MEDICAL INFORMATION
DIABETIC KIDNEY DISEASE
Diabetes mellitus is a medical condition that affects millions of individuals in the USA and is a worldwide problem leading to many medical complications. Diabetes is classified as Juvenile (Type I) or Adult (Type II). Juvenile diabetes is associated with insulin deficiency, as the pancreas does not secrete enough insulin into the bloodstream to keep blood sugar (glucose) levels in the normal range. Juvenile diabetes usually begins before the age of 30 years. It is treated with insulin injections, and some patients have received pancreas transplants. Adult Onset Diabetes (Type II) usually begins later in life and after age 30 years. Most patients have enough insulin in their bloodstream, but the insulin is not sufficiently effective to maintain normal blood sugar in Type II diabetes. Patients with Type II diabetes may be treated adequately by careful dietary habits that reduce fat and carbohydrate intake, but often require medications in addition to their diet. These medications that affect blood sugar are given orally, except that insulin must be given by injections or by insulin pump.
The complications of diabetes result in impairment of various organs of the body. Type I patients have to deal with large swings in their blood glucose and may have seizures from low blood glucose. They must make major emotional adjustments due to life-long dependence on insulin injections. Type II patients have to also deal with large swings in their blood glucose, but their biggest problem is the emotional adjustment to accepting that their medical therapy, whether diet or medications, is very complex and difficult to maintain so that they may actually derive a benefit from therapy. Many of the complications of diabetes, whether Type I or Type II is due to small vessel disease, which means that the small arteries of the body become swollen, constricted and undergo various degrees of arteriosclerosis. This small vessel disease predisposes patients with Type I and II diabetes to stroke, heart attack, visual loss, foot ulcers, abnormal bowel and stomach function and kidney disease. The kidney disease is manifested biochemically, in it's early stage without any symptoms whatsoever to the patient, with protein in the urine (proteinuria) and elevated creatinine in the blood. Creatinine is a normal waste product of the body's metabolism. Normally, there is a certain amount of protein excreted in the urine, but it is usually less than 250 mg per 24 hours. Patients with proteinuria may have microalbulminuria at higher levels of excretion, usually 500 to 3,000 mg per 24 hours.
A major goal of treatment of diabetes is to prevent progression of small vessel disease, including that which occurs in the kidney (Diabetic Kidney Disease). The first step is to control the blood sugar as close to the normal range as possible. Clinically, your physician can judge the adequacy of control of your blood sugar by having a measurement of hemoglobin A1c (a red blood cell pigment that is covalently chemically bound to glucose in the bloodstream). Additionally, the effects of various kinds of medications that do not actually affect level of blood glucose are also being investigated. Some of these medications are classified as anti-hypertensive drugs (blood pressure lowering medications). The mechanism of action of anti-hypertensive drugs is very complex, and all of these drugs generally lower the blood pressure in those patients who take them. It has been determined that one class of drugs known as ACEI (angiotensin converting enzyme inhibitors) decrease the progression of Diabetic Kidney Disease in Type I diabetes. This same class of drugs appears to decrease the rate of progression of major cardiovascular events in diabetic Type II patients who are treated for hypertension (high blood pressure}. It is generally accepted in the medical community that much clinical investigation remains to be carried out as to which drugs, including ACEI, are effective in preventing Diabetic Kidney Disease. Additionally, the effect of blood pressure medication on the Diabetic Kidney may not be related to the effect of the drug on blood pressure.
Patients are advised to consult with their physician and other medical sources for information on the control of diabetes mellitus complications. The content of this essay of Diabetic Kidney Disease should not be taken as an authoritative reference on medical complications of diabetes mellitus.
COR Clinical Research LLC participates in clinical research of many aspects of Type I and Type II diabetes mellitus. Specific details are available by directly contacting and visiting the center.