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
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, its 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
- you have had type I diabetes for more than five years
- 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
Diabetes and Food
When its 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 dont feel thirsty even though weve
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%
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, youll 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
A cardiovascular exam as measured by
- blood pressure
- peripheral pulses
- 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 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
- Slice squash. Steam in vegetable steamer or in small amount
of water until color has changed, about 5 minutes.
- Remove from steamer and place drained squash in bowl.
Drizzle liquid margarine and toss lightly.
- Sprinkle dill weed on top and serve
||2 grams protein
|46% calories from fat
||6 grams carbohydrate
|0 mg cholesterol
||3 grams total fat
Apple and Pineapple Chill
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
- Combine crushed pineapple and unflavored gelatin in a
saucepan. Allow gelatin to soften 5 minutes.
- Bring to a boil, stirring to dissolve gelatin. Remove
from heat. Stir in cold water.
- Fold in grated apple. Chill until firm.
- Top with 2 tbsp. fat-free whipped topping to serve.
||1 gram protein
|0% calories from fat
||21 grams carbohydrate
|0 mg cholesterol
||0 grams total fat
Note: Gel will turn the color of the apple peel unless folded
after the mixture begins to set, or peel the apple before
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
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.
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; firstname.lastname@example.org.
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.
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