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Take Care of Your Diabetes, Prevent Kidney Disease">
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ADA Moderator : Welcome to ADA Live!
Today our guest is Our guest is George L. Bakris, MD, Professor of Preventive Medicine and Internal Medicine, Rush University Medical Center, Chicago, IL, who will address your questions about kidney disease as it relates to diabetes. Our guest is George L. Bakris, MD, Professor of Preventive Medicine and Internal Medicine, Rush University Medical Center, Chicago, IL, who will address your questions about kidney disease as it relates to diabetes.
Welcome Dr. Bakris.
Dr. Bakris: Thank you. Pleasure to be here today.
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Austin Texas: If kidneys are working only 10% are there any other treatments other then dialysis? For example,red cells,medication to clean kidneys and meds to prevent liquid retention.
Dr. Bakris: Unfortunately, once you lose kidney function, in general, it does not return. If you are functioning at 10% you should be started on dialysis since your risk of dying from a cardiovascular complication, such as heart attack or stroke, is much higher than the general population.
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Mechanicsburg, Pennsylvania: I have a kidney transplant, donor was my brother. I take predisone and immurane for rejection. It will soon be 20 years. I have diabetes and high blood pressure and a lot of other problems. What is the longest time that a kidney that has been transplanted be expected to last. thank you Joe
Dr. Bakris: Kidney transplants can last at least 40 years. However, if your BP is up and glucose not well controlled you will definitely shorten its life span. You should try to get you BP down to <130 and HbA1c <7%
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Minneapolis, Minnesota: The studies that I've seen about using Ace Inhibitors as a preventor of kidney disease have been related to Type 2 patients. Should Type 1's who have do not have high blood pressure be on Ace Inhibitors? Have there been studies to base this decision on?
Dr. Bakris: Actually, the studies in type 1 diabetes is primarily around ACE inhibitors-although both ACE inhibitors and angitensin receptor blockers are effective in doing this
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Reidsville Ga.: Do predaibetics need to worry about kidney disease?
Dr. Bakris: In general-No. However, if you don't keep your BP <140/90 ideally <130/80 and exercise to delay development of diabetes your risk will be increased. Alternatively, if you develop diabetes you must keep your blood sugar under control to HbA1c <7%
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Mesa,AZ: Is there an Ace inhibitor that does not cause a sever cough? I have been on two different ones so far and the cough exhausts me and even gives ashma like symptoms sometimes. Right now I stopped taking the med and the cough is going away more every day.
Dr. Bakris: ACE inhibitors cause cough in about 20% of all Americans and about 50% of Japanese. In general, if you cough on one ACEI you'll cough on all of them. I suggest you use an angitensin receptor blocker as part of your regimen-It will achieve a similar effect without the cough
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Lancashire. United Kingdom: I have type 2 diabetes being treated with AVANDAMET tabs 2mg +1000mg twice a day I have also been put on RAMIPRIL caps 1.25mg once a day as at my last blood sugar levels test at the doctors the doctor stated she wanted me on the later tablets for blood pressure. I keep to a reasonable diet am 63yrs old but my weight is 19 stone as I am disabled and cannot exercise, I am mobile and my blood sugar in a morning is 8 on my test machine which is good for me. Have I any cause for concern over kidney problems because of any of the tablets I am on.
Dr. Bakris: If your kidney function is currently normal and you keep you HbA1c <7% or around there, avoid the use of pain medicines like Motrin and keep your BP <140 preferrably <130/80 your risk will be very low. The dose of ramipril that your on is very very low as the recommended dose from the clinical trials is 10mg/day. If your spilling protein in the urine you should have this dose increased.
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Livingston, NJ : Is it true that Metformin can damage my kindeys? I have t2 diabetes.
Dr. Bakris: Metformin CAN NOT damgae your kidneys! It should not be used however, if you have lost more than half of your kidney function because of the rare posiibility of developing another metabolic disorder that would result in too much acid in your blood.-This is however very rare
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Sugar Land TX: Is kidney failure inevitable with Diabetes II
Dr. Bakris: NO! Only about 35-40% of people with diabetes develop kidney disease. Risk factors include: family history of kidney disease, poorly controlled blood pressure >140/90 and poorly controlled blood sugar HbA1c >8%
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Istanbul,Turkey: Can ACE inhibitors help prevent CRF if given in long standing TYPE I DM before any renal problem?
Dr. Bakris: ACE inhibitors can prevent CRF in long standing diabetes if BP is kept <130/80 mmHg. However, keep in mind that only about 40% of people with Type 1 DM develop nephropathy
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Manassas, VA : I recently had some lab work done and there was a small amount of protein in my urine. I have t2 diabetes. Does this mean that I am heading for kidney disease? I'm very worried.
Dr. Bakris: It depends how much protein was found. If >300 mg/day then you already have kidney disease. If <300 or well below that you are at risk for a heart attack or strike but do NOT have kidney disease. Regardless, you should make sure your BP is <130/80 or close to that, that either an ACE inhibitor or angiotensin receptor blocker is appropriate doses is part of your BP lowering regimen and that you HbA1c be <7%-that will makedly reduce your CV and kidney disease risk.
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Omaha, NB : If I go on a low carb diet to try to manage my blood suger and add protein would that that result in Kidney damage?
Dr. Bakris: You should maximally consume 1gr/kd/day of protein. Eating 3-4 times that daily over years may injury your kidney but if you already have kidney damage you should limit protein intake to 0.8 gr/kg/day. If your trying to lose weight there is no substitute for avoiding fried foods and exercise.
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Pittsburgh, PA : I read that at a blood glucose reading of approximately 180 the kidneys start to remove sugar from the blood. My question would be whether or not forcing the kidney to do that filtering is the first step towards kidney damage? Do that enough, and do you need dialysis or a transplant? Obviously it is not an immediate effect, but if it is a step in that direction, then it seems to me that I really don't want to spike above 180 ever. Am I on the right track with this thinking?
Dr. Bakris: The value of 180 is the threshold at which the kidney can no longer keep sugar so it starts to spill it-Its like water running over a given size glass if you keep pouring. High sugar does injure the kidney but not by this mechanism it does so by stimulating a whole host of reactions that result in fibrosis and accelerated aging of the kidney
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Angleton, Tx: What happens to insulin if it accidently gets frozen?
Dr. Bakris: I don't know the answer for this definitely, but theoretically nothing-it should still be good
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River Falls, WI: Does having high cholesterol mean that you will get diabetes? Is there a formula that doctors use to determine the type of diabetes an individual might contract?
Dr. Bakris: Cholesterol and diabetes have little to do with each other. It is common for people with diabetes to have elevated cholesterols, however, millions of people have elevated cholesterol levels without presence of diabetes. Each has a different genetic predispostion. As far as determining which type of diabetes one has, it is primarily based on blood tests and history.
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hayden, idaho: i have a fasting blood glucose of 109,my dr. doesnt seem to be to worried but is sending me for another test .is 109 bad anough to moniter my blood at home? i had to check it 3 times a day while i was pregnant.but my dr. now wont give me a moniter .im just worried.
Dr. Bakris: The risk of developing diabetes later in life, if diabetic while pregnant is higher than women who don't have diabetes while pregnant. I would suggest that you go on an exercise program and limit carbohydrate intake, if over weight. If not overweight, you should check your fasting sugar every 6 months and watch for symptoms of waking up at night and frequently (3-4 times/night) going to the bathroom, being very thirsty frequently, and feeling more tired than usual for no apparent reason.
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Santiago, Chile, South America: My 15-year-old daughter was tested for glucose tolerance, but she was havng her period. Will that effect the results?
Dr. Bakris: Menstrual cycle should not affect glucose tolerance.
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NY, NY : I recently read that new Australian research has found that one-in-two patients with type 2 diabetes are also suffering chronic kidney disease. Doctors say the figures are much higher than doctors expected. The study was done by the Baker Heart Research Institute and blood samples were taken from almost 4,000 diabetes patients. Dr Merlin Thomas says most of the patients were aged in their mid 60s, and many did not know that their kidneys were being damaged.
Dr. Bakris: Kidney disease, like hypertension is a silent killer. You have to have lost over 70% of your kidney function before you have any symptoms and then they are NOT like diabetes but rather vague symptoms like feeling tired or with a decreased appetite-so the only way you would know if you had kidney disease is to have a blood test. Dr. Thomas is a friend of mine-and I think the point of that report was that many people with diabetes have kidney disease and they don't know it because of the symptoms of diabetes overshadow those of kidney disease for the reasons I mentioned.-Hope this clarifys it for you
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Sugar Land TX: Is kidney disease inevitable with Diabetes II?
Dr. Bakris: NO only about 35% of people with type 2 DM get kidney disease-see other responses to similar question for further details
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Matarie, LA : HI ,YESTERDAY I WAS DIAGNOSED WITH THE BEGINING OF KIDNey DISEASE FROM DIABETES. THE DOCTOR SAID I HAVE A SMALL AMT OF DAMAGED AND HE PUT ME ON ALL-TRACE 2.5MG. ONCE A DAY. CAN ANYTHING BE DONE LIKE DIET AND EXCERISE.
Dr. Bakris: Absolutely, you should follow ADA dietary recomendations and your doctor should refer you to dietician to educate you about that. You should be walking at least 30-40 minutes perday 6days aweek. The dose of ALTACE is very low and that should be increased to the dose shown effective in the studies, 10mg/day also your BP should be kept at <130/80 if possible and your blood sugar <7% HbA1c
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fresno, california: diabetis is primarily associated with which body system?
Dr. Bakris: Diabetes is the failure of the pancreas to either produce enough insulin to handle the sugar (glucose) in your system or making too much insulin and the muscles can't use it appropriately.
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rincon georgia: Please tell me how a diabetic can get help paaying for medicine and special shoes?Has insurance but still has a high co pay for medicines and will not cover shoes.Please Help
Dr. Bakris: As far as drugs, many companies offer programs to low income people who can't afford drugs. As far as shoes-I'm sorry I don't know the answer to this but would ask your local endocrinologist.
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Carlinville,IL: I am a 47 y.o. type 1 male caucasian,diagnosed 10 yrs ago.I am in relatively good health,but I do smoke,and do not exercise much,besides regular walking,from 1/2 mi to 4 miw/0-25 lb burden. I was on 2.5 mg ACE inhibitor(Altace,Lisinopril,..) for my 3rd thru 9th years,and I persuaded the PA to agree to let me off of it,so that we could see how well my kidneys do for a few HbA1c...No detectable increase in the protein in my urine was noted. Now, my doctor has once again seen me-in the PA's absence-and he noted that I was no longer taking Lisinopril. He would listen to no reason,chiding me and citing only that I 'will always be diabetic' as reason to be on the drug. I have agreed to go back on it,not wanting to lose my Medicaid coverage...He did not prescribe it initially-when I had no insurance at all. I would like your opinion about this. Thanks,Kris
Dr. Bakris: Unfortunately, what I offer is not opinion but fact based on over 25 years of reseach. It is critical that you maintain your HbA1c <7 (ideally <6.5%) and that your blood pressure be <130/80. An ACE inhibitor has been shown in many studies to be very effective but not in the low doses you're taking. Generally, commonly used ACE inhibitors like lisinopril should used at doses of 20-40 mg/day. Your doctor is correct -- diabetes is NOT curable and the risk of developing a heart attack of stroke is 6X higher than the general population. If you smoke it is more than 15 times higher-stop smoking!
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Indianapolis, IN: In patients with type 2 diabetes, that are on oral medication and insulin. Can these patients benifit from using insulin pumps. Giving that the pump will stand in for normal pacrease function and posible slow the onset of kidney disease.
Dr. Bakris: Insulin pumps will absolutely slow progression of kidney disease if they are placed in the very early stages of disease before any substantial kidney function is lost.
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new jersey: I am about seven months pregnant and just had a 1 hour glucose test done and the doctors called me today and want to send me for a three hour test because my results came in at 175 and they said that the highest I should be at is 139. What are the chances that is was fluke? Should I really really be worried?
Dr. Bakris: If you were truly fasting and not taking any new drugs-these are probably real results. You should be concerned and vigilant but not worried. In most cases diabetes goes away after delivery. But your risk for devleoping it later in life is higher so you will need to watch your weight and excercise as you get older.
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Dunedin, Florida: What specific dietary restrictions can a person who has been diagnosed with some kidney damage follow to postpone/prevent requiring dialysis?
Dr. Bakris: Low sodium 3-4 gram/day, low protein 0.8 gr/kg/day
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Grayson, GA: Can too much protein and not having a balanced diet to include carbs together with proteins and vegetalbe be part of the cause of kidney disease?
Dr. Bakris: No but it can increase its decline if already present
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san jose ca: my blood sugar is 104 am i diabetic
Dr. Bakris: No but you have impaired glucose tolerance and should exercise and reduce your weight by at least 20% of your current weight-also get advise from your doctor on other tips
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Denver, CO: Is there any connection between high protein diets and kidney disease in people with type 1 diabetes? Thanks.
Dr. Bakris: High protein diets will worsen kidney function in diabetes if already present and should be avoided. Ideally, a 0.8 gr/kg/day diet should be ingested.
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spring hill,florida: I recently had my 3mo labs drawn, and was told there were high levels of protein in both my blood, and also in my urine. I was just curious of how changing certain things in my diet could help my body out.Can you please tell me of a healthy diet to cut out some of that protein.Is it possible that I am getting to much protein?
Dr. Bakris: If you have high protein in both your blood and urine you need to see if it is albumin or other protein, especially if your over 55 years of age. That is easily checked with an electorphoresis of your urine. If it is albumin, you should cut your protein intake to 0.8 g/kg/day so if you weigh 170lbs you should not eat more than 6 oz of meat per day
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Chesapeake, Virginia: My husband was recently diagnosed with type 2 diabetes. He has a very foul smell to his breath. Is there a connection? Thank you. Cindy
Dr. Bakris: This is probably due to ketoses which occurs when blood sugar is not managed well. Once his blood sugar is controlled it should go away.
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Blue Springs, Mo.: Recently a young man staying with us with Type 1 has had spikes of over 300 to 500+ in his ounts during the day and drops from 41 - 50 at night. Since we are his stand in parents this is alarming to me and I am seeking ways to improve this recent trend. What do you suggest?
Dr. Bakris: This really should be monitored by a local endocrinologist. I would suggest avoiding large meals and instead have him eat multiple small meals during the day, say 6-7 meals.
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Taylorsville, Utah: What affect does alchool have on Diabetes.
Dr. Bakris: Alcohol gets metabolized to sugar so it will increase gluocse values and in those with diabetes make glucose control tougher. Having said that, a glass of dry red wine per day is permissible and helpful for reduction of cardiovascular (heart disease) risk.
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Tyler Texas: I am wanting to know if there are any symtoms of diabetes? Is there like a warning before onset or does it just suddenly occur?
Dr. Bakris: There is no warning before the onset of diabetes. If you have a family history and are 30% above ideal body weight you are definitely at higher risk.
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Marietta Georgia: I was just diagnosed with diabetes last thursday. I am trying to learn as much as possible. Can I drink diet soft drinks?
Dr. Bakris: Yes, but limit them because they do contain phosphates which are bad for bones
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River Falls, WI: Is there a formula that doctors use to determine the type of diabetes an individual might contract? Example-Is there a difference between how a doctor would determine diabetes between an individual who is 6' 2" 250 lbs and 5'3" 150 lbs?
Dr. Bakris: An overnight fast is adequate for determination of blood sugar. The highest levels of blood sugar generally occur 2 hours after a meal.
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ADA Moderator : We're close to the end of our time here today.
Do you have any thoughts on diabetes and kidney disease that you'd like to leave us with Dr. Bakris?
Dr. Bakris: The key to protecting against diabetic kidney disease is to keep your blood sugar controlled i.e. HbA1c <7%, keep your BP from going above 140/90 and ideally keep it below 130/80 and limit salt intake to 3-4 grams/day and protein intake to about 4 oz-6 oz of meat per day. This will ensure that your risk for developing kidney disease is maximally reduced.
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ADA Moderator :
That's it for today. Thanks so much for taking the time to be here Dr. Bakris.
Thanks to all of you who joined us by asking great questions or by just tuning in. If you wish to continue any of today's discussions please feel free to visit the ADA Message Boards.
Keep up to date with all the ADA Live events and reference the archives here.
We hope you found this interesting and informative and that you'll join us again next time here at ADA Live. Rite Aid Pharmacists and Diabetes Care Specialists will be with us next at 1:00 p.m. EST September 7, 2006. See you then.
Dr. Bakris: Thank you for inviting me. We had a lot of good questions today.
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