Type 1 Diabetes

Type 1 diabetes is the number 4 cause of kidney failure in the U.S. Each year, about 4% of kidney failure is due to type 1 diabetes.1 Diabetes can damage the tiny blood vessels inside your kidneys that filter out wastes and water. A healthy kidney has a million or so nephrons, or filters. Each nephron has a glomerulus — a tangled ball of blood vessels that keeps in cells you need and lets out what you don’t. Diabetes first harms the glomeruli. The vessel walls thicken and leak. An early sign that this is going on is microalbuminuria — tiny amounts of protein in your urine. Protein is a large cell that only leaks out when something is wrong. At a later stage, your urine might be foamy or bubbly. This means a bigger loss of protein.

What You Can Do

There is a lot of good news if you have diabetes. In fact, 30 years ago, nearly 1 in 3 people with diabetes could expect to have kidney failure. Today, it’s just 1 in 10.2

  • Don’t panic! It takes at least 10 years for kidney damage to occur — and if you have had type 1 diabetes for 25 years and don’t have kidney damage, you most likely never will.3
  • Ask for a urine test for microalbumin once a year – this will show if you are spilling tiny amounts of protein. If you are, this is a warning that your kidneys are at risk and you need to protect them. (While you’re at it, set up an eye check visit, too.) Even if you have protein in your urine, it can take 5-10 more years to lose enough function to have symptoms. So, you may have time to take action.
  • Get your hemoglobin A1c level checked each quarter. This 3-month average of your blood sugar levels is a great way to see how you are doing over time. Diabetes Guidelines for doctors recommend checking it every 3 months.
  • Check fasting and post-meal sugars. New blood glucose monitors let you test painlessly on your arm — instead of your finger.
  • Keep your blood sugar in control with diet, exercise, and medications. The better your control, the more you protect your kidneys. Using an insulin pump can make it easier to stay in control.
  • Keep a journal with your health history and your blood test results – this tool will help you track them over time to see how you’re doing.
  • Your best bet to prevent or slow kidney damage is to keep your blood pressure low (120/80 or less). If you have high blood pressure, take your pills as prescribed. Ask your doctor to change your drug if side effects or costs keep you from taking the one(s) you have.
  • Ask for an ACE-inhibitor or ARB. Even if your blood pressure isn’t high, these two classes of blood pressure pills can help protect your kidneys when you have diabetes.

Questions to Ask Your Doctor if You Have Type 1 Diabetes

  1. Am I doing all I can to protect my kidneys?
  2. If not, what more can I do?
  3. Is one of my blood pressure drugs an Ace-inhibitor or an ARB? (If not, should I take one to protect my kidneys?)
  4. What is my level of kidney function now?
  5. Has it changed over time, and if so how much?
  6. Based on where I am right now, what can I expect for my kidneys in the future?

Links to Learn More

1 USRDS 2006 ADR, table A.7 2 http://www.nih.gov/about/researchresultsforthepublic/kidney.pdf 3 http://kidney.niddk.nih.gov/kudiseases/pubs/kdd/index.htm