Uncontrolled diabetes leading to Renal Failure

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Source: Written for Spice your Life, by Dr. Nagarathnam Jetti, MBBS,DPH,DIH,FIAOH.
Diabetes has truly become a pandemic disease and with modern lifestyles being liberally adapted and practiced by all populations of the world, the incidence and prevalence of diabetes is sure to increase.

In this context, it is apt that one, whether he/she is a diabetic or not, has to know more about diabetes and its complications.

The Diabetes, if not controlled properly will lead to complications affecting all systems of the body progressively. Once damage occurs in a system it will be difficult to reverse the damage.

Notably kidneys, eyes, nerves, cardiovascular systems are affected. Since all the systems in the body function in a well coordinated manner, the bad effect in one system will affect other systems also.

Lets take one system at a time and understand better on how this actually affects and what can be done.

Renal system

We have two kidneys which act as controllers for the correct balancing of the water and electrolytes in the body. It is also an excreting organ for the waste products, chemicals and other unwanted materials from the body.

The waste products are removed from our body through various sources like skin, breath, urine and faeces. When there is a restricted intake of water, Kidneys manage the short supply of water and electrolytes to the body by reducing the formation of urine.

Coming to blood glucose, we can monitor by checking the threshold levels. As long as blood sugar is within 180 mg/dl the kidneys will retain the glucose but when the blood sugar crosses 180 mg/dl, the kidneys will allow the glucose to pass in the urine. Hence the threshold level of blood glucose is 180 mg.

Beyond 180 mg/dl, the glucose appears in the blood and we call the phenomenon as “Glucosurea”.
The glucose may appear in urine, even when the blood glucose is less than 180 mg/dl. The situation can be expected in ‘Renal dysfunction’.

How to know that a diabetic is developing Renal Failure / dysfunction?

Two main reasons that can attribute to a quicker damage to kidneys can be persistent hyperglycemia and high blood pressure. Renal failure is never sudden in this process, but may take long time for the kidneys to fail completely.

Two important tests are done to the Renal functions status.

1.    Micro Albuminurea – Total amount of urine excreted in the collected for the 24 hour period and then tested for Albumin levels.

2.    Creatinine level in the blood

What one has to do to stay healthy with Diabetes?

a.    Follow a healthy diet plan
b.    At least 30 minutes active, suitable exercise
c.    Proper medicines to control diabetes
d.    Check the blood glucose at frequent interval and record
e.    Control blood pressure and cholesterol
f.    Check your feet for cuts, blisters, swelling, redness, sores and sore toe nails.
g.    Brushing of teeth twice a day
h.    Avoid smoking
i.    Extreme moderation  / avoid alcohol

Specifically to prevent kidney problems

•    Good control of blood glucose
•    Good control of blood pressure
•    Use of ACE inhibitor or ARB drugs as prescribed by the doctor
•    To keep under check the Microalbuminurea  and serum creatinine levels (testing atleast once in 6 months)
•    Avoid taking pain killers like paracetamol regularly

Consult your doctor if you have these symptoms.

a.    pain or burning when you urinate
b.    frequent urge to go to bath room
c.    urine that looks cloudy or reddish
d.    fever or a shaky feeling
e.    pain in the back or on the sides below the ribs

‘X’ ray with contrast has to be avoided.

Albumin in urine

–    Less than 30 mg is normal
–    30 to 300 mg indicates early kidney disease

More than 300 mg indicates more advanced kidney disease

Serum Creatinine levels

Normal – 0.8 to 1.4 mg/dl.
Slightly low values for women

Now, we have seen that by allowing the blood sugar to be at high levels(hyper glycemea for a long period there  will be Renal damage ultimately and Renal failure.
Once the Kidney failure takes place, we have to resort to peritoneal dialysis or Haemodialysis to set right the various deranged parameters of   blood to lead a normal life.The dialysis also can  not  be prolonged for a long time and a stage will come where Renal transplantation has to be thought of.
We have to avoid this stage by strictly following the prescription of Drugs,Diet and Exercise  and regular periodic  checkup of B.P,Lipid profile,HbA1c and urine for Albumin.
Next time we will talk about the damage to the eyes, like, cataract, retinopathy etc.

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