March is National Kidney Month (yes, they have a month for that organ! and even a World Kidney Day on March 11). I realize the month is nearly over this year, but it's never too late to show your kidneys some love — especially if you have diabetes, which possibly puts them at risk.
I must admit, one of my biggest fears with diabetes is dialysis. While I'm huffing and puffing at the gym several times a week, I often think, "some people are getting dialysis instead of gym time!" I consider myself very fortunate.
* Their primary role is to maintain the balance of bodily fluids by filtering and secreting metabolites and minerals from the blood and excreting them, along with water, as urine.
* They control blood stream levels of many minerals and molecules including sodium and potassium, and help to control blood acidity.
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* They're important regulators of blood pressure and the production of red blood cells.
* With diabetes, when blood sugar levels run too high over long periods of time, small amounts of a blood protein called albumin start to leak into your urine. The more albumin that gets in, the less the kidneys are able to do their filtering job. As the filtering function drops, your body retains various wastes, which causes all kinds of nasty health problems. Eventually, your kidneys can shut down altogether, requiring dialysis to recreate that natural "blood filtering" function.
* Note that diabetic nephropathy, as it's called, can be caused in part by high blood pressure, and/or can also cause your blood pressure to rise — a lose-lose scenario.
I learned a bit about taking care of these vital organs while researching our book, Know Your Numbers, Outlive Your Diabetes.
Here are some of the top tips for looking after your kidneys:
* Get your microalbumin test! This urine test is the most sensitive early detector of kidney damage that's ever been available. It can show changes 10 to 20 years earlier than older tests could. It's often overlooked by doctors, I hear. So be sure to insist on it at least once a year.
* If you have diabetes and are over 45, experts suggest you should see a kidney specialist, called a nephrologist, at least once a year as well — in large part because early detection is key. If increases in microalbumin are identified early, they've got lots of treatments that can successfully decrease or even eliminate your chance of suffering kidney disease. These interventions include:
- aggressive control of blood pressure,
- improvement glucose control (that A1c test),
- and taking oral blood pressure drugs such as ACE inhibitors and ARB's (details below)
* It turns out that lowering your microalbumin is almost always about lowering your blood pressure. Experts say that even if your blood pressure is on target, the ACE inhibitors and ARB pills are useful, because they have a directly protective effect on your kidneys, separate from their effect on lowering your blood pressure.
* Lower your blood pressure target to less than 130 systolic (upper number), and below 80 diastolic (lower number). If your microalbumin remains high after initial treatments, my sources say you should even push to lower your systolic blood pressure to 125 or 120.
* Bringing down your A1c if it is high will also help you achieve kidney health.
Here's what Susan Guzman, head of Adult Clinical Services at the Behavioral Diabetes Institute in San Diego, CA, told me a while back when I was researching this topic:
"Even if you've been off-track for 20 years, bringing your A1c down can put off dialysis for a whole year. That's an important improvement to quality-of-life... This is an overlooked area in diabetes care. We try to communicate this message of hope that it's never too late to start."
Great message, Susan. Besides, if it's too late for our pancreases, it's nice to know there are some organs we can proactively preserve.