Diabetic Nephropathy

By Eileen B. Wyner, NP
Bulfinch Medical GroupEileen W

Diabetic Nephropathy (DN) or kidney disease is a potential complication of Diabetes. It may occur in people who have been living with Diabetes for a long time, as well as in people whose Diabetes is poorly controlled.  All people with Diabetes are at risk for DN but it appears that risk may be higher for people who are of Hispanic, African American, or Native American ethnicity.   

We are born with two kidneys which are responsible for several important bodily functions, the most well known being the making of urine (necessary for the removal of waste products from the bloodstream).  The kidneys also help to control blood pressure by regulating our water and mineral balance (also known as our electrolyte balance), and maintain red blood cell count by signaling the bone marrow to increase production of these cells.  Kidney disease occurs when blood sugars are continually too high. The filter system in the kidneys becomes damaged, allowing small amounts of protein to leak out through the urine. This is a painless condition without any symptoms at first, but over time will lead to high or hard to control blood pressure and lower extremity swelling if not treated.

The first step in preventing DN is maintaining good blood sugar control—the closer to goal you can keep your A1C safely, the better it is for your kidneys.  The next step is getting a microalbumin test when you see your health care provider.  This test checks for the presence of a protein called albumin in the urine.  Albumin is normally found in the blood and filtered by the kidneys; when kidneys are working properly albumin is not found in the urine.  When the kidneys are damaged, small amounts of albumin leak out into the urine.  This condition is called microalbuminuria.  The American Diabetes Association recommends receiving a microalbumin test at diagnosis and at least annually afterwards.

Managing elevated microalbuminuria includes working hard at getting your A1C to goal and starting a medication from the class ACE or ARB.  You may know these medications by their common names:  lisinopril or diovan. These medications are used for blood pressure control and are also a good choice for protecting your kidneys.  You may already be on one of these medications and the dose may need to be adjusted as needed.

Long term complications of DN can increase your chance of developing heart or blood vessel disease. Your kidneys may fail and you may need to start dialysis to filter your blood.  You may even need a kidney transplant. There is no cure for DN, however early identification and treatment can decrease worsening complications. When you go for your next Diabetes appointment, ask your health care provider about a microalbumin test to check your kidney status and start working on preserving it.

Heart Health, Nutrition

Hold the Salt

Salt and Pepper Shakers

Last week the USDA released the updated Dietary Guidelines for Americans for 2010.  In addition to limiting trans fats and eating more whole grains, fruits and vegetables, the new guidelines recommend people over 51 and those who have Diabetes or hypertension consume no more than 1,500 mg of sodium a day (that’s about a half a teaspoon).  Sodium—or salt— is a necessary nutrient for living; it balances water and electrolytes in cells, and helps nerves send messages to our muscles.  Most Americans consume much, much more than the recommended daily amount, and although we need some sodium in our diets to keep our bodies functioning, too much sodium can actually be harmful. 

High blood pressure (hypertension) is a medical condition where blood passes through blood vessels with too much force, forcing the heart to work harder to pump blood through the body.  Uncontrolled blood pressure can damage blood vessels which in turn can lead to serious heart complications such as heart attack and stroke.  So where does sodium fit in to this? Sodium attracts water; eating too much sodium can cause the body to hold on to water.  The extra fluid in the body puts pressure on blood vessels which in turn raises blood pressure.  

Some foods are natural sources of sodium, for instance dairy, meat and bread (salt works with yeast to make bread rise) and of course salt is added to many foods during the cooking process and at the table right before eating.  The greatest source of sodium in our diets, however, comes from packaged and processed foods where salt is used to preserve shelf-life and add flavor.  To get an idea of the sodium in food, check out this page which lists sodium content in many popular grocery store and restaurant items.    

When in doubt, check the Nutrition Facts on the back of the package; it’ll say how much sodium is in each serving.  Even foods whose packaging saying it’s “healthy” (like some brands of frozen dinners and canned soups) contain large amounts of sodium.  Whenever possible, opt for fresh foods over deli meat and packaged meals.  Try using dried spices and herbs for a low-sodium way to add flavor to a meal. 

What do you think about the new recommendations?  Do you think cutting back on the sodium in your diet will be difficult?

(Information reviewed by MGH Cardiologist and  Nutrition Department)
Heart Health, Nutrition

Heart Health Month: Healthy Diet, Healthy Heart

Apple, glass of milk, bread and heart

Remember the old saying “you are what you eat”? No, it doesn’t mean you’ll turn into a hot dog if you eat one every day—it’s the idea that diet has an impact on your health. Considering what we know about the link between heart disease and a diet high in saturated fat, there does seem to be some proof to that that statement.

But not everything is doom and gloom; some studies have shown that a healthy diet can have a positive impact on the health of your heart. For instance, a recent study suggests that a diet rich in whole grains is as effective at lowering high blood pressure as blood pressure medications. But probably the best known study looking at the effect of diet on blood pressure was the National Heart Lung and Blood Institute’s DASH (Dietary Approaches to Stop Hypertension) study.

Results for the study showed that the DASH eating plan—which emphasizes fruits, vegetables and low-fat dairy as well as whole grains, poultry and nuts while limiting saturated fat, cholesterol and sweets—was effective at lowering blood pressure among participants. The DASH eating plan was also higher in potassium, a nutrient that helps the heart beat properly, than a typical American diet (for more information about the study, check out this brochure from the National Institutes of Health).

So clearly, what you eat can have both positive and negative effects on your health. Because of the connection between Diabetes and high blood pressure, it’s important to take good care of your heart. But remember, diet is just one component of a healthy lifestyle; regular exercise is also a key part of maintaining overall health and wellness.

Be sure to talk to your Diabetes care team if you have any questions about your meal plan.

(Information reviewed by MGH Nutrition Department)