C less than 7%.

How can I prevent diabetes from causing kidney disease?

Work with your doctor to create a plan to prevent or slow damage to your kidneys. Even if your kidneys are already damaged, you can slow the damage from getting worse. Your plan may include to:

• Work with your doctor to control your blood sugar. Tell your doctor if your blood sugar is often too high or too low.
• Work with your doctor to control your blood pressure. Having both diabetes and high blood pressure can make you more likely to get kidney disease.
• Work with your doctor to manage your cholesterol. Cholesterol is a waxy, fat-like substance in your blood. Having both diabetes and high cholesterol can make you more likely to get kidney disease. High cholesterol can also make your diabetic kidney disease get worse faster. Ask your doctor what your cholesterol level should be and how you can control it.
• Take all of your prescription medicines as your doctor tells you.
• Meet with a diabetes educator or dietitian to help you create and follow an eating plan. 
• Quit smoking or using tobacco.
• Be active at least 30 minutes a day on most days of the week. Being active helps your body use insulin better. 
• Stay at a healthy weight. Ask your doctor what a healthy weight is for you.