Diabetic kidney disease, also known as diabetic nephropathy, develops when one’s kidney has trouble filtering waste from the blood.
An overview of diabetic nephropathy. Click the image to view a larger, clearer version.
When left untreated, the affected kidney may eventually fail and one would need either a kidney transplant or dialysis.
SYMPTOMS USUALLY SHOW UP UNTIL THE DISEASE IS AT AN ADVANCED STAGE, AND BY THEN, IT CAN BE MUCH HARDER TO MANAGE
According to Dr Kenneth Lai Koah Kien, it can take many years for diabetes to substantially damage the kidneys.
“Even then, the symptoms usually don’t show up until late in the course of the disease,” he says.
WHAT ARE THE SYMPTOMS, ANYWAY?
Unusual weight gain
Swollen ankles
Nausea or vomiting
Frothy urine
Lethargy
Urine breath
Itching
Reduced appetite
Swelling of the leg.
Blurring of visions and floaters (the eye can also be affected by kidney disease)
SO, WHAT SHOULD SOMEONE WITH TYPE 2 DIABETES DO TO DETECT DIABETIC KIDNEY DISEASE EARLY?
Dr Kenneth recommends the following:
If you have other health conditions alongside type 2 diabetes, keep them well-controlled too along with your diabetes
“These patients would need to monitor their co-morbidities closely with their doctors. These include hypertension, obesity, hypercholesterolemia, and smoking. All these are mercenaries of death together with diabetes,” he says.
Go for kidney disease screening
Recommended screening tests include:
A urine test called urine ACR to look for protein leakage
A simple blood test called serum creatinine test to look at kidney function
As for when one should start screening:
For type 2 diabetes, screening should start on the date of diagnosis.
For type 1 diabetes, screening should start 5 years after the onset of type 1 diabetes.
For the upcoming fasting month, we are pleased to share some important advice from the good people at Alpro Pharmacy.
WILL THE USE OF INHALERS INVALIDATE YOUR FASTING?
There are 2 types of inhalers: ‘preventer’ inhalers and ‘reliever’ inhalers. If you are unsure which of your inhalers is which, check with your doctor.
While fasting, you should continue to use your preventer inhalers, typically twice a day—before sahur and before you go to bed. It’s best to check with your doctor how often and when you should use your preventer inhaler.
Use your reliever inhalers when you have an asthma attack.
WILL FASTING PUT YOU AT RISK OF DEHYDRATION OR LOW BLOOD GLUCOSE (HYPOGLYCAEMIA)?
If you have diabetes, check your blood glucose 2 hours after sahur and when you experience symptoms such as dizziness, cold sweat, blurred vision, and shivering. Checking your blood glucose won’t invalidate your fasting.
If your blood glucose level is below 3.9 mmol/L, you will need to break your fast for the sake of your health.
People with diabetes shouldn’t delay breaking their fast. Keep some dates with you if you have diabetes and you’re fasting. That way, when you’re still stuck in traffic or at work during iftar, you can break your fast with 1 or 2 dates.
Eat foods rich in dietary fibre for optimal blood glucose control during the fasting month. Dietary fibre helps keep you feel full longer and stabilize your blood glucose levels.
HOW TO FAST WHEN YOU HAVE GASTRIC PROBLEMS
If you have gastric problems, break your fast by eating moderate amounts of foods.
Avoid eating fried foods and gassy drinks in too much amounts or too quickly.
Also, it’s best to avoid drinks that are high in caffeine, such as coffee.
Most people with diabetes or those that have someone close to them that have this disease will know that the disease can harm many organs in the body—such as the eyes, nerves, kidneys, heart, and more.
DO YOU KNOW THAT DIABETES CAN AFFECT THE TEETH AND GUMS AS WELL?
People with diabetes are more likely to have:
Periodontal or gum disease
Persistent bad breath
Tooth decay or cavities
Oral fungal infections
Oral ulcers
Loss of teeth
Diabetes can cause increased levels of glucose in the blood as well as saliva
Progression of gum disease, from gingivitis to the more serious periodontitis. Click on the image to view a larger, clearer version.
The increase of glucose in the saliva encourages the growth of bacteria in the mouth and together with food particles can build soft sticky whitish layer called plaque.
Plaque is the yucky smelly stuff that you can scrape off from your teeth if you haven’t been cleaning them properly. It is the main cause of bad breath.
If left unchecked, the persistent plaque buildup can cause tooth decay and harden to form tartar.
Persistent plaque or tartar buildup causes irritation to the gums
The gums can become red and swollen, and bleeding may occur.
This is the first warning sign that it’s time to visit the dentist.
Comparison of normal tooth and a tooth with periodontitis. Click on the image for a larger, clearer version.
Otherwise, the infection will go deeper under the gums, causing infection of the bone structure supporting the teeth. This is periodontitis, the second stage of gum disease.
The gums will start to recede, trying to pull away from the tartar formed. Over time the teeth will become unstable, and one may experience pain as a result.
At the final stage of gum disease, the teeth will become so infected and painful that it may need to be removed
In poorly controlled diabetic cases, the gum disease may progress much faster. The severity of the condition may be worse, which is why it is important to visit the dentist early to resolve the issues.
Diabetes and certain drugs can reduce the production of saliva in our mouth
Our saliva contains minerals to protect our teeth from tooth decay, mucin to keep the teeth moist and slippery, antibacterial substances to eliminate potentially harmful bacteria, and it also has the ability to neutralize the acids produced by bacteria in our mouth.
Without the presence of saliva, there is a higher risk of tooth decay and gum disease.
Dry mouth can increase the risk of developing fungal infections called thrush, which are painful white patches in the mouth.
In denture wearers, the dryness can decrease the suction effect of the denture and increase abrasion against the gums, leading to ulcers and mouth sores.
Smoking will worsen the condition further.
In severe uncontrolled diabetic cases, some people can develop burning mouth syndrome—a continuous burning sensation in the mouth that will alter taste and sensation.
HOW THE DENTIST CAN HELP YOU
Gingivitis or periodontitis
The dentist will need to carry out deep cleaning of the teeth and gums, in order to decrease the bacterial load and to allow the gums to heal.
However, the dentist can only do so much—you have to also keep good oral hygiene and use of mouthwash daily.
Fungal infections
Your dentist may prescribe some medications to kill the fungus responsible for the infection.
If you use dentures, they will be checked to ensure that they are still fitting properly. You must keep them clean in a disinfection solution at night.
Dry mouth
For most non-severe cases, the simplest solution is to keep your body well hydrated at all times. Drinking water regularly also moistens the mouth.
Only in severe cases are saliva substitutes prescribed.
Burning mouth syndrome is usually more complicated and will require specialist attention.
HELPFUL TIPS
A well controlled blood glucose level as well as a healthy diet and lifestyle are key to reducing and preventing oral health problems. Keeping your mouth healthy will also prevent diabetes-related health problems such as heart disease and kidney disease.
Good oral hygiene will keep your gums and teeth healthy. Brushing twice a day every day, and use a floss or water floss daily.
Visit your dentist regularly for a routine checkup. Please make sure you tell your dentist if you have diabetes. Keep your dentist updated about any changes to your health and blood sugar levels.
For denture wearers, make sure your dentures fit properly, and clean them by soaking them in denture disinfectant at night.
Quit smoking. Smoking will worsen gum condition and overall health.
Continuous glucose monitoring (often abbreviated as CGM) is basically a system that allows one’s blood glucose levels to be monitored automatically.
HELPS TO IMPROVE YOUR DIABETES MANAGEMENT
This system opens up a world of opportunities for better blood glucose management for people with type 1 diabetes as well as those on type 2 diabetes that require insulin.
After all, with information of their blood glucose levels that can be obtained immediately, they can make quick informed decisions about their food choices and the dosage of their insulin as well as when to administer it.
LETS YOU ANTICIPATE A POTENTIAL INCOMING MEDICAL EMERGENCY
The ability to observe the pattern of the rise and fall of their blood glucose also allows them to be alert of the possibility of a hypo- or hyperglycaemic episode, and take prompt measures accordingly.
NOT JUST FOR PEOPLE WITH DIABETES
Additionally, continuous glucose monitoring can also benefit people with kidney problems as well as pregnant women worried about gestational diabetes.
RECOMMENDED BY EXPERTS
It’s really not surprising, therefore, that the 23rd Hong Kong Diabetes and Cardiovascular Risk Factors—East Meets West Symposium reported a growing consensus on the definitions and targets of continuous glucose monitoring metrics to allow healthcare professionals and people with diabetes to make full use of this system in diabetes management.
Indeed, the United Kingdom has already taken steps to do this.
All in all, this is a remarkable example of how technology is making diabetes management, which can be complex and confusing to some people, considerably easier to figure out and implement correctly!
Continuous glucose monitoring is a feature in certain types of blood glucose monitor or glucometer. You can talk to your doctor or your pharmacist for more information on continuous glucose monitoring and whether you can benefit from using a glucometer that comes with this feature.
Reference: Oliver, N., Chow, E., Luk, A. O. Y., & Murphy, H. (2023). Applications of continuous glucose monitoring across settings and populations: report from the 23rd Hong Kong Diabetes and Cardiovascular Risk Factors – East Meets West Symposium. Diabetic medicine : a journal of the British Diabetic Association, e15038. Advance online publication. https://doi.org/10.1111/dme.15038
