If you have diabetes, you’ve got a lot on your plate, which may include a variety of diabetic complications. Depending upon your health, worrying about diabetic kidney disease might be the last thing on your mind. It shouldn’t be. What you do daily to manage your diabetes makes a big difference in your future kidney function, as well as your quality of life down the road. Here are six things you should know about this important complication of diabetes and what you can do decrease your chances of getting it.

Know Why You Care

Since diabetes is the leading cause of kidney failure in adults in the U.S., the more you understand about how your blood sugar affects your kidneys, the more committed you’ll be to keeping things in check. Don’t just do it because your doctor says you should, or because your spouse is hovering over your glucometer. Do it because you understand how a poorly managed blood sugar leads to damage in your body.

When your blood sugar stays higher than normal, it causes damage to the small blood vessels in your kidneys. These blood vessels serve tiny filters in the kidneys called glomeruli to keep needed proteins in your body and send waste toxins out. So when the vessels get damaged, your kidneys don’t function as they should, and you can end up with chronic renal failure (CRF). Since poorly managed chronic renal failure can advance to end-stage renal failure and the need for dialysis or kidney transplantation, it’s nothing to take lightly.

Know Your Blood Sugar

This really should go without saying when we’re discussing diabetes, but it’s surprising how many people who should monitor their blood sugars just don’t. It could be a matter of inconvenience, an assortment of other factors – or the BIG ONE – what they don’t know won’t hurt them. Well, in this case what they choose not to know can have dire consequences.

Depending upon the type of diabetes you have, and whether or not you take insulin, will help determine how often you should check your blood glucose levels.

Know Your Blood Pressure

Managing your blood pressure is a lot like managing your blood sugar - it’s the daily numbers that matter. Sure, it’s going to shoot up when something aggravates you, but a chronically high blood pressure can create all sorts of havoc in all sorts of places. Similar to the chicken and the egg, high blood pressure can be caused by kidney disease, and it can cause it as well.

Regardless of who started what, chronically high blood pressure creates increased stress on renal blood vessels and the fragile filtering tissue within the kidneys themselves. It’s important to know what your numbers are and to talk to your doctor about the range that’s best for you.

Know What to Test

If it’s diagnosed early enough, kidney disease can be slowed with the proper treatment. But if it’s not diagnosed until it’s had a chance to unpack its bags and put up its feet, kidney disease can progress to kidney failure. Since the timing of the diagnosis makes such a difference, it’s important to keep regular tabs on your kidneys’ health.

Important tests include:

• Hgb A1C – gives weighted average of blood sugar over past 3 months – test at least twice a year.
• Blood pressure – at least several times a year and more often if problematic.
• Estimated glomerular filtration rate (eGFR) – tests how well kidneys are filtering – at least annually.
• Urine – check for protein – at least once a year.
• Blood – check for toxins such as an increased blood urea nitrogen (BUN) and creatinine – according to need.

Know What to Look For

It’s important to know what the kidney disease symptoms are, but don’t wait until they show up to pay attention to your kidney health. By the time they appear, your kidney disease may already be established and progressing faster than you realize.

Early signs include:  

• Small levels of protein in the urine (microalbuminuria)
• Weight gain
• Ankle swelling: diabetes affects the healing process. This can lead to many other more serious complications. For more information, check out this guide to diabetic foot care.
• Using the bathroom more at night
• High blood pressure

Late signs include:

• Large amounts of protein in urine (macroalbuminuria)
• Increased blood urea nitrogen (BUN)
• Increased blood creatinine
• Nausea
• Vomiting
• Decreased appetite
• Weakness
• Increased fatigue
• Itching
• Muscle Cramps
• Anemia
• Decreased insulin need

Know What to Do

The good news is that there are many things you can do to prevent diabetic kidney complications.

• Keep a tight rein on your blood sugar – your doctor will help you know what level is best for you.
• Keep your blood pressure under control - usually under 140/90, or according to your doctor’s guidance.
• Follow the right diet – often that means low protein and low sodium, but your renal dietician can tell you what’s best for you.
• Ask your doctor about medications – ACE inhibitors not only lower high blood pressure, they improve kidney function as well.

Know Where to Find Help

Although diabetes is an incredibly common disease in our country, it’s easy to feel alone when facing the multiple challenges it presents. In addition to your doctor and renal dietician, there are many organizations that deal with kidney disease and specifically, support for those with diabetic kidney disease complications.

If you’re a diabetic, you certainly do have a lot on your plate. But by paying attention, knowing how to take care of yourself, and following through, you’ll increase your chances of enjoying happy, healthy kidneys for many years to come.

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