By Dr Sunita Bavanandan

ANDY, a diabetic, is a well-educated man with a demanding job. He thought he had things under control when he decided to turn to self-medication for his condition since he was so busy.

So, he defaulted on his follow-up visit to the doctor and decided to buy over-the-counter medications. He continued this for many years until he experienced increasing lethargy and early morning nausea. A check-up confirmed he had kidney failure and his diabetes control was poor.

In hindsight he wished he had taken the time to seek professional help for his diabetes management.

Anna is a 40-year-old who had everything; a wonderful husband, a high-paying job and a house to call her own. Fifteen years ago, she developed diabetes during her pregnancy and was treated for it. She thought she was all right after that so she subsequently never went for any tests, and never saw a doctor except for minor ailments like the flu.

Little did she know, many years after this episode of diabetes during pregnancy, her blood sugar levels had started to rise and she had become pre-diabetic. Only after her elder brother was diagnosed to have diabetes did she go for a medical check-up herself. By then she was diagnosed to already have type 2 diabetes..

Anna and Andy are just a few out of the many people suffering from diabetes and kidney disease. Some do not even realise that they are at risk of having diabetes or that their kidneys are failing.

Here is what you need to know about diabetes and kidney problems.

How diabetes affects kidneys

The kidneys function to cleanse blood from any waste products and excess fluid by filtering blood to produce urine. When the kidneys are unable to filter normally, dangerous accumulation of fluid and wastes occurs in the body.

It usually takes 10 to 20 years for diabetic patients with kidney disease to develop kidney failure. This provides a big window of opportunity for kidney failure to be prevented.

However, in many instances, diabetes has already been present many years before it is detected, and organ damage may already exist at the time of diagnosis. This is why early detection of diabetes is important. Early preventive measures must be taken to control your diabetes and prevent kidney failure.

What is diabetes mellitus?

Diabetes mellitus is a condition where there is insufficient insulin produced by the pancreas or the body is unable to respond to the insulin normally. Blood glucose levels will then rise and cause damage to organs, including the kidneys.

Did you know that diabetes mellitus is the leading cause of end-stage kidney failure in Malaysia? According to the 14th Report of the Malaysian Dialysis and Transplant Registry 2006, 57 per cent of kidney failure patients had diabetes mellitus.

Kidney care for people with diabetes

Manage your diabetes

Managing your diabetes well can prevent or slow down the progress of your kidney disease, especially if your diabetes was detected early.

Achieve and maintain your targeted blood glucose and blood pressure. High levels of these are the main factors that contribute to kidney damage. In addition, if there is already kidney damage with protein leaking into urine, it is important to minimise this protein leak because it will cause further injury to the kidneys. This is usually achieved with good blood pressure control and appropriate medication.

Patients with diabetes and kidney disease are at an increased risk of heart attacks and strokes so it is also important to achieve good control of lipid levels, exercise and control weight, as well as stop unhealthy habits such as smoking. The following shows the targets to achieve:

Blood glucose: 4.0mmol/L to 6.0 mmol/L (fasting); and less than 7-8 mmol/L after food

HbA1c: Less than or equal to 6.5%

LDL cholesterol: Less than 2.6 mmol/L

Triglycerides: Less than 1.7 mmol/L

HDL cholesterol: More than 1.02 mmol/L

Blood pressure: 130/80 mmHg or lower

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