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We Know It Does, But How? 

We Know It Does, But How? 

After all these years of reading my blog, I’m certain we all know that diabetes is the foremost cause of chronic kidney disease. But did you ever ask yourself how diabetes causes CKD? That would be a good thing to explore during National Kidney Month, so let’s do it. 

Let me first remind you that CKD is: 

“Damage to the kidneys for more than three months, which cannot be reversed but may be slowed” 

That’s from my first book, What Is It and How Did I Get it? Early Stage Chronic Kidney Disease, which was published in 2011… a dozen years ago.  

Do you remember what KDIGO stands for? It means Kidney Disease Improving Global Outcomes, which is  

“… the global nonprofit organization developing and implementing evidence-based clinical practice guidelines in kidney disease…. KDIGO guidelines translate global scientific evidence into practical recommendations for clinicians and patients.” 

Their latest definition of CKD is: 

“CKD is defined as abnormalities of kidney structure or function, present for > [that means greater than] 3 months, with implications for health….” 

11 years later, the definition of CKD is not that much different. 

And diabetes? How should we define that? The National Institute of Diabetes and Digestive and Kidney Disease [NIDDK] has us covered there: 

“Diabetes is a disease that occurs when your blood glucose, also called blood sugar, is too high. Blood glucose is your main source of energy and comes from the food you eat. Insulin, a hormone made by the pancreas, helps glucose from food get into your cells to be used for energy. Sometimes your body doesn’t make enough—or any—insulin or doesn’t use insulin well. Glucose then stays in your blood and doesn’t reach your cells. 

Over time, having too much glucose in your blood can cause health problems. Although diabetes has no cure, you can take steps to manage your diabetes and stay healthy.” 

That still doesn’t tell us how diabetes affects your kidneys, does it? The Centers for Disease Control and Prevention [CDC] helps a little: 

“Each kidney is made up of millions of tiny filters called nephrons. Over time, high blood sugar from diabetes can damage blood vessels in the kidneys as well as nephrons so they don’t work as well as they should. Many people with diabetes also develop high blood pressure, which can damage kidneys too. 

CKD takes a long time to develop and usually doesn’t have any signs or symptoms in the early stages. You won’t know you have CKD unless your doctor checks you for it.” 

We are getting close, but I don’t think we’re there yet. Bingo! MedlinePlus nailed it: 

“In people with diabetes, the nephrons slowly thicken and become scarred over time. The nephrons begin to leak, and protein (albumin) passes into the urine. This damage can happen years before any symptoms of kidney disease begin.” 

Kidney Care UK offers us even more information: 

“Diabetes can affect your kidneys in two main ways: 

Kidney disease (diabetic nephropathy). High glucose levels cause extra blood to flow through the tiny filters in your kidneys, so they have to work harder than normal to clean it. Over time this can damage the filters, causing them to leak. 

Disease of the kidney’s blood vessels (renovascular disease). High blood pressure causes a ‘furring up’ of the artery to the kidney, reducing the blood supply and causing scarring.” 

So now we have two places in our bodies that diabetes affects, the nephrons [filters] in the kidneys and the arteries leading to the kidneys. That explains why high blood pressure is the second foremost cause of chronic kidney disease. 

I tuned to the Mayo Clinic to see if there were any symptoms to warn us of the damage being done to our kidneys: 

“In the early stages of diabetic nephropathy, you would most likely not notice any signs or symptoms. In later stages, signs and symptoms may include: 

  • Worsening blood pressure control 
  • Protein in the urine 
  • Swelling of feet, ankles, hands or eyes 
  • Increased need to urinate 
  • Reduced need for insulin or diabetes medicine 
  • Confusion or difficulty concentrating 
  • Shortness of breath 
  • Loss of appetite 
  • Nausea and vomiting 
  • Persistent itching 
  • Fatigue” 

Maybe this would be a good time to differentiate between the types of diabetes. The most logical site to have this information would be EndocrineWeb … and it did: 

“Type 1 Diabetes 

This type is usually diagnosed in kids, teens, and young adults, but it can happen at any age. Type 1 diabetes occurs when your pancreas doesn’t make insulin. This means you have to take insulin every day. The Centers for Disease Control and Prevention (CDC) estimates that around 5% to 10% of people with diabetes have this type…. 

Type 2 Diabetes 

This type can also show up at any age, but it’s more common if you’re over 40. Type 2 diabetes occurs when your pancreas doesn’t make enough insulin, or your body isn’t using the insulin well. Around 90% to 95% of people with diabetes have this type. While it has historically affected mainly adults, the rate of type 2 diabetes in children and adolescents is rising…. 

Gestational Diabetes (Diabetes in Pregnancy) 

During pregnancy, some women who did not previously have diabetes develop it. This is called gestational diabetes. It usually disappears after the baby is born, but having gestational diabetes increases both your and your baby’s risk of developing type 2 diabetes later on.  

Prediabetes 

As the name suggests, prediabetes increases your risk of developing type 2 diabetes. In this stage, your blood sugar levels are higher than they should be, but not high enough to be diagnosed with type 2. The CDC says that 96 million adults in the United States have prediabetes. That’s more than a third of adults. Unfortunately, more than 84% don’t know they have it. 

When most people think of diabetes, they only think of type 1 and type 2. I knew about gestational diabetes only because one of sisters-in-law experienced it [Yes, unfortunately her son does have diabetes now.] I also had prediabetes and was doing a pretty good job of not allowing it to progress, if I do say so myself. However, losing ¾ of my pancreas to cancer threw me right into type 2 diabetes. 

Time for me to take my insulin. 

Until next week, 

Keep living your life! 

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