When nephropathy already exists

The more developed the kidney disease is, the more relevant is the degree of high blood pressure for the progression of the disease. If appropriate treatment can keep the blood pressure in the normal range at the stage of micro- or macroalbuminuria, the chances are good that the kidney damage will not proceed or will at least be delayed. This has been demonstrated in several studies. Figure 4.8 shows, as an example, the course of kidney disease in a patient who already had macroalbuminuria as a...

With nephropathy is there a point of no return

Another important question is whether there is any benefit of good blood sugar control once the signs of kidney failure, either micro- or even macroalbuminuria, have appeared. This was disputed for a long time. The opinion was that there was a point of no return, after which there could be no reversing the course of the disease - it would progress inexorably until dialysis was necessary, regardless of how well controlled the blood sugar level was. But the studies of recent years have shown...

How failing kidney function affects diabetes management

To achieve good blood sugar control in the presence of failing kidney function is a difficult task for patient and doctor. There are various reasons for this. In some people with diabetes the insulin sensitivity changes, for reasons that are often unclear the tissues no longer respond as well to insulin. This can lead to a worsening of the diabetes. Insulin - whether made by the body or injected as a drug - is partly broken down in the kidneys. When the kidneys are not functioning properly,...

Is there a threshold above which the risk noticeably increases

This question is of great practical interest for patients and doctors. To put it another way, 'How well must I manage my diabetes for the risk of nephropathy to be minimized Do I have to reach an HbAlc concentration of 6 or 7 or will 8 be enough ' The answer is the lower the HbAlc concentration, the lower the risk of microalbuminuria Neither the DCCT nor the UKPDS could establish a threshold at which the risk either rose or fell significantly. This relationship was the same for both groups,...

When blood pressure is too high in people with diabetes

In people with Type 1 diabetes, blood pressure usually rises only as a result of kidney damage. Whereas previously mainly normal blood pressure readings were obtained, as soon as microalbuminuria appears, the blood pressure begins to rise, although at first it may stay in the normal range. For example, if under normal albuminuria it was 125 80 mmHg, after the onset of microalbuminuria it might rise to 130 85 mmHg, then later to 135 90 mmHg. This is why there is no 'official' value for...

How does diabetes affect the kidneys

Generally, the changes produced in the kidneys by diabetes occur very slowly, taking place over years (Table 2.2, Figure 2.4). If they are recognized early, they can - with the right treatments - be reversed. The changes start, at the onset of diabetes, with an increase in the size of the kidneys and in the amount of blood passing through them. This first, early stage is known as 'the hypertrophy and hyperfunction stage' (stage 1) because of the enlarged kidneys, enriched in blood. Even at this...

Six grams of salt a day are enough

On average, each of us consumes about 9 grams of salt a day. Someone who likes to season their food can easily consume up to 12 or 15 grams a day Nutritionists, on the other hand, recommend only 6 grams per day. This amount is absorbed by the body from a mixed diet through the natural salt content of the foodstuffs, without the need for adding more salt. You should remember that the salt content of food is highly variable, so that it is easy to exceed the target amount. See Table 4.2 for a list...