The Main Reason Leading To The Rapid Increase Of Uremia,
Feb 08, 2023
Statistics show that the number of dialysis patients in China has been increasing in recent years: from more than 300,000 in 2013, it has risen to more than 800,000 by 2021 and will continue to rise in the future. An important source of the rapid increase in uremia is diabetic nephropathy!
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Now that diabetes is getting younger and younger, it is of great significance for kidney disease patients to know about diabetes in advance to prevent kidney damage caused by diabetes. Quickly take out your blood sugar test sheet and have a look, is it over the limit?
1. Living habits + medication + genetics
Lifestyle habits: eating more and moving less, abdominal obesity
Drug factors: commonly used drugs for kidney disease, hormones (prednisone, etc.), tacrolimus, cyclosporine, taking these drugs can easily lead to high blood sugar
Genetic factors: Immediate relatives with diabetes
The superposition of multiple factors significantly increases the risk of diabetes in patients with kidney disease. According to the "Global Diabetes Map", as of 2021, the number of people with diabetes in China has reached 140 million, ranking first in the world in total and about twice that of India, which ranks second.
Based on nephritis, diabetes will make the condition worse. Long-term elevated blood sugar aggravates the glucose metabolism load of the kidneys. At the same time, glomerular hyperperfusion, hyperfiltration, oxidative stress, immune inflammation, and other factors lead to increased urinary protein and decreased glomerular filtration rate. Some patients eventually develop uremia.
Therefore, patients with kidney disease who do not have diabetes must pay attention to early prevention to prevent diabetes; patients with kidney disease who have diabetes must control blood sugar, blood pressure, and urine protein to prevent uremia.
2. What are the symptoms of diabetes?
• Often hungry, eat a lot, but lose weight
This is due to the impaired use of blood sugar in diabetic patients, and the cells do not have enough energy supply, so the feedback will make people eat more, but the glucose eaten cannot be used, and the body relies on decomposing protein to obtain energy, which leads to Eat a lot but lose weight.
• Polyuria, polydipsia
This is due to the osmotic diuresis of the kidneys after the blood sugar rises, causing an increase in urine output, followed by thirst and drinking more water.
• Inexplicable hypoglycemia symptoms
Symptoms include cold sweats, palpitations, nervousness, cold limbs, fatigue, etc. Many people wonder how diabetes can cause hypoglycemia.
Many diabetic patients discover that they have diabetes because of hypoglycemia. The reason is that the secretion of insulin in diabetic patients is lagging. Normal insulin should be secreted after eating, and the peak of insulin secretion in diabetic patients is delayed. After returning to normal, the peak of insulin is ushered in, leading to hypoglycemia.
• Paresthesias of distal symmetry of extremities
For example, numbness, hyperalgesia, hypoesthesia, etc., are generally more serious in the lower limbs than in the upper limbs and are usually distributed like gloves or socks, which is a manifestation of peripheral neuropathy, a common complication of diabetes.
• Repeated skin purulent infections such as boils and carbuncles
Skin wounds heal slowly, and female patients have recurrent urinary tract infections or vaginitis. This is because diabetics are more prone to various infections, and the worse the blood sugar control, the more serious the infection.
Early diabetes is hidden and may not have symptoms. Patients with kidney disease can check their blood sugar by the way (one tube of blood can be checked at the same time) when rechecking their renal function to see if there is any increase.
3. How much blood sugar is diabetes?
Diabetes is diagnosed by any of the following:
1. Fasting blood glucose ≥7mmol/l;
2. Glycosylated hemoglobin ≥6.5%;
3. OGTT test 2h blood glucose ≥11.1mmol/l;
4. Random blood sugar ≥11.1mmol/l.
Typical symptoms + abnormal indicators can be used to diagnose diabetes; if there are no typical symptoms of diabetes such as polydipsia, polyphagia, polyuria, and unexplained weight loss, it is necessary to repeat the laboratory test on another day for confirmation.
4. Doing so is good for blood sugar control
1) Control food intake and maintain a healthy weight
When taking hormones (prednisone), will increase people's appetite. We must pay attention to controlling food intake and not let weight gain too fast. When you are hungry, you can eat fruits (for patients whose blood sugar has not yet reached the standard, take cucumbers and tomatoes as fruits), drink a glass of milk, and eat a small number of nuts. But don't leave a pack of snacks and a bottle of drink on the right.
2) Don’t just eat white rice and noodles as the staple food, but add some coarse grains appropriately
Eating a lot of sugar is not the only way to cause high blood sugar. Eating too much refined staple food such as white rice and noodles can also cause high blood sugar. Therefore, when patients with kidney disease eat staple foods, they can eat some coarse grains, such as unpolished brown rice, oats, wheat, and corn, instead of just eating white rice. The combination of thickness and fineness is more helpful in controlling blood sugar.
3) Eat a certain amount of fruit every day
Studies have shown that eating a certain amount of fruit every day can help prevent diabetes, and fruit can be added between meals. Kidney patients with normal blood sugar, renal function, and blood potassium have no restrictions on eating other fruits except carambola and can eat half a catty a day. Diabetics with stable blood sugar control can also eat fruits in moderation, giving priority to those with low glycemic capacity, such as apples, watermelons, blueberries, etc.
4) Eat vegetable pads first, then staple food
For patients with kidney disease with high blood sugar, the order of eating can be adjusted. First, eat a la carte or meat pads, and then eat staple food. This will make it easier to stabilize blood sugar.
5) exercise
After eating, don’t lie down to watch TV or use your mobile phone immediately. It’s good to get up to do housework or go for a walk. Exercise after meals can better control blood sugar and maintain weight. Strive to exercise for 30-60 minutes a day, and don't underestimate the effect of exercise, which is very helpful for blood sugar control.
5. Strive to reach the blood sugar target
In early diabetes, through a healthy lifestyle, the condition may be reversed to normal. However, most patients still need to insist on using drugs to keep their blood sugar up to target.
As for how much blood sugar is considered to be up to standard, different diabetic patients have individualized guidance. Some patients have very strict requirements; some can be more relaxed. In the picture below, you can feel the approximate range of strict, general, and loose blood sugar control:
It is usually recommended for most patients: glycosylated hemoglobin < 7%. To achieve this goal, the pre-meal blood sugar is generally controlled between 4.4-7.2mmol/l; the post-meal blood sugar is < 10.
For very young patients with long life expectancy, early kidney disease, few complications, and strong health awareness: it is recommended that the glycated hemoglobin is within 6.5%. To achieve this goal, the fasting and postprandial requirements will be stricter.
For elderly and infirm patients with short life expectancy and many comorbidities: it is recommended that the glycated hemoglobin is within 8%. To achieve this goal, the fasting and postprandial requirements are relatively loose.
for more information:ali.ma@wecistanche.com
