Blood Sugar Management

Long term Diabetes related complications are correlated strongly to excess glucose in our blood vessels. This excess glucose causes inflammation and swelling in the blood vessels. This makes them narrower, less flexible and more prone to building plaques.  When blood flow is reduced to major blood vessels, called Macrovascular, damage such as heart attacks, strokes and heart failure. Blood flow changes to small blood vessels bring microvascular injuries such as neuropathy, retinopathy, and nephropathy.

Let’s take a look at some microvascular diabetes related complications, their effects and how we can screen for them to prevent progression.

All  the blood in our bodies passes through our kidneys at a rate of about 150 quarts per day! And all that blood pumps through tiny blood vessels called nephrons. (This is where all the work of balancing electrolytes, other chemicals, blood sugar, fluid volume and waste filtration happens!) but these are tiny blood vessels and so they are at risk of damage

In the kidneys when these vessels are damaged they break like tiny glass tubes. And when these important vessels break they are not repaired and replaced, once they are gone they’re gone! Our kidneys don’t make new nephrons! When too many nephrons are lost our ability to perform all the important kidney functions decreases.

CDC statistics from 2017 report Chronic Kidney Disease is  experienced by 35% of people with diabetes.

Also 45% of people on dialysis for End Stage Renal Disease had a diagnosis of Diabetes Related ESRD

Early detection and prompt treatment can help prevent long-term kidney damage At least once/year have a urine albumin/creatinine ratio test and 24-hour urine microalbumin test check protein

To compound the importance of protecting kidney function:

The kidneys are responsible for filtering many medications from the blood stream,  and since people with diabetes are at a higher risk of other diseases this reduced kidney function can make treating other disease states more difficult. Renal function is a keystone to wellness, without which our total wellness quickly crumbles. Protecting kidney function is critical.

 

Prevention

How can we spot Kidney issues and screen for their onset before damage goes too far?

Early detection and prompt treatment can help prevent long-term kidney damage Screen for swelling/edema Changes in BP Changes in weight Changes in urination quality or frequency Fatigue   At least once a year, have a urine test to check protein BUN/GFR trends Electrolyte panels

 

There is also emerging data showing benefits of SGLT2inhibirot medications in benefitting kidney function of those who do have impaired renal function and we may find these benefits to be preventative with additional study.

 

We should always educate our patients in the best ways to prevent diabetes-related complications, and be sure to explain not just WHAT to do, but WHY.

Maintain controlled blood pressure: maintaining stable blood pressure through monitoring and consistency with treatment reduces pressure on the blood vessels making breakage or leakage less likely. Healthy blood pressure is below 120/80.

 

Maintain a healthy weight: added weight = added length of blood vessels = added pressure needed to keep blood circulating.

 

Avoid excess sodium: fluid follows salt is the old adage, so to avoid excess fluid increasing BP maintaining a diet lower in sodium can be beneficial.

 

Maintain good hydration: not enough fluid means kidneys are working harder. Like a pool pump trying to pump pudding instead or water. Keeping hydrated keeps the kidneys filtering easier.

 

Practice good coping techniques: stress causes an intense increase in blood pressure. In our high paced lives learning how to deal with stress in a healthy way reduces the impact on our vascular systems.

 

Smoking has been shown to have a direct causal impact on Nephropathy.