The Dynamic Duo 

Sorry Batman, not yours. I’m writing about Chronic Kidney Disease and diabetes. For a decade, I’ve been told diabetes is the number one cause of CKD. Got it… and (as you know) CKD. Then I learned that CKD can cause diabetes. Ummm, okay, I guess that sort of makes sense. And then, oh my, I developed diabetes. But how? I’d never questioned how that worked before, but I certainly did now.

Let’s go back to the beginning here. First of all, what is diabetes? I included this information in SlowItDownCKD 2013:

“According to MedicalNewsToday at https://www.medicalnewstoday.com/info/diabetes:

‘Diabetes, often referred to by doctors as diabetes mellitus, describes a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body’s cells do not respond properly to insulin, or both. Patients with high blood sugar will typically experience polyuria (frequent urination), they will become increasingly thirsty (polydipsia) and hungry (polyphagia).’”

Guilty on all three counts as far as symptoms. It gets worse. I uncovered this fact in SlowItDownCKD 2014:

“According to Diabetes.co.uk at https://www.diabetes.co.uk/how-does-diabetes-affect-the-body.html,

‘The kidneys are another organ that is at particular risk of damage as a result of diabetes and the risk is again increased by poorly controlled diabetes, high blood pressure and cholesterol.’”

This is getting more and more complicated. But again, how is diabetes damaging my kidneys?

It seemed to me that I had just posted a fact about this on SlowItDownCKD’s Facebook page, so I checked. Yep, I did on September 7th.

“Did you know that high glucose levels can make your red blood cells stiffen? This hinders your blood circulation.”

And this affects the kidneys how? Let’s think about this a minute. Way back when I wrote What Is It and How Did I Get It? Early Stage Chronic Kidney Disease, I included this information:

“A renal artery carries the blood, waste and water to the kidneys while a renal vein carries the filtered and sieved waste from the kidneys.”

The American Society of Hematology at http://www.hematology.org/Patients/Basics/ tells us there are four parts of the blood:

  1. Red blood cells
  2. White blood cells
  3. Plasma
  4. Platelets

Hmmm, so red blood cells compose one quarter of your blood and high glucose can make them stiffen. To me, that means a quarter of your blood will be working against you.  Not what we need… especially when we’re already dealing with Chronic Kidney Disease.

Back to my original question (again): How do high glucose levels affect the kidneys?

Thank you to the National Kidney Foundation at https://www.kidney.org/atoz/content/Diabetes-and-Kidney-Disease-Stages1-4 for exactly the answer I was looking for:

  • Blood vessels inside your kidneys. The filtering units of the kidney are filled with tiny blood vessels. Over time, high sugar levels in the blood can cause these vessels to become narrow and clogged. Without enough blood, the kidneys become damaged and albumin (a type of protein) passes through these filters and ends up in the urine where it should not be.
  • Nerves in your body. Diabetes can also cause damage to the nerves in your body. Nerves carry messages between your brain and all other parts of your body, including your bladder. They let your brain know when your bladder is full. But if the nerves of the bladder are damaged, you may not be able to feel when your bladder is full. The pressure from a full bladder can damage your kidneys.
  • Urinary tract. If urine stays in your bladder for a long time, you may get a urinary tract infection. This is because of bacteria. Bacteria are tiny organisms like germs that can cause disease. They grow rapidly in urine with a high sugar level. Most often these infections affect the bladder, but they can sometimes spread to the kidneys.

I would say I’m heart… uh, kidney…broken about this development, but the truth is I’m not. I don’t like it; I don’t want it, but I can do something about it. I’d already cut out complex carbs and sugar laden foods in an abortive attempt to lose weight for my health. Well, maybe my daughter’s wedding on October 6th had something to do with that decision, too.

The point is, I’ve started. I’m aware of the carbohydrates in food and I’m learning how to control my intake of them… just as I’m aware that I have to break in the shoes for the wedding. Something new has to be gotten used to. I’ve had a head start.

Why the emphasis on carbs, you ask. I turned to my old favorite The National Institute of Diabetes, Digestive and Kidney Diseases at https://www.niddk.nih.gov/health-information/diabetes/overview/diet-eating-physical-activity/carbohydrate-counting  for help:

“When you eat foods containing carbohydrates, your digestive system breaks down the sugars and starches into glucose. Glucose is one of the simplest forms of sugar. Glucose then enters your bloodstream from your digestive tract and raises your blood glucose levels. The hormone insulin, which comes from the pancreas or from insulin shots, helps cells throughout your body absorb glucose and use it for energy. Once glucose moves out of the blood into cells, your blood glucose levels go back down.”

If you’ve got diabetes, your body either is not producing enough insulin or not interacting well with the insulin it is producing. Measuring my blood sugar levels when I awaken in the morning has shown me that when I’m sleeping – when I cannot help my blood sugar levels come down by eating protein or exercising, even in my dreams – is when I have the highest blood sugar. During the day I can keep it under control.

And that’s where my medication comes in. The usual – Metformin – can cause nausea, which I deal with more often than not, so that was out. However, a new medication on the market just might do the trick. It’s only been a few days, but I do notice my blood sugar upon waking is getting lower each day. This medication is not a panacea. I still have to be careful with my food, exercise daily, and sometimes counteract a high carb food with a protein. I’m not there yet, but I’m learning.

Until next week,

Keep living your life!

You Mean it’s Really The Carbs?

sugarWhen I think of diabetes, or pre-diabetes, I think of sugar.  Your A1C measures the percentage of blood glucose (think sugar) in you, so I just presumed that’s why it was used to determine if you have diabetes. Last week, when I was researching this test, I came across material suggesting it was carbohydrates – not the sugar I had assumed – that needs to be cut down in an effort to slow down the disease.

As usual, I’m getting a little ahead of myself.  I think I’ve discovered a formula that works when explaining… and it starts with a definition. According to Medical News Today at http://www.medicalnewstoday.com/info/diabetes/,

“Diabetes, often referred to by doctors as diabetes mellitus, describes a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body’s cells do not respond properly to insulin, or both. Patients with high blood sugar will typically experience polyuria (frequent urination), they will become increasingly thirsty (polydipsia) and hungry (polyphagia).”

Mellitus comes from the Latin and refers to sugar sweetened. Notice that diabetes is often called Diabetes Mellitus.  Hmmmm, another reason I thought it was ingested sugar that causes the disease.  Yet, it is described as a metabolic disease; that is, a disease that deals with our metabolism – the way we process the foods we eat to gain energy.

Well then, where does insulin come in?  Just in case you forgot, insulin is “A natural hormone made by the pancreas that controls the level of the sugar glucose in the blood. Insulin permits cells to use glucose for energy. Cells cannot utilize glucose without insulin,” accordinginsulin to MedicineNet.com at http://www.medterms.com/script/main/art.asp?articlekey=3989.

Oh, so if your body is not producing enough insulin or none at all or the cells can’t respond to the insulin produced in the usual way, the energy from the blood glucose can’t be used to provide energy for your cells.  Accepted.  But isn’t blood sugar still sugar, say from candy, cake, cookies and the like?  You know, the things we don’t eat as Chronic Kidney Disease patients.

Well… yes and no. Certainly these food items contain sugar.  That’s part of what makes them so delicious.  But they are also carbohydrates, a word I usually associate with bread and pasta. MedicineNet’s definition of carbohydrate at http://www.medterms.com/script/main/art.asp?articlekey=6553 cleared up my confusion:

“One of the three nutrient compounds, along with fat and protein, used as energy sources (calories) by the body. Carbohydrates take the form of simple sugars or of more complex forms, such as starches and fiber. Complex carbohydrates come naturally from plants. Intake of complex carbohydrates, when they are substituted for saturated fat, can lower blood cholesterol. Carbohydrates produce 4 calories of energy per gram. When eaten, all carbohydrates are broken down into the sugar glucose.” cookies

Ahh! So all carbohydrates, whether from starches or sugars break down into sugar glucose.  This is starting to sound familiar. When I brought my pre-diabetes to the nutritionist at my nephrologist’s office, she gave me quite a bit of information and a handout from DCE, a dietetic practice group of the American Dietetic Association.  Did you know that starchy vegetables, fruits, juices and milk also contain carbohydrates?  It hadn’t occurred to me.

Remember the way to measure a half cup or a whole cup when you don’t have measuring cups but want to stay on the renal diet, including portion control?  It’s the size of your palm for half a cup and the size of a clenched fist for a whole cup.  The same measurements are used to measure a portion of carbohydrates.  Good for us, one less thing to learn.  You know measuring cups are better, but to be honest, I got a little tired of dragging them around with me in only a few weeks. measuring cups

You can also buy portion control plates on the internet, but frankly, it’s just as easy to measure it (whatever it is) out once and then know what that size portion is. For example, we needed glasses so when I first used one, I measured the water it held and now know the new glasses hold 15 oz. unlike the blue ones which hold 8 oz.

When we moved in together, we had two sets of plates (Ahem, of course mine were more attractive.)Bear’s set had only large dinner plates whereas mine had both large and smaller dinner plates.  Since we were both trying to lose weight, it made sense to use the smaller ones.  Now I can see a portion on the plate without having to measure it.  I do measure periodically just to make sure I haven’t allowed my assessment of a portion to grow bigger.  Funny how that happens over time.

The Mayo Clinic has a good diet plan for diabetes at http://www.mayoclinic.com/health/diabetes-diet/DA00027/NSECTIONGROUP=2, but it won’t work for Chronic Kidney Disease patients as it is.  For example, whole wheat flour raises your blood glucose less than white flour, but has too much phosphorous for us, so we are warned to avoid it. Yoghurt, cheese, beans, and nuts are no-nos on my renal diet, but are often recommended in diabetes diets.

You need to know what you can and cannot eat on your renal diet before you look at the diabetes diet so you know what to cross out immediately.  This is what makes it easier for me to plan what I’ll be eating that day.

black breadYou also need to space out your carbohydrates.  This grand-daughter of a Jewish miller from Russia really did miss sitting down to eat a whole loaf of fresh black bread at one sitting… with butter, no less.  The diabetic diet’s not that bad, though: for me it’s 2 to 3 carbohydrate portions at breakfast, lunch and dinner with a one carbohydrate portion at three snacks – one after each meal. As I understand it, each carbohydrate portion is 15 grams. You can find a comprehensive list of these foods at http://www.diabetesdaily.com/forum/food-diet/25848-15g-carbs-snack-list/

I never told you about The Men’s And Women’s Gathering hosted by The Salt River Pima-Maricopa Indian Community and open to all tribes as well as non-tribal members.  SlowItDown’s kidney education coordinator, Annette Folmer (left), and nurse CherylVietri (right) did a great job of answering all the questions asked..  The three of us were delighted at how interactive the session was.  We had a plan, but a better one presented itself during the education.  As a result, I ended up gladly donating 15 books to visiting tribal members.  What a way to start off SlowItDown’s career of bringing free ckd education to any community that needs it! IMG_0189

Until next week,

Keep living your life!