Type 2 Diabetes

Type 2 diabetes is the number one cause of kidney failure in the U.S. Each year, more than 40% of kidney failure is due to type 2 diabetes.1 Diabetes can damage the tiny blood vessels inside your kidneys that filter wastes and water out of your blood. 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 what you need and lets out what you don’t. Diabetes can harm 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 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 test will show if you have tiny amounts of protein in your urine. If so, it is a warning that your kidneys are at risk and you need to protect them. 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 three-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 blood sugars. New blood glucose monitors let you test painlessly on your arm — instead of your finger. Learning what makes your blood sugars go up or down will help you stay in control.
  • Keep your blood sugar in control with diet, exercise, and medications. The better your control, the more you protect your kidneys. This advice is even more vital if you have metabolic syndrome, a group of risk factors like:
    • Fat around your middle
    • High triglycerides and bad (LDL) cholesterol
    • High blood pressure
    • High levels of blood clotting factors
    • High level of c-reactive protein in your blood

This syndrome makes problems with small blood vessels much more likely, including vessels in the eyes and kidneys.4

  • Take baby steps. Lifestyle changes are hard to make. Don’t try to change lots of things all at once, choose one and do it for a month or two, then add one more. Reward yourself for successes — even small ones. Keep trying if you don’t succeed the first time. You can do it!
  • Keep a journal with your health history and your blood test results. This tool will help you track your results 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 about 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 2 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 be taking one to protect my kidneys?)
  4. What is my level of kidney function now?
  5. Has my kidney function 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 4 Abdul-Ghani M, Nawaf G, Nawaf F, Itzhak B , Minuchin O, Vardi P. Increased prevalence of microvascular complications in type 2 diabetes patients with the metabolic syndrome. Isr Med Assoc J.2006 Jun;8(6):378-82.