Last updated on January 5, 2022
Content By: Dr. Nikita Toshi BDS, Assistant Manager (Medical Review) & Dr. Ritu Budania MBBS, MD (Pharmacology) Head, Medical Affairs
Last updated on January 5, 2022
Living a happy and long life with diabetes mellitus is possible. So, what is diabetes mellitus? It is a metabolic disorder that affects the way our body uses blood sugar. Its prevalence especially in India has been increasing but by saying that medical advancements have also helped many people with diabetes manage their condition better than how it was in the past. As with any condition, early detection and a timely diagnosis result in a smoother recovery process. It’s when the condition is left undetected and untreated that it ends up spiraling into further complications.
Uncontrolled diabetes can affect the kidneys causing a condition called diabetic nephropathy. Not a term that many are familiar with. It is when your kidneys get affected by diabetes. If you have high blood sugar and you don’t do anything to keep it in check, it can prove dangerous for your vital organs including kidneys. Over time high blood sugar damages the high filtering units in each kidney which can also lead to kidney failure. But on the bright side of things, not everyone who is diabetic will develop kidney problems. If you follow your doctor’s recommendations, eat healthily and keep yourself active, you can protect yourself from this complication of diabetes. However, it is always better to be aware and prepared. In this article, let’s take a look at how diabetes affects the kidney if left untreated.
Living a happy and long life with diabetes mellitus is possible. So, what is diabetes mellitus? It is a metabolic disorder that affects the way our body uses blood sugar. Its prevalence especially in India has been increasing but by saying that medical advancements have also helped many people with diabetes manage their condition better than how it was in the past. As with any condition, early detection and a timely diagnosis result in a smoother recovery process. It’s when the condition is left undetected and untreated that it ends up spiraling into further complications.
Uncontrolled diabetes can affect the kidneys causing a condition called diabetic nephropathy. Not a term that many are familiar with. It is when your kidneys get affected by diabetes. If you have high blood sugar and you don’t do anything to keep it in check, it can prove dangerous for your vital organs including kidneys. Over time high blood sugar damages the high filtering units in each kidney which can also lead to kidney failure. But on the bright side of things, not everyone who is diabetic will develop kidney problems. If you follow your doctor’s recommendations, eat healthily and keep yourself active, you can protect yourself from this complication of diabetes. However, it is always better to be aware and prepared. In this article, let’s take a look at how diabetes affects the kidney if left untreated.
Written by
BDS, Assistant Manager (Medical Review)
Reviewed by
MBBS, MD (Pharmacology)
Diabetes nephropathy is a kidney disease that is caused as a complication of diabetes. It is one of the primary reasons for kidney failure. Kidney ailments related to diabetes follow one after the other as a large majority of people with diabetes suffer from diabetes nephropathy.
Diabetes nephropathy directly affects the way your kidneys function, making it difficult for them to perform their two chief tasks – (i) filtering the blood and (ii) removing excess water and waste substances from the body through urine.
This condition can be delayed by controlling your blood sugar and blood pressure levels and maintaining a healthy lifestyle coupled with adequate exercise for diabetes. Early diabetic nephropathy diagnosis can help in preventing severe complications in the long run, with the worst-case scenario being kidney failure. Patients who suffer from kidney failure will have to go through dialysis or a kidney transplant to fight diabetes nephropathy.
Let us look at what diabetes is, the role of the kidney and the inter-relation between diabetes and kidney ailments.
What is diabetes?
Diabetes is a medical condition that occurs when your blood sugar levels are too high. Diabetes, which is one of the most common non-communicable diseases in the world, appears when the body is unable to produce insulin or unable to utilise the insulin properly.
To analyse the relationship between kidney issues and diabetes, let us now see what diabetes does to the body.
How does diabetes affect our bodies?
The food we eat is converted into sugar in our body, which is then used as a source of energy. The pancreas gland, which is located behind the stomach, produces a hormone called insulin which facilitates the transport of sugar present in the blood into the cells and makes sure the body has enough energy.
This process does not work properly for people with diabetes because their bodies cannot produce enough insulin or because their bodies are unable to use the insulin that is produced.
This glitch in the system causes the pancreas to make more insulin. Over time, the pancreas struggles to produce increasing amounts of insulin and this leads to the accumulation of sugar in the blood, which can also signal the onset of kidney issues.
There are three main types of diabetes:
Type 1 diabetes is caused by an auto-immune disorder where the body destroys the cells that produce insulin. This causes the sugar to accumulate in the blood and leads to high blood sugar levels. Type 1 diabetes treatment mainly involves taking insulin, frequent blood sugar monitoring, strictly adhering to a diabetes diet plan, and exercising regularly.
Type 2 diabetes is caused by insulin resistance, where the body makes insulin but does not react properly to it.
Gestational diabetes is a form of diabetes that occurs in pregnant women due to a change in hormones and other pre-existing risk factors.
There are different types of tests such as diabetes urine tests and blood tests for diabetes, which can help you find out which form of diabetes you have. This is a crucial step in your diabetic nephropathy treatment. But before delving into treatment, now let’s take a look at the role of the kidneys.
How does the kidney function?
Kidneys are bean-shaped organs that are located below your rib cage, on either side of your spine. Your body has two kidneys and their main role is to filter the wastes and extra water in your blood to produce urine.
The kidneys play an important role in regulating blood pressure, producing red blood cells, maintaining fluid balance in the body and in keeping your bones strong and healthy.
The kidneys consist of millions of tiny units called nephrons. Each nephron consists of tiny filters. As blood flows through the kidneys, the filters in the nephron help remove waste substances from the blood while reabsorbing essential components like protein and red blood cells, back into the blood These wastes and excess water are excreted from the body as urine. The kidneys regularly filter your blood throughout the day. This filtering process gets affected when you are diagnosed with diabetes mellitus and kidney problems.
People with diabetes are more likely to be diagnosed with diabetic kidney disease as opposed to non-diabetic people. A study published in the Indian Journal of Nephrology by PP Varma showed that 40% – 60% of diabetic kidney disease is due to diabetes and high blood pressure. Furthermore, the Chronic Kidney Disease in the United States, 2021 by the Centers for Disease Control and Prevention notes that approximately 1 in 3 adults with diabetes may have diabetic nephropathy. It also says more than 1 in 7 adults in the USA, which is around 37 million people, have chronic kidney disease.
What does diabetes do to the kidney?
Kidney ailments and diabetes go hand in hand. Diabetes causes diabetic kidney disease, which is also known as diabetic nephropathy. High blood sugar affects the blood vessels in the kidney, which harms the kidney’s functioning and damages it. Over the years, the kidneys become weak and their filtration process becomes less efficient and eventually essential proteins may be excreted through urine.
As your kidney damage worsens, the kidneys also become unable to filter the waste particles in your blood. This causes the waste to accumulate in your body which can lead to serious health problems.
If you do not take adequate kidney disease prevention measures then your kidney disease could lead to total kidney failure, which is a life-threatening condition. You will have to undergo dialysis or a kidney transplant if your kidneys fail.
What is dialysis?
Dialysis is a process the doctors use to remove the excess fluid and waste from the blood because the kidneys are no longer functioning. There are two types of dialysis that a person with non-functioning kidneys have to go through:
Haemodialysis – This is when a tube is attached to a needle in the arm and blood passes through it to a machine. This machine filters the blood and sends it back to the body.
Peritoneal dialysis – This type of dialysis uses the inside lining of the abdomen
instead of the machine as the filter for the blood. An incision is made in the lower abdomen and a tube called a catheter is inserted into the abdomen.
Proper diabetic nephropathy diagnosis and diabetic nephropathy treatment are crucial in limiting the impact of diabetes on the kidney. Monitoring and controlling your blood sugar levels are also key steps in kidney disease prevention and one of the main ways to keep your kidneys healthy.
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Having seen the connection between diabetes and kidney disease and the impact diabetes has on your kidneys, we will now look at the steps to identify diabetic nephropathy. The early identification of diabetic nephropathy is crucial for serious kidney disease prevention.
The tricky aspect about diabetic nephropathy is that people often have no symptoms or are not aware of the warning signs. If you are diabetic, you should take a test for kidney disease at least once a year because a timely diabetic nephropathy diagnosis would largely help in controlling its impact.
The two common tests for kidney diseases that are used in diabetic nephropathy diagnosis are blood tests for diabetes, kidney function test and diabetes urine test.
You will be likely to be diagnosed with diabetic nephropathy if your urine tests show that there is protein in your urine. Additionally, if the doctor finds red blood cells are found in your urine sample, then it may indicate that you have kidney disease or a blood disorder. The urine test would also show if there are any urinary casts formed due to kidney disease. You may have kidney stones if there are crystals in your urine. The blood tests aid in checking how well your kidneys are functioning.
What is being tested?
A renal panel is a set of tests that are carried out to evaluate kidney functions. The tests measure levels of various substances in the blood and urine to determine the current health of your kidneys.
The levels of the following are checked in a renal panel:
Electrolytes – Electrolytes are electrically charged chemicals that are vital to the body. They help regulate fluids in the body and acid-base balance.
Minerals – Minerals like phosphorus (a mineral vital for energy production and muscle and nerve function) and calcium, which is one of the most important minerals of the body, are also checked.
Protein – Protein like albumin makes up 60% of the protein in the blood.
Urea and creatinine – Urea is a nitrogen-containing waste product that forms from the metabolism of protein; it is released by the liver into the blood and is carried to the kidneys, where it is filtered out of the blood and eliminated in the urine. Creatinine is another waste product that is produced by the body’s muscles; almost all creatinine is eliminated by the kidneys.
Glucose – This supplies energy for the body; a steady amount must be available for use and a relatively constant level of glucose must be maintained in the blood.
A few further values that can be tested using a Renal Panel are:
When to get tested?
If you have type 2 diabetes, then you must get a test for kidney disease done every year. Some individuals with type 2 diabetes may have a kidney disease even before they are diagnosed with diabetes.
The onset of diabetic nephropathy among type 1 diabetics is slower and may begin only after 10 years. However, it is advised that you take a test for kidney disease every year if you have had type 1 diabetes for more than five years for the timely treatment of diabetic nephropathy.
Remember, kidney disease can have lifelong consequences and it is essential that you get tested at regular intervals.
What are creatinine levels? Why should we measure them?
Creatinine can be defined as the waste product of creatine, which is a natural substance that the body uses to make energy. Creatine is a very popular supplement among bodybuilders as it helps in increasing muscle mass and offers instant boosts of strength.
From a diabetic perspective, high creatinine levels are very harmful to you. Creatinine is usually labelled as a waste substance by the kidney and excreted from the body via urine. However, if you are suffering from a kidney ailment, then the creatinine is not removed properly and remains in the body.
A simple blood test can measure the creatinine levels in your body and it is a routine test for kidney disease that doctors use to check how well your kidneys are working. Alternatively, your doctor may also tell you to take a creatinine urine test, where you will have to collect urine in containers over 24 hours.
A creatinine blood test would show your serum creatinine level. A normal serum creatinine level among adult men is 0.74 to 1.35 milligrams per deciliter of blood (mg/dL), while it is 0.59 to 1.04 mg/dL among adult women.
A urine test would measure the creatinine clearance, which tells you how well your kidneys can filter and remove the creatinine from the blood. The normal creatinine levels in the urine for adult men are between 77 – 160 millilitres of creatinine per minute per body surface area (mL/min/BSA). The normal creatinine levels in the urine for women differ based on their age and range from 78 to 161 mL/min/BSA for 18 – 29 year-olds and 56 to 131 mL/min/BSA for 60 – 72 year-olds.
Extremely high creatinine levels may indicate the need for dialysis.
How to prepare for a diabetes test?
The three primary types of blood tests for diabetes are fasting blood sugar tests, postprandial blood sugar and HbA1C tests. You will be required to fast overnight or for 8 – 12 hours before a fasting blood sugar test, while a random blood sugar test can be taken at any time of the day and does not need any specific preparation.
A postprandial blood sugar test is performed 2 hours after you have taken a complete meal. Postprandial blood sugar test is a common type 2 diabetes test. HbA1C is a test that gives an idea of the blood sugar levels over the past 3 months. No fasting is required for this test.
A diabetes urine test is a form of testing for diabetes in which you urinate into a container. The best way to prepare for a diabetes urine test is by making sure you are well hydrated and have plenty of water so that you will easily be able to produce a urine sample when required.
Preparing a loved one for a urine routine test
Getting tested for diabetes can be a nerve-wracking experience. You can make it a little easier for your loved ones by accompanying them to the clinic and by offering your constant support.
You can help your loved one prepare for a diabetes urine test by making sure they drink enough water and are well-hydrated ahead of the test. You will also need to see to it that your loved one informs the doctor of any medicines that they take regularly.
Other than that, it would also be useful if you looked up the basics of what is a diabetes urine test and raise your doubts, if any, with the doctor so that you gain a better understanding of the procedure and how to read the test results.
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Now that we have looked at how to identify diabetes nephropathy and the various tests associated with it, let us move on to the risk factors of diabetes nephropathy.
High Blood Pressure
Uncontrolled blood pressure greatly increases your risk of being diagnosed with kidney ailments. High blood pressure may damage the blood vessels in the kidneys which in turn damage the filters of kidneys. It also increases the scope for kidney ailments.
Uncontrolled blood sugar
High blood sugar levels mean there is a lot of sugar accumulated in the blood and this causes damage to the blood vessels supplying the kidneys and eventually damage the filtering units of kidneys. You need to know how to control blood sugar levels to reduce the risk of diabetic nephropathy. Uncontrolled blood sugar is also one of the primary risk factors for diabetes.
Lifestyle factors
Several lifestyle factors can also lead to diabetes mellitus and kidney problems. These include:
Smoking – Smoking can have a detrimental effect on your kidney health. It could further worsen your kidney damage. Smoking also narrows your blood vessels and makes your heart work extra hard.
Sedentary lifestyle – A sedentary lifestyle is a major risk factor for diabetic kidney disease. If you get little to no exercise and do not exercise regularly, it can lead to worsening of diabetes, which can lead to obesity which can have a negative impact on your kidneys.
Heart diseases – Having a heart disease such as a heart attack or a stroke would affect your heart’s functioning and the way it pumps blood. This could lead to kidney ailments in the long run.
No proper meal planning – Not having a proper diabetes diet plan will make you prone to diabetic nephropathy since diabetes and kidney ailments are directly related. A well-researched diabetes diet plan would help you understand which foods you should avoid and what is good for your body.
Obesity – Being overweight or obese, which is one of the key risk factors for diabetes, can lead to kidney issues. You can check your Body Mass Index (BMI) to get a clear picture. If you have a high BMI, then it means you have more fat in your body and this could cause multiple health complications including diabetic nephropathy.
Family history – If someone in your immediate family, such as your parents or siblings, have been diagnosed with diabetic nephropathy or kidney failure, then you have a greater risk of getting kidney diseases. Make sure you get tested regularly for and kidney issues and diabetes.
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Once you know the risk factors for kidney disease, the next step would be to get proper diabetes nephropathy treatment. Here are 7 measures you can take to protect yourself from diabetes mellitus and kidney problems.
#1 Keep blood pressure at optimum levels
If you have been diagnosed with diabetic nephropathy, then you must maintain a normal blood pressure level. The normal blood pressure level is usually around 120/80 mm Hg and this will go a long way in keeping your diabetes in check.
#2 Set a blood glucose level goal and monitor regularly
You must discuss with your doctor and set an ideal blood glucose level goal based on the extent of your diabetes. Take your medicines timely, make a few small lifestyle changes to control diabetes such as maintaining a nutritious diet and exercising regularly. Like mentioned earlier, it is very important for you to know how to control blood sugar levels to protect your kidneys from further damage.
#3 Test kidney health regularly and compare results with each test
Another useful step in managing diabetic nephropathy is by getting regular tests done to measure how well your kidney is working. You can opt for one of the tests for kidney disease and write down the results in a notebook or keep a track of them on your phone. Keeping a track of your results will help you in understanding whether your current regimen is working and or if any changes need to be made to better manage your diabetes and kidney-related ailments.
#Following a diet plan for diabetes and kidney disease
If you have diabetes, you would need to follow a well-balanced meal plan to keep your sugar levels in check. For kidney diseases too you need to avoid certain foods and limit the intake of others to protect your kidneys. Here are some tips that can help you plan your diet well:
Here are some foods that you can include in your diet:
Fruits – berries, grapes, cherries, apples, plums.
Veggies – cauliflower, onions, eggplant, turnips.
Proteins – lean meats (poultry, fish), eggs, unsalted seafood.
Carbs – white bread, bagels, sandwich buns, unsalted crackers, pasta.
Drinks – water, unsweetened tea.
IMPORTANT: The amount or portion size of your diet and fluid intake is very crucial if you are suffering from kidney disease. You must get a meal plan according to your health needs from a registered dietician and follow it sincerely.
Get complications treated early
Diabetic nephropathy can lead to multiple health complications including kidney failure, heart diseases, anemia, fluctuation in blood pressure and lung conditions. Taking a regular test for kidney disease will help identify these complications at the early stages and reduce the risk factor.
#5 Take medications regularly
Taking the medicines prescribed by your doctor will help in protecting your kidneys from further damage and could also limit the impact diabetic nephropathy has on your body. Make sure you are regular with your doses. Consult your doctor if a particular medicine does not agree with your system or if you feel your current medication plan is not yielding results.
#6 Develop a medication tracker (with medicine doses to take each day, sugar, cholesterol levels, etc)
You can use a medication tracker that will remind you to take your medicines on time and keep you on track. You can download a medication tracker onto your smartphone or also make one on a sheet of paper. This will ensure that you do not miss your daily doses and will also allow you to track the effect of the medicines on your body.
#7 Join a support group
Diabetes is one of the most common diseases in the world. However, you may feel at times feel low and feel like no one can relate to what you’re going through. This is where a support group can be helpful as you will meet people with conditions similar to yours and people who can relate to you. Sharing your experiences with those also suffering from diabetes and kidney issues may make you feel lighter and you can even exchange small tips and pointers to better manage your diabetes mellitus and kidney problems.
Caring for someone who has been diagnosed with diabetic nephropathy
Being diagnosed with diabetic nephropathy can be a nervy affair. If your loved one has been diagnosed with it then it is essential that you offer them your unconditional support and keep them in good spirits. You must be there for them when they need you but at the same time, you must also give them their space and not micromanage them.
You can also offer them support by practising a common hobby such as gardening or painting with them or even take up yoga, which is very useful for kidney disease prevention. Additionally, you can align your routine with theirs so that you can accompany them on walks or workout sessions and make sure they always have good company.
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You need to take extra care and caution to keep your kidneys safe, especially if you are diabetic. Here are some of the steps you can take toward your journey to recovery:
Maintaining healthy blood sugar levels
Learning how to control blood sugar levels is a vital step in kidney disease prevention. A high level of blood sugar, which is a symptom of diabetes, adds undue stress on the kidney and affects its functioning. You would need to follow a proper diet plan, exercise regularly and take periodic tests to ensure that your blood sugar levels are within the normal range.
Finding ways to control blood pressure
High blood pressure also increases the load on your kidneys and worsens your kidney health. You can control your blood pressure by taking medicines prescribed by your doctor, making small lifestyle changes such as reducing salt in your diet, eating less processed foods and getting ample physical activity.
Taking medicines prescribed by your doctor
You will be required to eat certain medicines, based on your needs, as part of your diabetic nephropathy treatment. These medicines play a significant role in diabetic nephropathy treatment and will help in keeping your blood sugar and blood pressure levels within the recommended range. Taking the prescribed medicines will largely help in controlling diabetes and help prevent kidney disease prevention. Never self medicate or take any herbal or nutritional supplement without discussing it with your doctor.
Getting smoking habits under control
If quitting smoking altogether is too difficult, then try to control your smoking and gradually scale it down. You can speak to your doctor about different methods of stopping smoking such as using nicotine patches, gums or other alternatives and adapt what suits you best. You can also look for a support group of people who are also trying to give up smoking. Interacting and being around people who are going through something similar will help you stay on track and make you feel accountable.
Getting enough sleep by monitoring your sleep patterns
It is essential that you get about 7 – 8 hours of sleep to help your body recover and function properly. Getting adequate sleep will boost your mood and also make you feel energetic. Managing stress and diabetes at the same time can be tough and a proper sleep pattern will help in better diabetes stress management.
Exercising to control diabetes
Keeping yourself fit and getting enough exercise are sure shot methods that reduce the risk factors of diabetes and also promote kidney disease prevention. Start small by taking short walks of 10 minutes each every 2 – 3 hours or between meals. Once you get used to it, you can go on a 30-minute walk 5 – 6 days a week.
Alternatively, you can also try swimming or cycling. If you like lifting weights, then you can opt for resistance training too. What form of exercise you do is not necessarily important, what matters is you move more and keep yourself active and maintain your body weight in a healthy range.
Regular exercising is a key component of diabetes stress management and it ensures that your blood sugar levels are under control.
Developing a diabetes meal plan and sticking to it
A diabetes meal plan would include loads of fruits and vegetables and whole grains along with lean sources of protein. You must limit or avoid salt/sodium. A healthy diabetes meal plan would need you to cut down on junk foods and fatty foods and steer clear of sugary drinks. Stick to water, fresh fruits and sugar-free drinks as much as possible. You can make these small lifestyle changes for diabetes control.
A typical Indian diabetes diet plan would include a strictly measured quantity of carbohydrates such as rice or rotis, a healthy amount of fibrous fresh fruits and vegetables, lean protein sources such as fish and low-fat dairy products. An Indian diabetes diet plan would also include whole grains such as brown rice, millets and oats.
Managing stress levels
Having kidney diseases can be stressful. Keeping a close eye on your nutrition, making sure you get enough exercise and taking regular tests can be a little exhausting. Managing your stress and diabetes could prove to be a challenge. However, it is important to do so because long-term stress would lead to an increase in your blood sugar and blood pressure levels, which are major risk factors for diabetes.
You can better your diabetes stress management with a few lifestyle changes. You can try meditation, practising deep breathing and journaling to help cope with the stress. You can also pick up a new hobby such as painting or tailoring or gardening – whatever makes you feel relaxed and calm. Another effective method would be practicing yoga for diabetes which can help in kidney disease prevention.
If you’re feeling overwhelmed then you can open up to a loved one or seek professional help by talking to a therapist. There’s no ‘one sock fits all approach’ here, you choose what works best for you and do only what makes you feel good and stress-free.
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What are the symptoms of diabetic kidney disease?
The most prevalent symptoms of diabetic kidney disease are:
If you experience any of the other symptoms, you must undergo a test for kidney disease and get timely diabetic nephropathy treatment. Early detection of these symptoms will help in kidney disease prevention.
How long does diabetes take to damage the kidneys?
People with type 1 diabetes may get diabetic nephropathy 10 years after they were diagnosed with diabetes while people with type 2 diabetes could have kidney disease even before they have diabetes. It basically depends on the extent of diabetes management. People who maintain sugar levels and blood pressure in a healthy range may never develop kidney disease.
Diabetes nephropathy usually takes time to cause irreparable damage. Being aware of kidney issues related to diabetes and their early identification can help arrest or even stop the progression of diabetic nephropathy. Screening for kidney function should be included in the annual health check-up.
Can you reverse the damage caused to the kidneys by diabetes?
It is difficult to completely reverse the damage caused by diabetes to your kidneys but you can slow the progress of diabetes nephropathy through early detection. Identifying the prevalence of kidney disease in the early stages plays a big role in reducing long-term complications. Furthermore, you can also avoid or reduce the impact of the damage with early diabetic nephropathy treatment.
What happens to kidneys with diabetes?
Kidneys with diabetes cannot do their basic functions, which is to filter the blood and get rid of the waste particles through urine.
People with diabetes have high blood sugar levels and this damages the kidneys and harms their functioning. Over time, the kidneys become weak and their filtration process becomes less efficient. Therefore, timely diabetic nephropathy diagnosis and diabetic nephropathy treatment are crucial in limiting the impact of diabetes on the kidney.
What is the importance of food in Diabetic Nephropathy?
Food plays a very important role in limiting the impact of diabetic nephropathy. You will need to follow a different meal plan, which will be similar to a type 2 diabetes diet plan with added changes like reduced salt and protein intake. Your diet must consist of whole grains, fruits and fibrous vegetables and lean sources of protein in a very limited amount.
An Indian diabetes diet plan would include limited quantities of rice and rotis and plenty of fruits and vegetables. You can also include low-fat dairy products.
You will have to limit your salt and potassium intake and avoid any form of junk, fatty and processed food items. You will also have to stick to non-sugary drinks and stay away from beverages with bucketfuls of sugar like colas.
Maintaining a balanced diet plan is extremely important for those with diabetic nephropathy. Consult a registered dietician for a meal plan based on your health and eating habits.
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