Management of diabetic kidney

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disease 23

4.1 The benefits of good blood sugar control 23

• Is there a threshold, above which the risk noticeably increases? 26

• With nephropathy, is there a 'point of no return'? 27

• How failing kidney function affects diabetes management 29

4.2 The benefits of good blood pressure control 32

• What is normal blood pressure? 32

• When blood pressure is too high in people with diabetes 35

• How blood pressure affects the development of kidney damage 36

• When nephropathy already exists 36

• How low should the blood pressure go? 37

• There are more than 100 blood pressure-lowering drugs - which are the best? 39

• It is important to manage your blood pressure yourself 40

4.3 Eating correctly - it's all about protein and salt! 43

• The kidneys and protein - what is the connection? 43

• Not all protein is the same 43

• What happens when you eat too much protein? 45

• Salt and the kidneys 47

• Six grams of salt a day are enough 47

4.4 Smoking - a particularly dangerous habit for diabetics 51

4.5 High levels of fatty acids in the blood -

bad news in every case 54


• Not all fat is the same 54 What can you do about high blood fat levels? 56 Some practical tips 58

5 Diabetics with kidney failure are threatened in other ways 61

5.1 How diabetes can affect your sight 61

5.2 Kidney failure also endangers the heart 66

5.3 The brain also suffers from arteriosclerosis 71

5.4 A common problem - poor circulation in the legs 74

5.5 The diabetic foot - how to avoid amputation 78

6 What else to consider 85

6.1 Urinary tract infection - particularly common in women with diabetes 85

6.2 X-ray examinations - contrast agents may be dangerous in patients with kidney failure 88

• Precautions to be taken during X-ray examinations 88

6.3 Dental problems in people with nephropathy 89

• What do teeth have to do with the kidneys? 90

7 Prospects yesterday and today 91

8 Special situations 95

8.1 Pregnancy and diabetic nephropathy 95

• What to do before getting pregnant 95

What to do during the pregnancy 96

When diabetic nephropathy is already present 97

What happens to kidney function during pregnancy? 97

8.2 Sport and diabetic nephropathy 100

• Rules for exercising with hypertension and nephropathy 100

9 When kidney function fails ... 105

• Typical problems 105

• What you can do about these problems 106

9.1 The different possibilities for kidney replacement therapy 108

Peritoneal dialysis 108

Is peritoneal dialysis suitable for you? 109

Haemodialysis 110

What to look out for 112

Transplantation 113

Is a transplant suitable for you? 114

References 117

Appendix 119

• Calculation of creatine clearance by age, body weight and serum creatine 121

• Cuff sizes for the measurement of upper arm blood pressure in adults 122

• Blood pressure-lowering drugs 123

• Diabetes and kidney organizations 127

• General health websites 129

• Diabetes information websites in other languages 131

Index 135




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There is still much to do!

The treatment of diabetes mellitus has improved markedly over the past two decades. With different education programmes, very precise meters for measuring blood sugar levels and blood pressure in the clinic and at home, new drugs, new insulins, and simple injection devices (pens), doctors and patients today have many methods of controlling blood glucose concentrations. In recent years, this has undoubtedly led to a better quality of life and prognosis for people with diabetes.

The problem of the typical complicating conditions that accompany diabetes has, however, not yet been solved. The St Vincent Declaration, which was adopted by many countries in 1989, stated that the rate of diabetic complications would be reduced through intensive treatment, but this has not been achieved. The goal was to reduce diabetes-associated kidney damage and to decrease the number of diabetic patients needing dialysis by one-third. Unfortunately, the opposite is the case: today, diabetic nephropathy is one of the most frequent causes of kidney replacement therapy in the Western world.

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