The body has a complex and amazing way of controlling energy and chemical needs. One of the substances produced by the body to deal with the starch and sugars in food is insulin. Insulin is produced by an organ in the body called the pancreas whenever a starch or sugar containing food is eaten. The pancreas is located deep in the belly under the stomach and contains cells called islet cells that specifically produce insulin. The pancreas also produces other chemicals important in digesting the fat and proteins in food but the islet cells of the pancreas are responsible for insulin that in turn lowers blood sugar levels after a meal.
Diabetes is also called Diabetes Mellitus and is a disease that occurs when the body either does not produce enough insulin or cannot effectively use the insulin it already produces. This leads to an increase in blood sugar levels which over time leads to damage of many organs such as the heart, blood vessels, nerves, eyes and the kidney.
According to a 2014 International Diabetes Federation (IDF) report, approximately 46 out of every 1,000 adults in Nigeria between the age of 20 and 79 years have diabetes with an estimated 4 million cases many of which are undiagnosed. Several thousands are estimated to die from diabetes related conditions every year. Some women may develop diabetes during pregnancy resulting in large babies, or other problems in pregnancy. After the pregnancy, the diabetes may disappear but for some patients, it is the beginning of what will later present as full blown diabetes.
For the Nigerian score card from the International Diabetes Federation click here
For contact information of the nearest Diabetes Association of Nigeria representative near you, click here
For a clinical overview of diabetes mellitus in Nigeria, click here
Symptoms of uncontrolled diabetes
Common symptoms of type 1 diabetes include:
Excessive thirst, frequent urination, sudden weight loss, severe tiredness and blurred vision.
People with type 2 diabetes may have the same symptoms but they may be less noticeable. Many patients have no symptoms and are only diagnosed after several years with the condition. In Nigeria over 50% of people with type 2 diabetes are are estimated to not be aware they have the condition at the time of the diagnosis.
There are two main types of diabetes:
- Type 1 diabetes is an autoimmune disease that prevents the body from producing enough insulin. Type 1 diabetes occurs most often in children and young adults. Approximately 5 to 10 per cent of people with diabetes have type 1 diabetes.
- Type 2 diabetes is a disease that results from the body’s inability to make effective use of the insulin produced. Genetics, obesity and lack of appropriate diet and physical activity are factors that appear to play a role in the development of type 2 diabetes. Type 2 diabetes occurs most often in adults over the age of 40 and accounts for up to 95 percent of all diabetes cases. However, as a consequence of increased obesity and inactivity among young people, type 2 diabetes is now affecting children and young adults.
Complications of diabetes. Without proper insulin production and action, sugar remains in the blood, leading to long term raised blood glucose levels. This can result in short and long-term complications, many of which, if not prevented and left untreated, can kill. All these complications have the potential to reduce the quality of life of people with diabetes and their families.
What does diabetes do to the kidneys?
With diabetes, the small and large blood vessels as well as the heart are injured. Small blood vessel damage over long periods of time eventually leads to poor function and eventually failure of the kidneys as well as other important organs such as the eyes. Because of the kidney damage from diabetes, waste products begin to accumulate in the blood and damage other body organs, the body will loose protein in the urine when there should be little to no protein in the urine and the body will retain more water and salt than it should, which can result in weight gain and ankle and eye swelling. Diabetes also may cause damage to nerves in your body. This can cause difficulty in emptying your bladder. The pressure resulting from your full bladder can back up and injure the kidneys. Also, if urine remains in your bladder for a long time, you can develop an infection from the rapid growth of bacteria in urine that has a high sugar level.
How many diabetic patients will develop kidney disease?
Three out of every 10 patients with Type 1 diabetes and 1 to 4 out of every 10 patients with Type 2 diabetes eventually will suffer from kidney failure. It usually takes 10 or more years of uncontrolled diabetes to cause kidney disease but it could occur earlier
What are the early signs of kidney disease in patients with diabetes?
The earliest sign of diabetic kidney disease is an increased excretion of protein in the urine. This is present long before the usual tests done in your doctor’s office show evidence of kidney disease, so it is important for you to have this test on a yearly basis. Weight gain and ankle swelling may occur. You will use the bathroom more at night. Your blood pressure may get too high. As a person with diabetes, you should have your blood, urine and blood pressure checked at least once a year. This will lead to better control of your disease and early treatment of high blood pressure and kidney disease. Maintaining control of your diabetes can lower your risk of developing severe kidney disease.
What are the late signs of kidney disease in patients with diabetes?
As your kidneys fail, your blood urea nitrogen (BUN) levels will rise as well as the level of creatinine in your blood. You may also experience nausea, vomiting, a loss of appetite, weakness, increasing fatigue, itching, muscle cramps (especially in your legs) and anemia (a low blood count). You may find you need less insulin. This is because diseased kidneys cause less breakdown of insulin. This does not mean your diabetes is getting better and you should not stop trying to treat your diabetes. If you develop any of these signs, call your doctor.
Prevention of diabetic kidney disease
The prevention of diabetic kidney disease starts with
- Control your diabetes- daily checking blood sugar and hemoglobin A1c every couple of months to see how well your blood sugar is controlled is important
- Control high blood pressure- target systolic blood pressure should be 130/80 or less
- Get treatment for urinary tract infections
- Correct any problems in your urinary system such as obstruction by kidney stones
- Avoid any medicines that may damage the kidneys (especially over-the-counter pain medications)
- Get check ups and blood tests of your blood and urine to assess your kidney function at least once a year
- Get enough exercise and control your weight.
Treatment of diabetes
- Treatment of type 1 diabetes typically includes a carefully calculated diet, physical activity, blood glucose testing and daily insulin injections. Some patients may be candidates for islet cell or pancreas transplant
- Treatment of type 2 diabetes typically includes appropriate diet, exercise, home glucose testing, oral medication/tablets and/or insulin. More recently medications that are not insulin but are injectable have become available and are useful in controlling blood glucose. Pancreas or islet cell transplant is not usually given to patients with type 2 diabetes.
Currently the only known cure for diabetes is a pancreas/islet cell transplant. For patients not receiving a transplant, taking medications along with diet and exercise is very effective in controlling blood sugar and avoiding complications.
Remember That Good Care Makes a Difference
People with diabetes should
- have their doctor measure their A1C level at least twice a year. They should aim to keep it at less than 7 percent.
- work with their doctor regarding insulin injections, medicines, meal planning, physical activity, and blood glucose monitoring.
- have their blood pressure checked several times a year. If blood pressure is high, they should follow their doctor’s plan for keeping it near normal levels. They should aim to keep it at less than 130/80.
- ask their doctor whether they might benefit from taking an ACE inhibitor or ARB.
- ask their doctor to measure their kidney function at least once a year to learn how well their kidneys are working.
- ask their doctor to measure the amount of protein in their urine at least once a year to check for kidney damage.
- ask their doctor whether they should reduce the amount of protein in their diet and ask for a referral to see a registered dietitian to help with meal planning.