Kidneys. They're sort of an "out of sight, out of mind" organ, much like the spleen (and plenty of other gooey things inside us that we'd rather not know about). But March is National Kidney Month, so it's a good time to learn more about these organs and how to protect them from diabetic damage. Thus, we're focusing this edition in our new monthly series on complications on these two friends who've got our back — literally.
Your kidneys, for those who were gone that day in biology class, are powerful little guys that are about the size of your fist, and are located on either side of your spine, just below your ribcage. Although kidneys don't do much to cause notice, they are in charge of some very important procedures, including removing waste from the body, balancing the body's fluids, releasing hormones that regulate blood pressure, producing a form of vitamin D that strengthens bones, and controlling production of red blood cells. Busy guys — probably why we have two of them.
Approximately 30% of type 1 diabetics and up to 40% of type 2 diabetics will get some form of kidney disease in their lifetime, normally after 15 to 20 years of having diabetes. Here's what you need to know: Albumin is a protein that is found in the blood, but if the kidneys are working properly, there won't be any albumin in your urine.
It happens to be an itty-bitty protein, so if there is a problem with your kidneys, it's the first protein that "leaks" into your urine. When you have a small amount of protein in your urine, it's called microalbuminuria, and as it progresses, it becomes something called albuminuria or proteinuria — fancy names for the presence of albumin or protein in the urine. Hint: these substances don't belong there, and are clues that something is wrong.
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This is why getting your annual microalbumin test is essential. The test isn't hard to do, though it can be mega awkward. Nowadays, you can check microalbumin with a spot check (preferably in the morning since it's "fresh" - yuck!). Sometimes you may still be asked to provide an overnight or 24-hour collection, which is a pain but better to suffer now than later. When do you need to do the test? If you have type 1 diabetes, every year after you hit the 5-year mark of diabetes. If you have type 2 diabetes, you should do the test at diagnosis and then every year after that.
Elevated levels of microalbumin in one exam are not necessarily cause for a freak-out; albumin can sometimes "flush itself"and sometimes you can have protein in your urine from other causes. Your doctor will issue follow-up tests, which will determine whether kidney damage is detected. Once there is concern, you'll be referred to a nephrologist (kidney specialist).
Life with Chronic Kidney Disease
First, the bad news: Like heart disease and retinopathy, there really is no way to reverse diabetic kidney disease. Bummer. So what's the good news? With early detection, medication and a proper diet, you can slow down and even stop the progression of kidney disease. There are 5 stages of kidney disease, with Stage 5 being the worst (kidney failure). But once you have any kidney damage, you officially have Chronic Kidney Disease and you need to get on top of things right away.
Elizabeth, a type 1 for the past 21 years, was recently diagnosed with stage 1 kidney disease. She says, "I would have not known this was happening if it weren't for the fact that I recently switched endocrinologists and had my yearly labs done. I've not had any symptoms of anything other than hypertension, which was being treated via ACE inhibitors and diuretics."
Elizabeth caught her kidney disease early, so she's working with her doctor to slow down and hopefully stop it from progressing. How do you do that? Top tips are:
- Take an ACE inhibitor. These are pills to reduce blood pressure. Lower blood pressure not only protects your heart, it also protects your kidneys.
- Eat a low-protein diet. Once you have a diagnosis, a low-protein diet is suggested to ease stress on your kidneys, but thankfully, research shows that a low-protein diet is not necessary if you don't have signs of kidney disease (otherwise what the heck would we eat when we're trying so hard to go low-carb?)
- Avoid meds that stress the kidneys. Talk to your doctor about all the medications you are taking, as some can cause more trouble for your kidneys than you might think.
- Stay on top of your diabetes. This might sound obvious, but maintaining tighter control of your blood sugars will ease the damage caused to the blood vessels in the kidneys.
Kidney disease can be virtually symptom-less, even for people developing kidney failure. It's only when your kidneys actually fail (the 5th and final stage of kidney disease) that you might find yourself feeling sick or bloated, and by the time your kidneys do fail, you'll have to go on dialysis or get a kidney transplant.
Life with Stage 5 Kidney Failure
Dwight Emery knows a thing or two about diabetes complications. Diagnosed with type 1 as a child in 1974, Dwight started dealing with retinopathy as early as high school, and as an adult, has suffered with neuropathy. Even at age 16, Dwight knew he had kidney trouble as well, but chose to ignore it.
"I've known all my life the complications that can happen. Being youthful, it is easier to think it won't ever 'be me'," Dwight says. "In that, youth can be the thing that fools us into believing we are 'invincible'. Diabetes is a disease that takes away that invincibility we think we have and turns us very mortal."
Today, Dwight is dealing with stage 5, or end stage, kidney failure, and is on an at-home dialysis program while he awaits a kidney transplant. Dwight also must severely restrict is diet, because his kidneys cannot handle the pressure required of a normal diet.
"Dialysis is no joke, no fun, and the diet drastically changes from a diabetes diet," Dwight explains. Even healthy foods are off his "kidney diet" list: "No more oranges, no more milk, no more ice cream, no more chocolate, no more pizza, or cheese, no more tomatoes. Every time I do eat, I have to take phosphorus binders, three pills, so the food doesn't poison my body."
Dwight, and many others, use PD dialysis, which is an independent form of dialysis that does not require going into a clinic. Doing dialysis at home doesn't mean it's easier, as the procedure must be done up to 4 times a day, including overnight. Dwight tries to take care of his dialysis during the night while he sleeps, though he says sometimes it is painful, causing sleepless nights.
Where the Help Is
Whether you have stage 1 kidney failure, like Elizabeth, or are on dialysis with kidney failure, like Dwight, there are lots of resources to help you. The National Kidney Foundation and the American Association of Kidney Patients are organizations with lots of information and ways to connect to resources to help you live with kidney disease. The National Kidney Foundation also offers a message board for patients and their families. There are also forums dedicated to folks with kidney disease, like HealthBoards, and personal blogs like MyChronicKidneyDisease and MyKidney.com. For us PWDs, there are sections on diabetes forums where you can discuss kidney disease, like at TuDiabetes and DiabetesDaily.
Some final words of advice from Dwight: "Live the best you can, and know it can and does get worse if you don't fight with all you have. Fight according to what you want out of life. In reality, life does depend on it."
Dwight's a great example of a fighter, and we appreciate he and Elizabeth sharing their experiences here.