Keeping Your Kidneys Healthy with Diabetes

Intro: We’re talking wellness at MemorialCare Health System. It’s time for Weekly Dose of Wellness. Here’s Deborah Howell.

Deborah Howell (Host): Welcome to the show. I am Deborah Howell and today our guest is Dr. Gaytri Gandotra, a nephrologist specializing in kidney care at Orange Coast Memorial Medical Center. Welcome, Dr. Gandotra.

Gaytri Gandotra, MD: Hi, thank you.

Deborah Howell (Host): So great to have you on the program today. Diabetes is a multisystemic disease that affects many organs, most commonly the eyes, the nerves, and the kidneys. Education and early intervention is of utmost importance in preventing diabetic kidney disease and dialysis. So today we will talk a little bit about the possible long-term effects on the kidneys due to diabetes, how to properly manage diabetes to avoid damage to our kidneys, and ways to help keep your kidneys strong. So doctor, what is diabetes?

Gaytri Gandotra, MD: So diabetes is a condition where your blood sugar is high either because of lack of or our body's resistance to a hormone called insulin. And insulin is secreted by cells in our pancreas and it has important effects on the metabolism of carbohydrates, fats, and proteins. So once we eat, our blood glucose becomes elevated, and insulin gets secreted, and it allows for our fat, liver, and muscle cells to use the blood sugar. Okay. So typically there's two types of diabetes. There's type one diabetes, where our body's own immune system attacks the cells of the pancreas. So we don't have any insulin, and the way to treat this is by injecting insulin into ourselves. This accounts for about 15% of diabetics. The second type is where we are resistant to insulin. So this presents after the age of 40 typically.

Deborah Howell (Host): Okay. And then how does diabetes go ahead and affect our kidneys?

Gaytri Gandotra, MD: So in the early stages, the kidneys start to hyper-filter. So the high blood sugar basically affects the kidneys. So inside the kidney, we have a million functioning units called nephrons. Just like we have neurons in the brain, in the kidney we have nephrons. So the filtering units because of the high blood sugar begin to enlarge and expand. It compromises the integrity and eventually we start spilling protein into the urine. So when we spill protein into the urine, that's how diabetes affects the kidneys and it's also known as diabetic nephropathy. So this is the first sign of kidney disease.

Deborah Howell (Host): Got it. And what are the symptoms to look out for that may indicate your diabetes may be affecting your kidney health?

Gaytri Gandotra, MD: So it's hard to tell specifically if there's symptoms because of the diabetes. The only way when your kidney filtration rate starts to go down, that's known as our GFR. As the GFR declines, we can have symptoms like shortness of breath, fatigue, weakness, just overall not feeling well, nausea, vomiting, and so on.

Deborah Howell (Host): All right. Are there some tests that are done to verify that you may have kidney disease due to diabetes?

Gaytri Gandotra, MD: Right. So it's important for your doctor to check your urine for protein. And that's something we don't - some doctors do, but that's - it's very important to make sure we do this at least once a year. This can be done with a simple urine analysis, or it can be done on spot samples of urine. Other ways to do it are checking your urine for protein over a 24-hour sample, where you urinate into a container for 24 hours. Other tests are routine blood tests like checking your blood creatinine level, that's something we check in our chemistry. Knowing your GFR or your filtration rate is also very important. So these are the few tests we can do to check to see if diabetes is affecting our kidneys.

Deborah Howell (Host): That's why they always make you pee into the cup when you go to the doctor.

Gaytri Gandotra, MD: Yes.

Deborah Howell (Host): Thank you for demystifying that for many of us. What are some ways to manage diabetic kidney disease if someone tests positive for protein in their urine?

Gaytri Gandotra, MD: So people often think that diabetics will think, well, you know, my blood sugar is under control. You have to understand the dynamic of the kidneys. So if our blood pressure, not blood sugar, if our blood pressure is high, we have higher pressures inside the filter, the kidney filter. And if you have higher pressures, you're going to spill more protein in the urine. The goal is to not have protein in the urine. We normally, we can put out up to 150 milligrams a day, that's in a normal, healthy, a healthy individual. So the minute we, when we start putting out say 500 milligrams a day or one gram a day, that's when you know that diabetes has basically affected your kidney filter. So blood pressure control is of utmost importance, very important. So I tell all my patients to get a blood pressure machine and when they're home in a relaxed environment, to at least I would say a few times a week, check their blood pressures and write it down in a notebook. And keeping a blood pressure log is very important. So the target blood pressure is less than 130 over 80 for diabetics.

Deborah Howell (Host): So that's 130 over 80. And that's for both, both types of diabetes?

Gaytri Gandotra, MD: Yeah, that's for both types of diabetes. If you have protein in your urine, your target blood pressure is lower, and that's 125 over 75. Because you want to keep the pressure down so that you don't put protein out in the urine. Other important things are to make sure obviously that your blood sugar is well-controlled. And to have your hemoglobin A1C, which is a test, it's a marker for diabetics, it's a three-month test, that number should be less than seven, that should be your target hemoglobin A1C. And there are certain classes of medications which your doctor will prescribe for you if you have high blood pressure and protein in the urine. So they, they kind of hit two birds with one stone, those medications will reduce the protein in the urine and bring your blood pressure down.

Deborah Howell (Host): Got it. Now let's say that you are diagnosed with diabetes. What are some ways to prevent diabetic kidney disease if you're living with diabetes?

Gaytri Gandotra, MD: Well, the ways to prevent it is what we talked about, is checking your, making sure you get an annual screen, you check your urine for protein, you check your kidney function, keep your blood pressure under control. There have been studies that show if you stop smoking, there's an additional benefit. Physical activity and exercise, just overall living a healthy lifestyle will prevent you from getting diabetic kidney disease.

Deborah Howell (Host): I think that pretty much almost answered in full my next question, which was going to be, are there some other good ways to keep your kidneys healthy in general to prevent kidney disease?

Gaytri Gandotra, MD: Right. So, I call it the eight golden rules, and to keep your kidneys healthy, and this is for people without any kidney impairment, and others, weight loss, physical activity is very important. A low salt diet, less than 2,400 milligrams a day is very important. People oftentimes say we eat out, we eat processed foods, those have a lot of sodium in it and that can increase your blood pressure over time. I mean, you will invariably eat sodium without even knowing it, you know, just in a slice of bread. So a low salt diet, a potassium-rich diet is good for your kidneys because it helps to lower your blood pressure. So that's in fruits and vegetables. A low intake of total and saturated fats, limit your alcohol intake, stop smoking if you do, and make sure you find ways to relieve your stress.

Deborah Howell (Host): And exercise is one of the best.

Gaytri Gandotra, MD: It is. Exercise is one of the best. And that's the one that shows if you exercise for 30 minutes five times a week, that is the one that will drop your systolic blood pressure without taking a medication by say five. So if you have a blood pressure of 140 over 80, that'll bring it down to 135 over 80.

Deborah Howell (Host): Incredible. And, and it's just, you know, light walking even does that, 30 minutes, you know, there are some...

Gaytri Gandotra, MD: Exactly.

Deborah Howell (Host): You don't have to get on a machine, you don't have to kill yourself, but make sure you walk at a good pace for you and uh, 30 like you said, 30 minutes, five times a week. I have a friend who always says every muscle, every day. And I think the stretching regimens, in in yoga or just stretching routines in general help all our organs.

Gaytri Gandotra, MD: Right. And people are, it's interesting to see that people will continue to not adhere to these measures or change their lifestyle, but they'll continue to take medications, which have a lot of side effects. So I'm a big proponent of, um, trying to wean off your blood pressure meds. If people do six months of this, they can even come off of one of their blood pressure pills. You don't need all the all the medications to keep your... I mean there's no point in in not adhering to a healthy lifestyle and just taking pills to bring your blood pressure down. So...

Deborah Howell (Host): Just get a kitten and put the kitten in your lap and your blood pressure will drop by 50 points. That's my plan.

Gaytri Gandotra, MD: Yes.

Deborah Howell (Host): Well, thank you so much, Dr. Gandotra, for the great information today. It was really wonderful having you on the program.

Gaytri Gandotra, MD: Okay, thanks for having me.

Deborah Howell (Host): I'm going to go dump out all my salt shakers.

Gaytri Gandotra, MD: Okay, great.

Deborah Howell (Host): For more info or to listen to a podcast of this show, go to memorialcare.org. That's memorialcare.org. I'm Deborah Howell. Catch you next time and have yourself a fantastic day.