October /November 2001

Diabetes - The Medical Perspective

Diabetes & Your Kidneys

Our kidneys are incredibly powerful filters! They get rid of poisons and waste products from our body and save all the important things. The kidneys do all this using millions of tiny, delicate filtering units called glomeruli. Diabetes can damage these small filters. Kidney damage is more common in those who have diabetes.

Normally proteins in your blood are too large to get through glomeruli filters - so they are saved. When these filters are damaged, protein, may leak into the urine. One protein that will leak into the urine when the kidneys are damaged is albumin.

Several years after a person has been spilling albumin in their urine, the kidneys may begin to spill larger amounts of protein. This can be detected by a standard urine dipstick.

Not all people who have diabetes will develop kidney disease. Because many do, it’s important to have your kidneys checked. This way treatment can start early.

If you know you have albumin in your urine you can take steps to protect your kidneys from further damage.

You should be tested for microalbuminuria every year if

1. you have had type I diabetes for more than five years
2. you have type II diabetes.

If you are not sure if your doctor has checked your urine, ask about it at your next visit. Your doctor may have tested you for protein in your urine (called proteinuria). It is a simple dipstick test, done in the doctor's office. If that test is negative, you should ask about the more sensitive test that can detect small amounts of albumin in urine (microalbuminuria).

If you have proteinuria or microalbuminuria, ask your doctor if you should go on a low-protein diet. If your doctor says yes, ask to talk to a registered dietitian (RD). It is hard to plan a well-balanced low protein diet without professional guidance. A dietitian can help you work out a healthy, low-protein meal plan.

Diabetes and Food

When it’s hot and humid there is one nutrient that gushes to mind - water! To keep your body working it needs an ongoing supply of water.

Your body will lose more water in hot weather and during strenuous exercise, so it is important to remember to drink more. Sometimes we don’t feel thirsty even though we’ve lost a lot of water and need to replenish ourselves. This happens more often as we age.

With even mild water loss or dehydration you can begin to feel sluggish and weak. With more water loss a person can suffer from heat exhaustion or heat stroke.

Drinking water and other beverages are the easiest source of water. We "eat" a lot of water in solid foods as well. Juicy fruits and vegetables can contain up to 90% water!

How much water do you need each day? During mild weather and without strenuous activity, a person needs about 1 to 1 1/2 liters of water for every 1,000 calories. That is about 8 cups of water if you are eating 2000 calories.
However, you’ll need more water if it is very hot or very cold, you are exercising, you are eating a high fiber diet, you are ill, or if you are pregnant or breastfeeding.

If you seem to be always thirsty or always urinating, talk to your doctor. Make sure you are checking your blood sugar. High blood sugar can make you feel excessively thirsty and cause you to urinate more often.

Exercise as a Part of Living

Experts now suggest that those with diabetes who are over 35 and have not been involved in regular activity obtain a physical exam and stress test before starting an exercise program. The exam should include:
Level of glycemic control as measured by blood sugar and hemoglobin A1C.
A cardiovascular exam as measured by

• blood pressure
  
• peripheral pulses
  
• bruits
  
• blood lipids
  
• EKG at rest and during activity for those with known cardiovascular disease, those who are over 30 years of age with type 1 diabetes; those with type 1 diabetes for longer than 15 years; or those older than 35 years of age with type 2 diabetes.
• A neurological evaluation.
• An eye exam by an ophthalmologist or a certified optometrist.

Recipes to Try

Summer Squash with Dill

(4 Servings)

4 yellow summer squash or zucchini, about 5-6" long and 1 1/2" in diameter, washed
1 tablespoon liquid margarine
1-2 teaspoondried dill weed

1. Slice squash. Steam in vegetable steamer or in small amount of water until color has changed, about 5 minutes.
2. Remove from steamer and place drained squash in bowl. Drizzle liquid margarine and toss lightly.
3. Sprinkle dill weed on top and serve

Per serving:

Apple and Pineapple Chill

(6 servings)

1 can (20 oz.) crushed pineapple in its own juice
1/2 c. cold water
1 small apple, grated fat-free whipped topping
1 pkg. unflavored gelatin

1. Combine crushed pineapple and unflavored gelatin in a saucepan. Allow gelatin to soften 5 minutes.
2. Bring to a boil, stirring to dissolve gelatin. Remove from heat. Stir in cold water.
3. Fold in grated apple. Chill until firm.
4. Top with 2 tbsp. fat-free whipped topping to serve.

Per serving:

Note: Gel will turn the color of the apple peel unless folded after the mixture begins to set, or peel the apple before grating.

Medication Update

Devices for taking insulin

Most people who take insulin to manage their blood glucose inject the insulin with a needle and syringe. This delivers insulin just under the skin.
Several other devices for taking insulin are now available, and even more are under development.

Insulin pens can be helpful if you want the convenience of carrying insulin with you in a private way. An insulin pen looks like a regular pen with a cartridge. Some pens use replaceable cartridges of insulin; other pen models are totally disposable. The tip of the pen is similar to the needle on an insulin syringe. To select the desired dose of insulin you turn a dial and press a plunger on the end of the pen to deliver the insulin just under the skin.

Insulin jet injectors send a fine spray of insulin through the skin by a high pressure air mechanism instead of needles. This is similar to some flu shots you may have received.

External insulin pumps connect to narrow, flexible plastic tubing that
ends with a needle inserted just under the skin near the abdomen. The insulin pump is about the size of a deck of cards, weighs about 3 ounces, and can be worn on a belt or in a pocket. Users set the pump to give a steady amount of insulin continuously throughout the day. Pumps release larger amounts of insulin (several units at a time) at meals and at times when blood sugar is too high.

Devices under development include:

Implantable insulin pumps that are surgically implanted, usually on the left side of the abdomen.

The insulin patch which is placed on the skin to give a continuous low dose of insulin.

The inhaled insulin delivery system which provides insulin as a dry powder that is inhaled through the mouth directly into the lungs where it passes into the bloodstream.

New Resources

The following are resources focus on kidney health and are available through the National Kidney and Urologic Diseases Information Clearinghouse, 3 Information Way, Bethesda, MD 20892-3580, or via the internet at http://www.niddk.nih.gov/health/kidney/kidney.htm or from the National Diabetes Information Clearinghouse, 1 Information Way, Bethesda, MD 20892-3560; ndic@info.niddk.nih.gov. Single copies are generally free.

Prevent Diabetes Problems: Keep Your Kidneys Healthy, NIH Publication No. 00-4281, May 2000.

Kidney Disease of Diabetes. NIH Publication No. 01-3925, July 1995; Updated: April 2001.

Your Kidneys and How They Work, NIH Publication No. 98-4241, March 1998.