World Kidney Day
March 11, 2010
Dr. Joyce M. Richey, Presenter
Keck School of Medicine of USC
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Diabetes -Greek derivation, to
siphon, passing through
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What Is Diabetes ??
INSULIN
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Glucose (Sugar)
Goes where it’s
needed for
energy!
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Insulin – the “Miracle” Drug
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Types of Diabetes
Type I
Type II
“juvenile” IDDM
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“adult” NIDDM
Usually in children, can
be adults
0.5% of populations
Family History
Fatal if not treated
Usually normal weight
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Usually in adults, increasing
in children
5-10% of population
(epidemic)
Family History
Increased prevalence in
minorities
80% of patients are obese
•Gestational
Diabetes
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Diabetes Treatment
Type I
 Insulin
Type II
 Insulin
 Oral Medications
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Who Does Diabetes Affect?
Prevalence
>20 million; one third don’t know they have it
 >41 million with pre-diabetes

Greater in minority populations
African Americans; ~2 times than Caucasians
 Hispanic Americans, ~2 times than Caucasians
 Native Americans, 50% of the Pima Indians

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Pre-Diabetes
What is Pre-Diabetes?
Comes before type 2 diabetes
 Blood glucose higher than normal but not yet
diabetes
 Normal fasting glucose: Below 100
 Pre-diabetes: 100 – 125
 Diabetes: 126 and above

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Pre-Diabetes
What Does It Mean?
 You
have a greater chance of
getting type 2 diabetes
 You are more likely to get
heart disease or have a stroke
or kidney disease
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Diabetes and Obesity Epidemic
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Obesity and Diabetes
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Causes of Obesity

Lack of physical activity/sedentary
 Genetics
 Unhealthy eating patterns
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“Digging Our Graves”
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Apple or Pear?
Android
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Gynoid
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Variability of VAT among obese subjects
RF-149, Male,
Age 40, BMI 54.4
WC: 142 cm
VAT volume: 3162 cm3
SAT volume: 9158 cm3
RF-107, Female,
Age 41, BMI 49.5
WC: 118 cm
VAT volume: 559 cm3
SAT volume: 11,658 cm3
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Obesity is not Restricted to Humans
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Symptoms of Diabetes
Frequent urination (bedwetting in
children)
 Excessive thirst
 Extreme hunger
 Unusual weight loss
 Increased fatigue
 Irritability
 Blurry vision

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Diabetes Testing

Urine Analysis

Blood Test (Fasting Glucose) (less than or
equal to 100 mg/dl;101 – 126 mg/dl, prediabetes; greater than 126 mg/dl,
diabetic)

Oral Glucose Tolerance Test (OGTT)
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Diabetes Testing “ A1C?”

Measures your sugar level for the past 2-3
months

Should be checked at least twice a year

The higher the number, the higher risk for
diabetes complications
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What should your A-1-C be?


Ideally it should be
less than 7!
However, please
check with your
healthcare provider
for a reasonable goal.
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A1C
%
5
6
7
8
9
10
15
Blood Glucose
mg/dl
90
120
150
180
210
240
390
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Major Complications
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Complications of Diabetes
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Heart disease and stroke; 2-4 greater risk
accounts for > 65% of all deaths in people
with diabetes
Leading cause of blindness (retinopathy)
Leading cause of kidney failure (nephropathy)
Nerve disease and amputations (neuropathy)
>300,000 diabetes-related deaths/year
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Kidney Failure
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Kidney Disease
Also known as Nephropathy (nehFROP-uh-thee)
 Over time kidney disease is caused by
 Diabetes
 High
blood pressure
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Your Kidneys
 Your
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kidneys are
two bean-shaped
organs about the
size of your fist.
 They are located
just below the rib
cage, near your
back
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Kidney Disease
 Signs
and Symptoms
 Swelling
in extremities, ankles, legs,
hands
 Shortness of breath
 Feeling tired
 Nausea and vomiting
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Kidney Disease
 Later
Signs and Symptoms
 Loss
of appetite
 Feeling cold
 Poor concentration
 Itchy skin
 Bruising
 Weight loss
 Muscle cramps
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Tests to find kidney
problems

A blood test helps to measure your GFR

GFR stands for Glomerular (glo-MEHyoo-lur) Filtration Rate. The GFR shows
how well your kidneys are filtering
wastes from the blood.

Microalbumin (My-crow-alb-YOU-min)
 A urine test that measure the amount
of protein in the urine
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What You Can Do to Prevent, Delay,
or Treat Kidney Damage
Keep your blood glucose levels in your target
range
 ADA suggests:
 70 to 130 when you wake up and before
meals
 Under 180 two hours after eating a meal
 Ask your doctor about the best blood glucose
targets for you

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What You Can Do to
Prevent, Delay, or Treat
Kidney Damage

Have an A-1-C check (A-one-see) at least twice a year
 Shows your blood glucose level for the
past 2 to 3 months
 The higher the A-1-C, the greater the risk
for kidney disease
 If 7 or higher, you may need a change in your plan
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What You Can Do to
Prevent, Delay, or
Treat Kidney Damage

Aim for your target blood pressure level
 ADA
suggests under 130 over 80
Ask your doctor about your target blood
pressure
 Ask your doctor about medicines that
slow down kidney disease

 ACE
Inhibitors (AYCE in-HIB-ih-tor)
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 ARBs (ay-ar-bee)
Slowing Down Kidney
Disease
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Eat a well-balanced meal plan
Cut back on salt and high sodium foods
Limit your protein if your doctor tells you to
Limit potassium and phosphorus
Limit supplements and drugs that are hard
on your kidneys
Watch out for injected dyes used in X-rays
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Steps to Delay or Prevent
Type 2 Diabetes
 Weight
loss
 Regular physical activity, such as
walking or gardening about 30
minutes a day
 Healthy eating
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Diabetes Prevention and Treatment
Increase Physical Activity!
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 Choose
Healthy Eating
low-fat dairy products,
lean meats, poultry without skin,
and fish
 Limit saturated fats
 Minimize trans fats
 Limit high cholesterol foods
 Eat more fruits and vegetables
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Fried Vs. Baked
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(4)
7 inch fillets
1 egg
Cornmeal
Salt/pepper
1 stick of butter of
half cup of oil
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(4) 7 inch fillets
2 teaspoons of lemon
Salt/pepper
Bread crumbs
Spices
(oregano,oil,parsley
sprigs, lemon
wedges, tomato
wedges)
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Fried vs. Baked
Nutritional Value
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Calories 410
Fat = 26 grams
57% fat calories
Cholesterol = 183 mg
Sodium = 859 mg
Protein = 36 mg
Carbohydrate = 7 mg
Fiber = 1 g
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Calories 290
Fat = 8 grams
25% fat calories
Cholesterol = 66 mg
Sodium = 263 mg
Protein = 35 mg
Carbohydrate = 19
mg
Fiber = 2 g
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Remember the 3 P’s of Prevention

Planning

Preparation

Portions
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Remember
Learn all you can about diabetes and
kidney disease
 Keep your blood pressure and blood
glucose levels in your target range
 Take your medicines
 Have regular checkups
 Get lab tests each year to know how
well your kidneys are working

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“Know that your body is a temple”
1Cor. 6:19-20
KEEP IT HEALTHY!
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