Ref: CHB/News Bulletin/002/2012

DIABETES AND YOU –Diabetes can cause many complications and can lead to Kidney disease and failure, heart problems, eye sight loss and also complications in feet.

Diabetic Kidney Disease

diabetes_2_aJust like elsewhere in the body the kidneys of diabetics are in danger of being affected by the high sugars. Diabetes is the leading cause of kidney failure in the world. 40% of type 1 diabetics develop kidney failure within thirty years of the onset of their disease. 12% of Type 2 diabetics' kidneys are already slightly affected by diabetes by the time they are diagnosed. This is because Type 2 diabetes is often an initially silent disease often only found coincidentally when a doctor decides to check for it.

Kidneys are vital to our bodies serving the purpose of cleansing the blood of waste products. Kidneys also serve other functions such as controlling the acid levels in the blood, helping to regulate blood pressure and stimulating blood production in the bone marrow as well as calcium and other salt regulation.

The kidney is made up of tiny little parts called nephrons. Each nephron receives blood from the body. The blood then passes through a filter in the nephron. Certain substances pass through into the urinary tubes, while others such as proteins are held back in the blood. In the urinary tubes there are a number of special pumps that act to fine tune the level of different substances such as salts and acid in our body. This ensures that levels of all substances in our blood are tightly regulated.

diabetes_2_bWith time, in diabetics the filter of the kidney termed the "bowman's capsule" becomes leaky. This causes proteins that are normally retained in blood to escape through the filter into the urinary tubes where they are lost from the kidneys. Although at late stages the loss of protein may be so massive that it causes the body to swell up, in most patients this loss of protein may be relatively silent. In fact often the protein loss cannot be detected on ordinary urine tests and so physicians have to order a special check called Urine Microalbumin in order to pick up the protein loss.

diabetes_2_cIf picked up early good sugar and blood pressure control together with special medications called ACE inhibitors or ARBs can halt or delay progression of the kidney damage. However, if left unchecked, the damage may progress to cause kidney failure. Once the kidneys begin to fail the process cannot be reversed and the function then continues to decline over time with some patients eventually needing dialysis to purify the blood of toxins.

However even after kidney failure has set in your physician can help you by monitoring your kidney functioning and helping you to control those factors that may cause kidney function to decline faster. For instance all diabetics (even those without kidney damage) are advised to keep their B.P. below 130/80.

Your physician will also help you to control your sugar better so that further damage to the kidneys is avoided. Also your physician will adjust your medication to ensure that the medication itself does not either damage the kidney or accumulate excessively in blood.

It is important for diabetics whose kidneys are even slightly affected to avoid use of painkillers called NSAIDs. These can cause further damage to the kidneys. Examples of NSAIDs include diclofenac and brufen. If you are not sure of whether a painkiller that you use is an NSAID then ask your doctor or pharmacist.

In addition to kidney protein loss and kidney failure, diabetics having a low immunity and high sugar in their urine are especially susceptible to urinary infections. These infections can ascend up to the kidney and thus it is important that diabetics with urine infections get treatment fast and for at least ten days.

Good monitoring of diabetic patients helps kidney complications to be detected early. Of note, the yearly diabetic eye visit gives a clue as to which patient is likely to have early silent changes in the kidney. If microalbumin in urine is picked earlier with good medical care the condition can be reversed. In a study involving 386 patients with microalbumin in urine it was found that after six years 60% of patients the microalbuminuria actually disappeared. However by the time protein loss in urine becomes large enough to be detected in routine urine tests, the condition can no longer be reversed. Therefore it is important for diabetics to check the urine for microalbumin at least once in a year.

Diabetes and Cardiovascular Disease risk

Cardiovascular disease is a term that encompasses all those diseases that affect the heart and the blood vessels. This includes heart disease, stroke and peripheral arterial disease.

As mentioned earlier diabetes causes changes in the blood vessels. With time the blood vessels of all diabetics get narrowed and hard. In addition excess cholesterol, a common problem amongst diabetics, gets laid down in the inner lining of arteries. This process is referred to as atherosclerosis.

As the vessels narrow the blood supply to all organs is diminished resulting in poor functioning of those organs.

Heart muscle is itself supplied with blood through special vessels called the coronary arteries. As the blood supply to the heart is diminished the heart muscle itself suffers from lack of oxygen. This weakens the heart. In many diabetics over time, the heart fails to pump as efficiently as before.

The cholesterol that deposits in the arteries damages the vessels further and prompts the formation of clots. If these clots form in the coronary arteries the heart muscle suffers from a sudden severe shortage of oxygen resulting in either angina or a heart attack. In a heart attack the lack of oxygen results in death of a portion of the heart muscle whereas in angina the heart muscle gets severely injured but if treated on time can recover.

While most patients who suffer from angina or a heart attack suffer intense chest pain, this is often not the case for diabetics who can undergo large heart attacks and only suffer from tiredness or some breathing difficulty. This is dangerous because it can lead to delays in diagnosis and treatment of heart attacks.

The same process that affects the coronary arteries of the heart also affects the blood supply to the brain. Sudden blockages lead to stroke and paralysis. Also the weakened arteries are also more likely to burst resulting in bleeding into the brain.

Similarly there is decreased blood flow to the extremities. This can cause painful cramps on walking.The decreased blood flow also predisposes the feet to the formation of ulcers often leading to eventual rotting of the leg necessitating amputations.

Peripheral arterial disease may also present with the problem of impotence which is a type of sexual dysfunction. Diabetic men who feel they may have a problem with normal sexual function should consult their doctors. Good diabetic control, avoidance of smoking and sometimes adjustment of blood pressure medication may be all that is required to treat the problem.

Diabetics are at risk of all these complications and thus require close monitoring by their physician who will try to catch complications early and prevent worsening. The best way to prevent or arrest complications is to control the blood sugar as tightly as possible. Along with that other factors that increase the risk of cardiovascular disease also have to be minimized. This means that blood pressure should be well controlled. Cholesterol levels should be kept low and smoking should be stopped.

To be continued................................

Dr Nasreen Hirji
Extracted from

"Community's health – CHB's priority"

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