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Prevent diabetes problems

Keep your kidneys healthy

Number

3in a

Series

of 7

National Diabetes Information

Clearinghouse

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 Prevent diabetes problems:

Keep your kidneys healthy

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 Contents

Whatarediabetesproblems?..................................1

WhatshouldIdoeachdaytostayhealthy withdiabetes?...........................................................2

Whatdomykidneysdo?..........................................3

HowcanIpreventdiabetes

kidneyproblems?.....................................................4 Howcanmydoctorprotectmykidneysduringspecialx-raytests?........................................6

Howcandiabeteshurtmykidneys?

WhatcanIdoifIhavekidneyproblems

.......................7

causedbydiabetes?..................................................9

HowwillIknowifmykidneysfail?......................10

Whathappensifmykidneysfail?.........................11

WillIknowifIstarttohavekidneyproblems?......13

HowcanIfindoutifIhavekidneyproblems?...................................................13

PronunciationGuide...............................................14

ForMoreInformation...........................................15

MoreintheSeries..................................................18  Acknowledgments..................................................19

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What are diabetes problems?

Toomuchglucoseinthebloodforalongtimecancausediabetesproblems. Thishighbloodglucose,alsocalledbloodsugar,candamagemanypartsofthebody,suchastheheart,bloodvessels,eyes,andkidneys. Heartandbloodvesseldiseasecanleadtoheartattacksandstrokes. Youcandoalottopreventorslowdowndiabetesproblems.

Ureters

Kidneys

Bladder

Yourkidneysaretwobean-shapedorgansaboutthesizeofyourfist. Theyarelocatedjustbelowthe

ribcage,nearyourback.

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 What should I do each day to stayhealthy with diabetes?

Followthehealthyeatingplanthat youandyourdoctorordietitianhave workedout.

Beactiveatotalof30minutesmost

days. Askyourdoctorwhatactivitiesarebestforyou.

Takeyourmedicinesasdirected.

Checkyourbloodglucoseeveryday.

Eachtimeyoucheckyourbloodglucose,writethenumberinyourrecordbook.

Checkyourfeeteverydayforcuts,blisters,sores,swelling,redness,or

soretoenails.

Brushandflossyourteetheveryday.

Controlyourbloodpressureandcholesterol.

Don’tsmoke.

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 What do my kidneys do?

Thekidneysactasfilterstocleantheblood. Theygetridofwastesandsendalongfilteredfluid.Thetinyfiltersinthekidneysarecalledglomeruli.*

Whenkidneysarehealthy,thearterybringsbloodandwastesfromthebloodstreamintothekidneys.Theglomerulicleantheblood. Thenwastesand

extrafluidgooutintotheurinethroughtheureter.Cleanbloodleavesthekidneysandgoesbackintothebloodstreamthroughthevein.

 Glomeruli(tiny filters in

the kidney)

Ureter

(wastes and fluid

go out in urine)

Vein(clean blood

leaves the kidney)

Artery(blood and wastes

enter the kidney)  ➔

➔          ➔

Youhavetwokidneys.Yourkidneyscleanyourbloodandmakeurine. Thisdrawingshowsacrosssectionofakidney.

*Seepage14fortipsonhowtosaythewordsinboldtype.

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 How can I prevent diabeteskidney problems?●  Keepyourbloodglucoseasclosetoyourgoalas

 youcan. Formanypeople,thislevelisasclosetonormalaspossible. Forothers,ahigherbloodglucosegoalmaybebetter. Askyourdoctor

 whatbloodglucosenumbersarehealthyforyou.

●  Keepyourbloodpressurebelow140/80tohelppreventkidneydamage. Bloodpressureiswritten

 withtwonumbersseparatedbyaslash. Forexample,120/70issaidas“120over70.”

Forsomepeople,ahigherbloodpressuregoal

maybebetter. Askyourdoctorwhatnumbersarebestforyou. Ifyoutakebloodpressurepillseveryday,takethemasyourdoctortellsyou.Keepingyourbloodpressureundercontrolwillalsoslowdownorpreventdamagetoyoureyes,heart,andbloodvessels.

Keepyourbloodpressureundergoodcontrol.

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 ●  Askyourdoctorifyoushouldtakepillstoslowdownkidneydamage. Twokindsareavailable:

•  ACE(angiotensin-convertingenzyme)inhibitor

•  ARB(angiotensinreceptorblocker)●  Followthehealthyeatingplanyouworkoutwith

 yourdoctorordietitian. Ifyoualreadyhave

kidneyproblems,yourdietitianmaysuggestyoucutbackonprotein,especiallyanimalproductssuchasmeat,milk,cheese,andeggs.

●  Haveyourkidneyscheckedatleastonceayearbyhavingyoururinetestedforprotein. Thistestiscalledtheurinaryalbumintest.

●  Haveyourbloodtestedatleastonceayearforcreatinine. Theresultofthistestshouldbeusedtofindyourglomerular ltrationrate(GFR),ameasureofkidneyfunction.

Pillscanhelpyoucontrol yourbloodpressureandslowdownkidneydamage.

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 ●  Haveanyotherkidneytestsyourdoctorthinksyouneed .

●  Avoidtakingpainkillersregularly.Dailyuseofpillslikeaspirinoracetaminophencandamagethekidneys. Takingasingledoseofaspirineverydaytoprotecttheheart,however,shouldbesafe.Takingacetaminophenforoccasionalpainshouldalsobesafe. Butifyouaredealingwithchronic

pain,suchasarthritis,workwithyourdoctortofindawaytocontrolyourpainwithoutputting yourkidneysatrisk.

●  Seeadoctorrightawayforbladderorkidneyinfections. Youmayhaveaninfectionifyouhavethesesymptoms:

• painorburningwhenyouurinate

• afrequenturgetogotothebathroom• urinethatlookscloudyorreddish• feverorashakyfeeling• painin yourbackoron yoursidebelowtheribs

How can my doctor protect mykidneys during special x-ray tests?X-raytestsusingacontrastagentposeariskto

 yourkidneys. Ifyouneedxrays,yourdoctorcangiveyouextrafluidandmedicinebeforeandafterthexraystoprotectyourkidneys. Oryourdoctormaydecidetoorderatestthatdoesnotuseacontrastagent.

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How can diabetes hurt my kidneys?

Whenthekidneysareworkingwell,thetinyfiltersinyourkidneys,theglomeruli,keepbloodproteinsinsideyourbody. Youneedtheseproteinstostayhealthy.

Highbloodglucoseandhighbloodpressuredamagethekidneys’filters. Whenthekidneysare

damaged,proteinsleakoutofthekidneysintotheurine. Theurinaryalbumintestdetectsthislossofproteinintheurine. Damagedkidneysdonotdoagoodjoboffilteringoutwastesandextrafluid.Wastesandfluidbuildupinyourbloodinsteadofleavingthebodyinurine.

Kidneydamagebeginslongbeforeyounoticeanysymptoms. Anearlysignofkidneydamageiswhen

 yourkidneysleaksmallamountsofaproteincalledalbuminintotheurine. Buttheonlywaytoknowaboutthisleakageistohaveyoururinetested.

Withmoredamage,thekidneysleakmoreandmoreprotein. Moreandmorewastesbuildupintheblood. Thisdamagegetsworseuntilthekidneysfail.

Diabetickidneydisease(DKD)isthemedicaltermforkidneyproblemscausedbydiabetes. DKDaffectsbothkidneysatthesametime.

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Healthy kidney

Ureter

(wastes and fluid)

Artery

(blood and wastes)

Vein

(clean blood)

Noalbumin,aprotein,isleakingfromthehealthykidney.

      ➔

➔    ➔ 

Unhealthy kidney

Ureter(wastes, fluid,

and protein)

      ➔

➔     ➔ 

Vein

(blood with

waste products)

Albumin

Artery

(blood and wastes)

 Albumin,aprotein,is

leakingfromtheunhealthykidney.

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What can I do if I have kidneyproblems caused by diabetes?

Onceyouhavekidneydamage,youcanslowitdownorstopitfromgettingworsebycontrolling

 yourbloodglucoseandbloodpressure. Takingan ACEinhibitororan ARBisimportantforbothcontrollingyourbloodpressureandreducing

kidneydamage. However,ifyouarepregnant,youshouldnottakean ACEinhibitoror ARB.Ifyouhavediabetes,youshouldhaveyoururineandbloodtestedregularlytoseehowwellyourkidneysareworking. Thetestresultsshouldbegivento youas yoururinealbuminandGFRresults.

Keepingbloodpressureundercontrolhelpstokeepyourkidneyshealthy.

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How will I know if my kidneys fail?

 Atfirst,youcannottell.Kidneydamagefromdiabeteshappenssoslowlythatyoumaynotfeelsickatallformanyyears. Youwillnotfeelsickevenwhenyourkidneysdoonlyhalfthejobofnormalkidneys. Youmaynotfeelanysignsofkidneyfailureuntilyourkidneyshavealmoststoppedworking. However,gettingyoururineandbloodcheckedeveryyearcantellyouhowwell

 yourkidneysareworking.

Onceyourkidneysfail,youmayfeelsicktoyourstomachandtiredallthetime. Yourhandsandfeetmayswellfromextrafluidinyourbody.

Youmayfeelsick

toyourstomach whenyourkidneysstopworking.

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 What happens if my kidneys fail?

Onewaytotreatkidneyfailureiswithdialysis.

Dialysisisatreatmentthatdoessomeofthework yourkidneysusedtodo. Twotypesofdialysisareavailable(seepage12). Youand yourdoctor willdecidewhattypewillworkbestforyou.

Dialysisisatreatmentthattakeswasteproductsandextrafluidoutofyourbody.

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 1. Hemodialysis. Inhemodialysis,yourbloodflowsthroughatubefromyourarmtoa

machinethatfiltersoutthewasteproductsandextrafluid. Thecleanbloodflowsbacktoyourarm.

2. Peritonealdialysis. Inperitonealdialysis,yourbellyisfilledwithaspecialfluid. Thefluidcollectswasteproductsandextrawaterfrom

 yourblood. Thenthefluidisdrainedfromyourbellyandthrownaway.

 Anotherwaytotreatkidneyfailureistohaveakidneytransplant. Thisoperationgivesyouanewkidney. Thekidneycanbefromaclosefamily

member,friend,orsomeoneyoudonotknow. Anewkidneymustbeagoodmatchforyourbody.Youmaybeondialysisforalongtimebecausemanypeopleareonawaitinglistforanewkidneyfromdonorstheydonotknow. Youaremorelikelytohaveakidneytransplantifyouknow

someonewhoisabletodonateakidneytoyou.

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Will I know if I start to havekidney problems?

Notlikely. Youwillknowyouhavekidneyproblemsifyourdoctorchecksyourbloodforcreatininetomeasure yourGFRand yoururineforalbumin. Donotwaituntilyoufeelilltohave

 yourbloodandurinecheckedforsignsofDKD.

How can I find out if I havekidney problems?

Twolabtestscantellyouandyourdoctorhowwell yourkidneysareworking.

● Eachyear,makesureyourdoctorchecksasampleofyoururinetoseeifyourkidneysareleakingsmallamountsofalbumin.

●  Atleastonceeachyear,yourdoctorshouldcheckyourbloodtomeasuretheamountofcreatinine. Creatinineisawasteproductyourbodymakes. Ifyourkidneysarenotcleaning

 wasteproductsfromyourblood,theycanbuildupandmakeyousick. Yourdoctorcanuseyourcreatinineleveltocheck yourGFR. Resultsofthistesttellyouhowwellyourkidneysareremovingwastesfromtheblood.

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 Pronunciation Guide

albumin (al-BYOO-min) angiotensin (AN-jee-oh-TEN-sin) artery (AR-tur-ee) creatinine (kree-AT-ih-neen) dialysis (dy-AL-ih-siss) glomerular (gloh-MAIR-yoo-lur) glomeruli (gloh-MAIR-yoo-ly) hemodialysis (HEE-moh-dy-AL-ih-siss) inhibitor (in-HIB-ih-tur) peritoneal (PAIR-ih-toh-NEE-uhl) 

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 For More Information

Diabetes Teachers (nurses,dietitians,pharmacists,andotherhealthprofessionals)

Tofindadiabetesteachernearyou,calltheAmerican AssociationofDiabetesEducatorstoll-freeat

1–800–338–3633,orlookontheInternetat www.diabeteseducator.org  andclickon“FindaDiabetesEducator.”

Dietitians

Tofindadietitiannearyou,contacttheAcademyofNutritionandDieteticsat www.eatright.org  and

clickon“FindaRegisteredDietitian.”Government

TheNationalKidneyandUrologicDiseasesInformationClearinghouse(NKUDIC)ispartof theNationalInstitutesof Health(NIH). Tolearnmoreaboutkidneyproblems,writeorcallNKUDIC,3InformationWay,Bethesda,MD20892–3580,1–800–891–5390;orsee www.kidney.niddk.nih.govontheInternet.

The National Kidney Disease Education Program

(NKDEP)ispartof theNIH. Tolearnmoreaboutkidneyproblems,writeorcallNKDEP,3KidneyInformationWay,Bethesda,MD20892,1–866–454–3639;orsee www.nkdep.nih.govontheInternet.

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Togetmoreinformationabouttakingcareofdiabetes,contact

National Diabetes Information Clearinghouse1InformationWayBethesda,MD 20892–3560Phone: 1–800–860–8747TTY: 1–866–569–1162Fax:703–738–4929

Email: ndic@info.niddk.nih.govInternet: www.diabetes.niddk.nih.gov 

National Diabetes Education Program

1DiabetesWayBethesda,MD 20814–9692

Phone: 1–888–693–NDEP(1–888–693–6337)TTY: 1–866–569–1162Fax:703–738–4929Email: ndep@mail.nih.govInternet: www.ndep.nih.gov 

 www.yourdiabetesinfo.org

 American Diabetes Association

1701NorthBeauregardStreet Alexandria,VA22311Phone: 1–800–DIABETES(1–800–342–2383)Email: askADA@diabetes.org

Internet: www.diabetes.org 

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   JDRF

26Broadway,14thFloor

NewYork,NY10004Phone: 1–800–533–CURE(1–800–533–2873)Fax:212–785–9595Email: info@jdrf.orgInternet: www.jdrf.org

National Kidney Foundation

30East33rdStreetNewYork,NY10016Phone:1–800–622–9010or212–889–2210Fax:212–689–9261Internet: www.kidney.org

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More in the Series

ThePreventDiabetesProblemsSerieshassevenbookletsthatcanhelpyoulearnmoreabouthowtopreventdiabetesproblems.

Forfreesinglecopiesofthesebooklets,write,call,fax,oremailthe

NationalDiabetesInformationClearinghouse1InformationWayBethesda,MD 20892–3560Phone: 1–800–860–8747TTY: 1–866–569–1162

Fax:703–738–4929Email: ndic@info.niddk.nih.gov

Thesebookletsarealsoavailableat www.diabetes.niddk.nih.gov ontheInternet.

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 Acknowledgments

PublicationsproducedbytheClearinghouseare

carefullyreviewedbybothNIDDKscientistsandoutsideexperts. TheNationalDiabetesInformationClearinghousethanksthepeoplewhohelpedrevieworfield-testtheoriginalversionofthispublication:

 For the American

 Association ofDiabetes Educators

Lynn Grieger, R.D., C.D.E.  Arlington, VT

Celia Levesque, R.N., C.D.E.

Montgomery,  AL  Teresa McMahon,

Pharm.D., C.D.E.

Seattle, WA

Barbara Schreiner, R.N., M.N., C.D.E.

Galveston, TX

 For the American

Diabetes Association

Phyllis Barrier, M.S.,

R.D., C.D.E.  Alexandria, VA

Linda Haas, Ph.C., R.N., C.D.E.

Seattle, WA

Kathleen Mahoney,

M.S.N., R.N., C.D.E. Drexel Hill, PA

Randi Kington, M.S., R.N., C.S., C.D.E. 

Hartford, CT

 For the Centers for

Medicare & Medicaid

Services

Baltimore, MD

Jan Drass, R.N., C.D.E. 

 For the Diabetes Research

and Training Centers Albert Einstein

School of Medicine

Norwalk Hospital

Norwalk, CT

Jill Ely, R.N., C.D.E. Sam Engel, M.D.

Pam Howard,  A.P.R.N., C.D.E. Indiana University

School of MedicineIndianapolis, IN

Madelyn Wheeler, M.S.,

R.D., F.A.D.A., C.D.E. VA/JDF Diabetes

Research Center Vanderbilt School of

Medicine

Nashville, TN

Ok Chon Allison,

M.S.N., R.N.C.S.,  A.N.P., C.D.E.

Barbara Backer, B.S.

James W. Pichert, Ph.D.

 Alvin Powers, M.D.

Melissa E. Schweikhart

Michael B. Smith

Kathleen Wolffe, R.N. 

 For the Grady Health

System Diabetes Clinic Atlanta, GA

Ernestine Baker, R.N., F.N.P., C.D.E.

Kris Ernst, R.N., C.D.E. Margaret Fowke, R.D., L.D. Kay Mann, R.N., C.D.E. 

 For the Indian Health

Service

 Albuquerque, NM Ruth Bear, R.D., C.D.E. Dorinda Bradley, R.N., 

C.D.E.

Terry Fisher, R.N. Lorraine Valdez, R.N., 

C.D.E.

Red Lake, MN Charmaine Branchaud,

B.S.N., R.N., C.D.E.  For the Medlantic Research

Center

Washington, DC

Resa Levetan, M.D.  For the Texas Diabetes

Council

Texas Department of

Health

 Austin, TX

Luby Garza-Abijaoude, M.S., R.D., L.D. 

The NDIC also thanks Katherine R. Tuttle, M.D., F.A.S.N., F.A.C.P., of  the Providence Medical Research Center, Sacred Heart Medical Center in Spokane, WA, and the University of Washington School of Medicine in Spokane and Seattle for reviewing the updated version

of this publication.

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 1DiabetesWay

National Diabetes Education Program

Bethesda,MD 20814–9692Phone: 1–888–693–NDEP(1–888–693–6337)TTY: 1–866–569–1162Fax:703–738–4929Email: ndep@mail.nih.govInternet: www.ndep.nih.gov

 www.yourdiabetesinfo.org

TheNationalDiabetesEducationProgramisafederallyfundedprogramsponsoredbytheU.S.DepartmentofHealthandHumanServices’NationalInstitutesofHealthandtheCentersfor

DiseaseControlandPreventionandincludesover200partnersatthefederal,state,andlocallevels,

 workingtogethertoreducethemorbidityandmortalityassociatedwithdiabetes.

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National DiabetesInformation Clearinghouse

1InformationWayBethesda,MD20892–3560Phone:1–800–860–8747TTY:1–866–569–1162Fax:703–738–4929Email:ndic@info.niddk.nih.govInternet: www.diabetes.niddk.nih.gov

TheNationalDiabetesInformationClearinghouse(NDIC)isaserviceoftheNationalInstituteofDiabetesandDigestiveandKidneyDiseases(NIDDK). TheNIDDK ispartof theNationalInstitutesofHealthoftheU.S.DepartmentofHealthandHumanServices. Establishedin1978,theClearinghouseprovidesinformationaboutdiabetestopeoplewithdiabetesandtotheirfamilies,healthcareprofessionals,andthepublic. The

NDICanswersinquiries,developsanddistributespublications,andworkscloselywithprofessionalandpatientorganizationsandGovernmentagenciestocoordinateresourcesaboutdiabetes.

Thispublicationisnotcopyrighted. TheClearinghouse

encouragesusersofthispublicationtoduplicateanddistributeasmanycopiesasdesired.

Thispublicationisavailableat www.diabetes.niddk.nih.gov. 

This publication may contain information about medications and,

 when taken as prescribed, the conditions they treat. When prepared,

this publication included the most current information available.For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1–888–INFO–FDA

(1–888–463–6332) or  visit  www.fda.gov.  Consult your health care

provider for more information.

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NIH Publication No 13–4281