Diabetes Mellitus is one of the chronic illnesses the global community unanimously took part in combat against it. It is easily preventable by adopting a healthy lifestyle but once an individual is diagnosed, management can be quite challenging because treatment options depend on your body’s response towards the medications. If not controlled strictly, complications are:

Short term

  • Hypoglycemia
  • Hyperglycemia
  • Diabetic ketoacidosis
  • Hyperglycemic Hyperosmolar State
  • Lactic acidosis

Long term

  • Microvessels: Kidney disease (Nephropathy), nerve disease (Neuropathy), Eye disease (Retinopathy)
  • Macrovessel: Stroke, heart disease (diabetic cardiomyopathy), vessel blockage in the legs (peripheral vascular disease), atherosclerosis (fat deposits in the blood vessel)
  • Skin problems including slow-healing wounds
  • Susceptible to infections such as urinary tract infections and skin infections
  • Pregnancy complications such as miscarriage or inborn physical deformities

In 2009–2011, diabetes was the primary cause of End-Stage Renal Disease (ESRD) in about 60% of patients in Malaysia, Mexico, and Singapore. The incidence of ESRD due to diabetes also rises in the older age group. Hence, a kidney function test is one of the main investigations done during a follow-up. The presence of albumin protein urine is quantified and a high amount of it in the urine increases the chances of being diagnosed with complications of kidney failure.

How does diabetes cause kidney problems?

Kidney problems caused by diabetes is also known as diabetic nephropathy. Kidneys contain tiny blood vessel clusters called glomeruli that filter waste in the body. Over time the high blood sugar associated with diabetes cases, especially ones which are not well managed causes high blood pressure. Consequently, the increased pressure in the kidney’s filtration system decreased kidney function and kidney failure.

How do I know if I have kidney problems?

If not diagnosed earlier through blood and urine tests and only after the appearance of physical signs and symptoms of kidney dysfunction, the individual is in urgent need of medical’s attention. Please see your doctor as soon as possible if :

  • Increasing blood pressure level
  • A large number of bubbles in urine
  • Swelling of feet, ankles, hands or eyes
  • Increased need to urinate
  • Less need for insulin or diabetes medicine
  • Confusion or difficulty concentrating
  • Loss of appetite
  • Nausea and vomiting
  • Persistent itching
  • Easily tired

How does Glucophage protect kidneys?

Glucophage is just one of the trade names sold under the medication type known as Metformin. Metformin belongs to the category non-sulfonylureas, also known as biguanides. Glucophage is generally safe with high effectiveness and fewer side effects if compared to other anti-diabetic medications. Aside from its blood glucose-lowering function, it also has a vital role in the protection of kidneys. At the molecular level, Metformin normalizes blood sugar level thus reduces oxidative injury on kidney cells. However, since last year, after years of countless research, FDA reaches a decision that recommends Metformin to be used cautiously in patients with moderate severity of Chronic Kidney Disease (eGFR more than 30 mL/min/1.73 m2). Use of metformin at an eGFR < 30 mL/min/1.73 m2 is associated with higher acidosis risk and therefore should not be used.

Will all diabetic get diabetic kidney disease?

No, because it is a preventable complication. As the saying goes, prevention is better than cure. As part of the recommended treatment by DoctorOnCall, a patient requires dietary salt restrictions, adherence to the prescription schedule, regular follow-ups and active lifestyle. Not to forget, quit smoking and taking alcohol.

The same advice applies to those who already have developed mild to moderate kidney disease. Preventative steps are recommended as it helps to prevent or delay kidney failure. Kidney failure occurs when the kidneys are functioning at less than 15% than normal.

References

  1. Lim A. (2014). Diabetic nephropathy – complications and treatment. International journal of nephrology and renovascular disease, 7, 361–381. doi:10.2147/IJNRD.S40172
  2. De Broe, M. E., Kajbaf, F., & Lalau, J.-D. (2017). Renoprotective Effects of Metformin. Nephron, 138(4), 261–274. doi: 10.1159/000481951
  3. (2018, September 21). Lactic Acidosis Risk in Metformin Patients With Reduced Kidney Function. Retrieved from http://www.diabetesincontrol.com/caution-using-metformin-for-patients-with-reduced-kidney-function/