Diabetes and Renal Disease
Definition
Diabetes is a disease that occurs when the body is not able to use sugar, as it
should. The body needs sugar for growth and energy for daily activities. It gets
sugar when it changes food into glucose (a form of sugar). Glucose is carried
through the bloodstream to provide energy to cells. A hormone called insulin is
needed for the glucose to be taken up and used by the body. Diabetes occurs
when the pancreas is not able to make enough insulin or the insulin that is
available is not effective.
Statistics
Prevalence of diabetes:
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Age 20 years or older: 16.9 million. 8.6 % of all people in this age
group have diabetes.
Age 65 years or older: 7 million. 20.1% of all people in this age group
have diabetes.
Men: 7.8 million. 8.3% of all men have diabetes.
Women: 9.1 million. 8.9% of all women have diabetes.
Approximately 17 million people in the U.S., or 6.2 % of the
population, have diabetes.
While an estimated 11.1 million have been diagnosed, unfortunately,
5.9 million people (or 1/3) are unaware that they have the disease.
Deaths among people with diabetes:
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In 1999, approximately 450,000 deaths occurred among people with
diabetes aged 25 years and older. This figure represents about 19% of
all deaths in the United States in people aged 25 years and older.
Overall, the risk for death among people with diabetes is about 2 times
that of people without diabetes.
Diabetes was the sixth leading cause of death listed on U.S. death
certificates in 1999.
Causes
The cause of diabetes is unknown, although both genetics and environmental
factors such as obesity and lack of exercise appear to play roles.
Symptoms
Some symptoms may include:
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Sudden vision changes
Excessive thirst
Extreme hunger
Frequent urination
Nausea, vomiting, or stomach pains
Unexplained weight loss
Tingling or numbness in hands or feet
Fatigue
Very dry skin
Sores that are slow to heal
More infections than usual
Types of Diabetes
Noninsulin-Dependent or Type 2
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Most common type of diabetes
This type usually develops gradually, most often in people over age 40
Type 2 diabetes occurs when the body does not make enough insulin or
the body makes insulin but cannot properly use it
Insulin-Dependent or Type 1
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Appears suddenly and most commonly in younger people under age 30
(sometimes referred to as juvenile diabetes)
Type 1 diabetes occurs when the body destroys the cells in the pancreas
that produce insulin, usually leading to a total failure to produce insulin
Gestational Diabetes Mellitus (GDM)
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Occurs in some women during pregnancy
This condition may occur in the second half of pregnancy where the
woman may have high blood glucose levels
As the pregnancy ends, the blood glucose levels will return to normal
Related Terms
Hypoglycemia
Condition that occurs when blood glucose levels are too low.
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Symptoms may include: cranky, tired, sweaty, hungry, confused, and
shaky and is some instances can lose consciousness or experience a
seizure
Eating sugar may treat hypoglycemia
Hyperglycemia
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Occurs when blood sugar is too high
Symptoms may include: extreme thirst, frequent urination, fatigue,
blurred vision, vomiting and weight loss
Diabetic Nephropathy
Kidney disease occurs when there is damage to the kidney
Treatments
The key is keeping a balance of the following:
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Taking insulin as prescribed by a physician
Having a healthy diet
Regular exercise
Losing weight
Testing blood sugar levels regularly
No smoking
Insulin
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There are different types of insulin based on how soon the insulin starts
working (onset), when it works the hardest (peak time), and how long it
lasts in your body (duration)
Many people who take insulin use a syringe, but other methods of
delivery include a pen and an insulin pump
A common side effect from insulin is a hypoglycemic attack resulting
from low blood glucose levels
Oral Medications
There are five different classes of diabetes medications that work in the body
to improve blood glucose levels:
Sulfonylureas
This class of drugs works by stimulating the pancreas to release more insulin
and is often one of the first oral therapies given to people with type 2 diabetes.
Common side effects include weight gain, mild gastrointestinal disturbances,
alcohol intolerance, mild skin irritations and hypoglycemia or low blood
glucose levels.
Biguanides (Metformin)
This drug is often prescribed in combination therapy with other diabetes
medications or insulin, and can be used as a first line of treatment. This class
works by keeping the liver from releasing too much glucose and helping the
body better respond to its own insulin. Metformin, on its own, can minimize
the risk of hypoglycemic attacks. Common side effects may include nausea,
diarrhea or mild gastrointestinal disturbances and loss of appetite.
Alpha-Glucosidase Inhibitors
This class of drugs helps delay the digestion of sugars and carbohydrates by
releasing them slowly into the system, avoiding high blood glucose levels after
meals. Common side effects include nausea, diarrhea, mild gastrointestinal
disturbances, bloating and gas.
Thiazolidinediones (TZD)
This class helps sensitize the muscle cells to insulin and reduce the amount of
glucose released by the liver, resulting in increased glucose uptake. Side
effects may include nausea, vomiting, abdominal pain, fatigue, loss of appetite
and dark urine.
Meglitinides
This class of drug also stimulates the pancreas to release more insulin. As with
many diabetic drugs, however, hypoglycemia is a potential side effect.
Accommodations
Hypo/Hyperglycemia:
Allow for storage of medications such as insulin, and/or food
Supply an area to test blood sugar levels
Supply an area to administer medications (insulin)
Provide appropriate containers for needles/syringe disposal
Provide a rest area for reorientation after hypo/hyperglycemic episode
Frequent breaks for food as needed
Fatigue or Weakness:
Frequent rest breaks
Reduce or eliminate strenuous activities
Anti-fatigue mats or padded carpeting
Provide rest area with cot
Flexibility to sit or stand
Job sharing
Shorten work day and extend work week
Vision Impairment: (e.g.-sudden vision changes)
If benefit from magnification, consider options to enlarge with magnification
devices or computer screen magnification software
If does not benefit from magnification, consider options for accessing
information through Braille, tactile graphics, or voice output technology
Provide a tape recorder
Provide a reader
Flexible schedule to use public transportation to and from work
Use of service animal for assistance with mobility
Nephropathy: (e.g.-Kidney Disease)
Provide easy access to restroom facilities
Allow a flexible schedule or time off for treatment (dialysis)
Neuropathy: (e.g.-Nerve damage)
Modify job tasks requiring fine finger dexterity
Provide protective clothing and equipment
Eliminate or reduce the need to use sharp objects
Cognitive Complications:
Provide written job instructions and prioritize assignments
Use of day planner or electronic organizer
Provide flexible work hours
Minimize distractions
Recommended Readings
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Job Accommodations Network (JAN) The Job Accommodation Network (JAN) is a free consulting service
that provides information about job accommodations, the Americans
with Disabilities Act (ADA), and the employability of people with
disabilities.
http://www.jan.wvu.edu/links/
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American Diabetes Association The American Diabetes Association is the nation's leading nonprofit
health organization providing diabetes research, information and
advocacy. The mission of the organization is to prevent and cure
diabetes and to improve the lives of all people affected by diabetes. To
fulfill this mission, the American Diabetes Association funds research,
publishes scientific findings, provides information and other services to
people with diabetes, their families, health care professionals and the
public. The Association is also actively involved in advocating for
scientific research and for the rights of people with diabetes.
http://www.diabetes.org/
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Research Article Martz, E., Roessler, R., & Livneh, H. (2002). Responses to insulin
reactions and long-term adaptation to diabetes. Journal of
Rehabilitation, 68 (2), 14-21.
Renal Disease
Function of the kidney:
The kidney has three basic functions:
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Filter: The kidney acts as a filter to remove waste products and fluids.
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Blood pressure control: The kidney acts with a substance, renin, to control blood
pressure from becoming high. If the kidneys are not removing enough fluid, urine,
blood pressure can rise. The heart works harder pumping blood to the body when
there is extra fluid to be pump blood through.
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Hormone production: The kidney produces a hormone, erythropoietin. This
hormone is responsible for red blood cell production in your bone marrow. The
kidney also produces the active form of Vitamin D so a person is able to absorb
calcium.
Statistics:
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In the United States, 15%-20% of kidney failure cases are due to hypertension.
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Hypertension is second only to diabetes as the leading cause of kidney failure.
It is estimated that hypertension affects 20% of the adult population in most
countries.
Types of Renal Failure:
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Acute Renal Failure:
Kidneys could be damaged suddenly. This could be due to injury, disease or
toxins. When remedies for these are sought, kidney functions could be restored.
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Chronic Renal Failure:
If you have chronic renal disease, you are slowly losing kidney functions. Over a
period of time this could lead to kidney failure and serious health complications.
You may not even be aware of this in the beginning. It is not possible to restore
the functions you have already lost. But it is possible to control or retard the
process of deterioration.
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End Stage Renal Disease (ESRD):
Chronic Renal failure progresses to a point when kidneys work less than 10%
capacity. At this point, the kidneys are no longer fulfilling their role of removing
waste and excess fluids from the body. So, toxins begin to build up in the blood
causing a person to become ill. There is currently no cure for End-Stage Renal
Disease.
This condition is fatal unless dialysis on a regular basis or kidney transplant is
performed, to restore kidney functions.
Causes:
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Diabetes
Diabetes is the most common cause of kidney disease.
Diabetes is a metabolic disorder caused by the insufficient insulin secretion or
inefficient usage of the insulin secreted by the body.
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Hypertension
Hypertension or high blood pressure is defined as a blood pressure reading of
greater than 140/90* in adults over 18 years of age.
*Measured in mm Hg (millimeters of mercury)
Other Causes include:
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Chronic Glomerulonephritis
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Polycystic Kidney Disease
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Kidney infections
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Lupus
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Kidney Stones
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Some congenital defects like pylonephritis
Symptoms:
Early stages of kidney disease are asymptomatic. As the disease progresses the following
symptoms are experienced:
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Burning or difficulty during urination
More frequent urination, especially during the night
Blood in the urine
Puffiness around the eyes or swelling of hands and feet
Pain in the back or side, below the ribs
Diagnosis:
Blood Tests
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Creatinine
Any form of activity leads to the breakdown of muscle. This is then replaced by
body building foods. When the muscle breaks down, a waste product called
creatinine is produced. This is moved from the blood to the urine by the kidneys.
When kidneys are not working well, creatinine builds up in the blood.
The normal (serum) creatinine range is 0.6 to 1.2 mg/dl. However, some labs may
define the normal range a little differently. Besides, your diet may also have an
impact on the creatinine level. However, if your creatinine level is consistently
beyond the normal range, there is reason to believe that your kidneys have a
problem.
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Blood Urea Nitrogen (BUN)
Urea is a waste product in the blood. This is produced when the cells take protein
from the blood. Urea contains nitrogen. It is the work of the kidneys to expel urea
from the blood into the urine. If your kidney functions are affected, more urea
than is normal is found in the blood.
Normal blood contains 7 to 20 milligrams of urea per deciliter of blood. If your
BUN is more than 20 mg/dl, your kidneys may not be working at full strength. An
increase in BUN could also suggest other health problems.
Urine Tests
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Creatinine Clearance
Another way to measure kidney function is the Creatinine Clearance test. This test
shows how fast your kidneys remove creatinine from the blood. Clearance is
measured in milliliters per minute (ml/min).
Creatinine Clearance is arrived at by comparing the amount of creatinine in your
urine to the amount of creatinine in your blood.
Proteinuria
Normally, kidneys filter out wastes from blood. They also reabsorb any nutrients that
may have gone out with the wastes. When the kidneys are affected proteins, so
valuable to the body, begin to slip out with the wastes. This leads to a condition called
proteinuria.
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Ultra sonogram
When there is enough evidence in your blood and urine tests to suggest a problem, the
first test you will be asked to take an ultra sonogram of the abdominal area. These help to
detect if there are growths or obstructions in your kidney.
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Computer Aided Tomography (CAT) scan
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Magnetic resonance Imaging (MRI).
Biopsy
A renal biopsy involves snipping off of a tiny bit of kidney tissue for study under a
microscope. This study helps to know if there is any problem at the cellular level in the
kidneys.
http://www.webhealthcentre.com/general/rd_diag.asp - TOP#TOP
Treatment:
Dialysis-The process of removing waste matter and maintaining electrolyte balance
through diffusion is called dialysis. Usually performed by the kidneys, this is performed
by artificial means in kidney patients.
The two main types of dialysis are:
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Peritoneal Dialysis
Peritoneal dialysis occurs inside the body. It uses your peritoneal membrane (the
lining of you abdomen) as the filter. For this treatment, a tube called a catheter is
surgically placed through the wall of your abdomen.
o Continuous Ambulatory Peritoneal Dialysis (CAPD)
Allows gravity to draw dialysis solution into and out of the peritoneal cavity, using a
system of tubing and bags.
Usually, CAPD is performed four times a day. Each solution exchanges lasts about
half an hour. Assist devices help people with problems seeing or with problems using
their hands to do CAPD.
o Automated Peritoneal Dialysis (APD)
The second type of peritoneal dialysis, automated peritoneal dialysis (APD)
involves a machine. You attach the tubing and solution bags to the machine.
Before going to sleep, you connect the tubing to the peritoneal catheter. During
the night the machine performs the dialysis.
Haemodialysis
Blood is pumped outside the body to an artificial kidney machine. The machine
cleanses the blood and returns it to the body. Only a small amount of blood is out of
the body at any time.
The average person receives three treatments per week. Each treatment lasts three to
four hours. There are two options for haemodialysis: (1) home haemodialysis, and (2)
in-centre or clinic haemodialysis.
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http://www.webhealthcentre.com/general/rd_treat.asp TOP#TOPTransplantation
During a transplant, a healthy donated kidney is placed deep under your skin near
your hip bone. In some cases, the non working kidneys may be removed to control
infection or high blood pressure.
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Research Article:
Symister, Petra; Friend, Ronald. (1996). Quality of life and adjustment in renal
disease: A health psychology perspective. [References]. [Chapter] Resnick, Robert J
(Ed); Rozensky, Ronald H (Ed). Health psychology through the life span: Practice
and research opportunities. (pp. 265-287). Washington, DC, US: American
Psychological Association. xvii, 464 pp.
**Please refer to the Diabetes Module for more information.