Diabetes And Kidney Disease

Diabetes mellitus (DM) is commonly referred to as simply diabetes. It is a metabolic disorder characterized by either insufficient amounts of insulin being produced by the pancreas or the ineffective use of insulin by the body's cells. It can be classified as either type 1 or type 2.

DM is a chronic disease, which means that it develops and persists over a long period of time.

Similar to high blood pressure, it has a gradual and silent onset.

Many people with this disease may not be aware of its presence because it displays little to no symptoms in the early stages.

During the first ten (10) years or so of this disease there are no symptoms, and it can only be detected by routine testing of the blood sugar levels.

This disorder is widespread and is one of the main causes of kidney disease and kidney failure.

It is estimated by the World Health Organization (WHO) that approximately 220 million people worldwide, suffer from this dreadful disease. This figure is projected to almost double over the next 20 years.

In many cases, however, this disease is completely avoidable. Simple dietary and lifestyle adjustments, such as healthier dietary choices, regular physical activities, maintaining a normal body weight and avoiding tobacco use, can contribute significantly to preventing or delaying the onset of DM. For those already affected by this disease, early detection and effective diabetes treatment are essential keys for successful control and management of the disease.

Diabetes mellitus (DM) should not be confused with diabetes insipidus (DI). DI is caused by a hormonal deficiency that affects the regulation of water in the body. This is a completely different disorder from DM, which is a metabolic disorder affecting the regulation of the body's blood sugar. This article refers specifically to DM and not DI. All references to "diabetes" are specific to DM only.

In order to appreciate how DM affects the body, it will be helpful to understand metabolism and how the body converts food into energy, under normal circumstances.

How Does DM Affect Metabolism?

Diabetes mellitus is a disorder of metabolism. Metabolism is the way our bodies use food to obtain energy.

After eating a meal, blood sugar levels tend to rise. In a healthy person, this is a signal for the beta cells to secrete insulin, which transports the glucose from the bloodstream into cells, thereby keeping the blood sugar level within normal range.

Between meals, blood sugar levels gradually fall. To prevent the blood glucose levels from falling too low, another specialized group of pancreatic cells, called alpha cells, secrete a hormone called glucagon, which acts in the opposite manner to insulin.

Insulin is a hormone that helps the body's cells to absorb glucose (sugar), which the body uses as a prime source of energy. Insulin is manufactured by cells in the pancreas, called beta cells, and it is transported throughout the body via the bloodstream, where it plays a crucial role in converting glucose into useable energy.

With most diabetic patients, this system of regulating blood sugar levels does not function efficiently. Due to low levels of insulin produced by the pancreas, or the inefficient use of insulin by the body, the cells are prevented from absorbing glucose. This causes the glucose levels in the blood to rise above normal levels.

The pancreas is a flat organ situated in the posterior abdomen (towards the back of the abdomen), behind the stomach. It has two main functions. First, it functions as a digestive organ, in that it secretes enzymes into the intestinal tract that helps to breakdown food into a form that the body can use. Secondly, it acts as an endocrine organ, in that it produces insulin and other hormones for secretion directly into the bloodstream that regulate the metabolism of glucose, proteins and fats.

Type 1 DM

Type 1 tends to first occur in young adults and children. It is sometimes referred to as insulin-dependent or juvenile-diabetes and is responsible for approximately 10 percent of all diagnosed cases.

With type 1 DM, the body stops producing insulin, or does not produce enough. Patients must, therefore, take daily insulin injections or use an insulin pump. Without daily injections of insulin, type 1 patients will not survive for very long. They must also control blood glucose levels by diet and exercise.

People with type 1 DM are more likely to develop kidney failure. Up to 40 percent of people with this form of the disease develop kidney failure, between the ages of 30 to 50 years.

Type 2 DM

Type 2 DM first occurs more often in people over the age of 40, however, it can occur at any age... even during childhood. It is sometimes known as non-insulin dependent or adult-onset-diabetes. This is much more common and accounts for about 90 percent of all diagnosed cases.

Many people with type 2 do not respond properly to their own insulin or to injected insulin. This is sometimes referred to as an insulin-resistance condition. In some cases, people with type 2 can control their blood glucose levels with meal planning and physical activity. Others must take pills that not only stimulate the production of insulin, but also reduce insulin resistance and decrease the liver's output of glucose. Others may also require injections of insulin in addition to pills.

Healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use can prevent or delay the onset of type 2 diabetes.

How Does Diabetes Affect The Kidneys?

Diabetes mellitus causes glucose levels to build up in the blood and urine, which causes excessive urination, thirst, hunger, and problems with fat and protein metabolism. It causes damage to the small blood vessels in the kidney. When these blood vessels are injured, the kidneys cannot perform their function properly and, consequently, excess water and salt is retained in the body. The excess fluid in the body can result in weight gain and swelling of the ankles.

In some cases, it may take many years for a diabetic patient to develop kidney disease. Sometimes, the filtering function of the kidneys is actually higher than normal, in the first few years of developing this disease. This process is known as hyper-filtration. This happens as the kidneys try to respond to the excess glucose in the blood. Over time, however, this begins to affect the kidneys and their filtering function begins to drop.

Generally, kidney damage rarely occurs within the first 10 years of developing this disease. Sometimes, as much as 25 years will pass before there are any signs of kidney failure. The risk of developing kidney failure decreases, for most people who live with this condition for more than 25 years, without any signs of kidney damage.

Diabetes mellitus is most common in adults over the age of 45 years. It is also more common in women than in men and in people of African and Hispanic descent.

Other risk factors are obesity, physically inactivity, and having an immediate family member with diabetes.

Symptoms of Diabetes and Kidney Disease

Due to low levels of insulin or the poor response to insulin, the cells are prevented from absorbing glucose. Consequently, there is a buildup of glucose in the blood. When this blood (with excessive glucose) passes through the kidneys, these organs cannot absorb all of the excess glucose. This excess glucose accompanied by water, goes into the urine and causes frequent urination, in order to get rid of the additional water drawn into the urine.

This, in turn, triggers excessive thirst and hunger, to replace the water and the glucose lost in urination. Additional symptoms may include:

  • hypertension,
  • blurred vision,
  • unexplained weight loss,
  • irritability,
  • weakness,
  • fatigue, and
  • nausea and vomiting.

Diabetes is also a contributing factor in many deaths from heart disease, kidney failure, and other conditions. Some studies have also suggested that there is a link between diabetes mellitus and kidney stones.

Diabetes mellitus is a very serious condition and should not be taken lightly. It affects the quality of a patient's life and is responsible for almost 4 million deaths per year. It is very important for diabetic patients to implement and maintain an effective diabetes management program, to effectively control their blood glucose levels.

If you are not diabetic... then prevention is the best way to avoid the complications associated with diabetes and kidney disease. Healthier lifestyle choices, including healthy diet, regular exercise, and avoidance of harmful substances (such as tobacco and drugs), will go a long way in preventing and slowing the effects of this terrible disease.