Nephropathy alone is damage or disease of the kidney; however, diabetic nephropathy is kidney disease that is associated with long-term diabetes also referred to as Kimmelstiel-Wilson disease or intercapillary glomerulonephritis.

This disease affects the tiny blood vessels found in the glomerulus, which is the main structure in the capillary blood vessels of the kidneys. This structure is vital for the blood to be filtered. Clinically the signs of nephropathy are the excess filtration of protein in the urine, impaired kidney function, and high blood pressure. When diabetic nephropathy becomes severe it can lead to kidney failure, end stage renal disease and the need for dialysis or even a kidney transplant is necessary. An individual with type 1 – insulin-dependent or type 2 – non-insulin-dependent can suffer from nephropathy.

In Type 1 diabetes individuals it is believed that 25% to 45% of patients will at some time develop nephropathy. The common time frame for nephropathy to show signs is between ten and fifteen years after the beginning of diabetes. (1)

In Type 2 diabetes individuals the disease is not as aggressive but is noted in Pima Indians more often with 50% developing nephropathy after twenty years of suffering from diabetes. (1)

Symptoms

There are no early warning symptoms of nephropathy. The progression of the disease is slow and will not be discovered when the kidneys ability to function properly begins to have problems. The symptoms most commonly associated with nephropathy include tiredness, feeling under the weather, frequent hiccups, foamy urine, headache, itching, nausea, vomiting, swelling of the legs, morning swelling around the eyes, weight gain due to retaining fluid, and poor appetite.

Risk Factors

Risk factors for developing Nephropathy include individuals with long standing Type 1 Diabetes or Type 2 Diabetes.

Diabetic nephropathy is responsible for 35% of End Stage Renal Disease also known as stage 5 kidney disease in the United States with estimated at $50,000 per patient per year. Type 1 diabetes patients have a higher risk of developing nephropathy; however, those with type 2 diabetes can also develop nephropathy. Recent research has shown that the number of type 1 diabetes patients developing nephropathy is decreasing. This could be due to an increase in better preventive measures.  A recent study, San Antonio Heart Study did show that more Mexican Americans with type 2 diabetes were now developing nephropathy. The report showed that during the 7 to 8 study that an increase from 5.7 percent in 1979 was 15.7 percent in 1988. The study confirmed that individuals with various end stage renal disease was higher among those with type 2 diabetes due to the fact that more individuals have this type of diabetes.  (2)

Risk Factors that cannot be controlled

The main risk factors that cannot be controlled includes a family history of high blood pressure, family history of kidney disease, and your origin with more individuals being of American Indian, Hispanic, or African American descent.

The main reason a person develops nephropathy is associated with glomerular hypertrophy and an increase in the renal size. The reason this occurs is not actually known however, it is believed to be due to high blood pressure.

Risk factors you can control

The good news is that most of the risk factors associated with nephropathy are controllable. Blood pressure is a major factor. Those with high blood pressure have a higher risk of developing nephropathy along with poor glucose control which is the blood sugar level are both contributing factors. For patients with high blood pressure and uncontrolled blood sugar levels the risk of developing nephropathy increases within twenty years. For patients that are controlling their blood sugar and keep it below 8.1% the risk is much lower, however for those that have a concentration above 11% the risk of developing nephropathy is higher. (3)

The sad news is that in most patients at the time of a diagnosis of diabetes, around 80 percent have abnormal blood pressure.

Smoking has shown an increased risk of developing or increasing the progression of nephropathy. A study in 1983 with patients diagnosed with type 1 diabetes of 192 men and 109 women all classified as smokers, concluded cigarette smoking contributes to the development of nephropathy. (4)

Treatment

Treatment of nephropathy is to prevent complications and to keep the disease from becoming worse. The best treatment is to control the blood pressure to help slow kidney damage. The medications often used in treating high blood pressure include angiotensin receptor blockers or antiotensin-converting enzyme. These medications are often prescribed to individuals with high blood pressure that are showing sings of kidney disease.

Along with this blood sugar levels should be checked often and a diabetic diet followed closely. During the early stages of nephropathy, this is a very important factor for slowing the disease. Your physician can also prescribe medications that can help control the blood sugar levels. The most common medications in the treatment of diabetes include melformin, sulfonylureas, thiazolidinediones, meglitinides, alpha-glucosidase inhibitors, and dipeptidyl peptidase-4 inhibitors.

Infections are a common issue with patients suffering from nephropathy such as urinary tract infection, which is treated with antibiotics.

In the final stages of nephropathy, the treatment is usually dialysis or kidney transplant.

Sources:
1) Ari Kostadaras, M.D. – Nephrology Hemodialysis Hypertension Clinic, New York
2) American Diabetes Association
3) Ari Kostadaras, M.D. – Nephrology Hemodialysis Hypertension Clinic, New York
4) American Diabetes Association

VIAject is a new treatment for diabetes.  It is a modified form of insulin that is designed to have superior onset of action and provide better glucose control.

The hope is that it will provide better simulation of normal, body insulin release patterns after eating.

This is important as even temporary abnormalities in blood sugar can cause damage over time.

The condition

Diabetes is one of the most common health conditions.  There are two main forms.

Type I diabetes is characterized by the destruction of insulin producing cells in the pancreas.  Type II is in general characterized by the development of resistance to insulin.

In both cases, the body is less able to process sugar, causing accumulation in the blood and damage to the body.

The problem

While we are able to give insulin to people with diabetes, there are some issues.  One of the most important is that traditional insulin has the tendency to form hexamers, or six-sided structures.

Since your body has to manually break down the hexamer, this can cause a significant delay in how long it takes the insulin to start working.

A possible solution

VIAject is a form of modified insulin that has had certain Zinc elements removed.  The removal of these elements prevents it from binding with itself and forming globs.

Because of this modified structure, VIAject is available more rapidly to the body than regular insulin and can be described as an “ultra-fast” insulin.

In one study, VIAject reached a certain measure of metabolic activity at around just 33 minutes, versus 51 minutes for lispro, and 66 minutes for human soluble insulin.

In theory, this rapid availability will provide better diabetes control.

A recent six month study of people with Type II Diabetes showed that VIAject had significantly lower rates of hypoglycemic events compared to regular human insulin (RHI).

There, those on VIAject had only .33 events per month, while those on RHI had .66.

Additionally, it is possible that VIAject helps prevent weight gain.  Some data has shown that use of VIAject can lower the amount of weight gained by persons with diabetes over time.

While it does not promote weight loss, it might work better than current therapies to prevent weight gain.

Related Articles:

1. Bydureon Diabetes Drug, Side Effects
2. 10 Tips for Living With Type 1 Diabetes

Sources:

1) Intra-Individual Variability of the Metabolic Effect of a Novel Rapid-Acting Insulin (VIAject™) in Comparison to Regular Human Insulin
2) An Open-Label, Multicenter Trial of VIAject® vs. Regular Human Insulin in Patients with Type 1 Diabetes – Abstract

Treatment of Diabetes

There are two major types of Diabetes: Type I and Type II.

Type I is typically genetic and is caused by the body attacking itself, destroying the cells in the pancreas that create insulin.

By contrast, Type II is typically caused by a combination of genetic predisposition and lifestyle choices, and is generally associated with being overweight.

The two types of diabetes have the same end result: there becomes too much sugar in the bloodstream, which causes a lot of problems.  But their treatments are different.

What does Insulin do?

Insulin helps the body digest and remove glucose, or sugar, from the bloodstream.  It is released from the pancreatic cells in response to the digestion of glucose.  Insulin effects almost every cell but is particularly important in the

Muscles, where it promotes the conversion of sugar into glycogen, a form used to store store

Liver, where it also promotes the conversion of sugar into glycogen

Fat cells, where it promotes the conversion of sugar into fat

Treatment for Type I Diabetes:

Type 1 is characterized by limited to no production of insulin, and treatment for it focuses on replacing the insulin that the body isn’t making.

A key problem in doing so is that insulin is a protein, so it can not be given orally as the stomach will digest it. Also, insulin tends to first pair up with itself, then form into larger complexes that take a long time to be broken.  This means that insulin by itself takes a relatively long time to start acting, so it has to be taken a while before eating, which is inconvenient.

Chemical modifications to insulin help solve the speed of delivery problem.  By exchanging two chemical parts of insulin, a lysine and a proline, the interactions that promote aggregation are disrupted.  This makes the insulin quickly accessible, which means it can be taken almost before a meal.

This instant release form of insulin helps replicate the spike in insulin that the body releases to help digest a meal.  It does not, however, mimic the low level of insulin that naturally exists.  To do so, other insulin derivatives were made, particularly glargine and detemir.

Glargine is a chemically modified form of insulin that, while a liquid in acidic environments, becomes solid in the body.  This means that it hangs around for a lot longer, ensuring a low baseline level of insulin activity throughout the day.  Detemir works similarly, but is made by attaching a fat to insulin which makes it harder for the body to remove.

Typical treatment combines long acting insulin with short acting to try to mimic the body’s natural pattern.  Failure to do so can result in blood glucose irregularities which can, if done poorly, cause a diabetic coma, or worse.

One innovative treatment approach is a continually connected monitor/release system.  The system can allow for greater control over insulin levels; on the other hand, it has to be worn continually, and patients non-adhering to doctor’s orders can possibly be worse with it.

Concerns about Actos

You may be considering pioglitazone or Actos to help treat your diabetes.  But you absolutely need to know that Actos has some very serious side effects and that it’s not entirely clear how well it works.

Pioglitazone, or Actos, is a very popular treatment for Type 2 Diabetes, with prescriptions counting for about 20-25% of total.  It works on peroxisome proliferator activated receptor-gamma receptors to improve sensitivity to insulin in various parts of the body.

The good thing is that Actos does have some benefits.  It seems to lower blood pressure, and seems to have a positive effect on certain important markers of health, like urine composition and levels of lipids in the blood.

And some studies like PROactive have shown that it has significant benefits in lowering risk of mortality from certain aspects of diabetes.

Concerns

First, the way that PROactive measured its outcomes was not properly done and changed in the middle of the study, almost certainly to make the medication come off as being better.  And most of the other studies don’t clearly show health benefits.

Yes, Actos or Pioglitazone does seem to have significant effect on certain physiological factors.  But those measures don’t necessarily translate to improved life-span or reduced risk of events.  And even the PROactive study didn’t have statistically different outcomes for certain serious diabetes related problems.

One analysis of 22 studies argued that 21 of them showed only improvement in surrogate measures.  That means that the medication was shown to have some sort of physical effect but not necessarily have health benefits.

Heart Failure

Worse.  Pioglitazone might significantly increase the risk of heart failure.  In one study, rate of heart failure went up from 2% to 4%, and in another from 8% to 11%.  This is despite having some effects that are good for the heart, like reducing thickness of certain arteries.

Actos also increases risk of bone fracture, and, like a related medication that was withdrawn from the market, may have significant liver toxicity.

Thoughts

Because of these factors, and the lack of definitive and convincing long-term studies focused on measuring health end-points, Pioglitazone’s cost-benefit analysis is not clear.  Its use over other options for Diabetes management should be very carefully considered.

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Metformin, brand name Glucophage

You may be taking or considering metformin if you have Type II diabetes, “prediabetes,” or, though the scientific evidence for its use isn’t so solid, polycystic ovary syndrome.

Metformin works in several ways. It helps certain parts of the body respond properly to insulin, reduces how much glucose is released into the bloodstream, and does a few other things.

Most of what we know about Metformin is good. It doesn’t seem to cause weight gain, and in fact, may cause slight weight loss. It’s affordable. And it has 4 decades of use, meaning we know a lot more about it than many other medications.

One study showed that use of metformin over several years reduced mortality – or death - rates related to diabetes by an impressive 36%.

Side effects of metformin

Metformin’s side effects are mostly mild and treatable, though there is a the rare chance of a problem called lactic acidosis. About 30% of users experience some sort of side effect, including indigestion and diarrhea.

Taking metformin with a meal is one way to reduce problems, as well as taking an extended release version. The immediate release form has about a 17% rate of diarrhea, for instance, while the extended release has only about 8%.

Some have complained that metformin makes them smell bad.

Lactic acidosis is a very rare side effect that is fatal about 50% of the time. Estimates of how often it occurs range from 1/30,000 patient-years to a bit higher.  But assuming you meet the criteria for using metformin, most likely you shouldn’t worry about it.

Most doctors strongly feel that the benefits of metformin outweigh the risks of lactic acidosis.  As one doctor puts it, “Of 10,000 diabetic patients treated for 10 years with metformin, only 10 will die from lactic acidosis. [Based on a large study] of those 10,000 patients… metformin would [have prevented] 500 diabetes related deaths.”

Because of how effective metformin seems to be, some doctors argue for more aggressive use of the medication than is currently done.

Most common metformin side effects: nausea, metallic taste in mouth, some weight loss, vomiting and abdominal bloating.  Cramping or a feeling of fullness is also fairly common.

Talk to your doctor: if you feel excessively weak, have heartbeat changes or irregularities, chest pain, or signs of an allergic reaction.  Some people experience hypoglycemia, or too low blood sugar, on Metformin, which is also important to watch for.  Signs include chills, weakness and dizziness.

You may need to stop use if you are going to get an X-ray or scan that involves injection of die into your body.

This list does not include everything; see manufacturer’s insert for more.

Notes

Metformin can cause Vitamin B12 and folic acid deficiencies, so make sure to be eating a well balanced diet.  Additionally, remember that the initial and ideal treatment for type II diabetes is exercise and improved diet.

And it’s important to take metformin as your doctor directs.  It takes a while to start working and needs to be taken as recommended.

There are several conditions which mean you shouldn’t take metformin, like kidney problems. It’s possible that a significant amount of the lactic acidosis occurs in people who, according to the strict guidelines, shouldn’t have been taking the medication.

Related articles:

1. Bydureon Diabetes Drug, Side Effects
2. 10 Tips for Living With Type 1 Diabetes
3. What are the symptoms of Diabetes?

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Diabetes is an increasingly serious problem in the USA, and is a medical condition characterized by high levels of sugar in the blood.

The blood sugar hurts the kidneys, raises blood pressure, and contributes to heart disease. As such, untreated diabetes can lead to kidney failure, heart attacks, and amputations.

Right now, about 20 million people have diabetes, of which an astonishing 6 million don’t know they have it. The economic cost is staggering, an estimated $116 billion annually.

What are the symptoms of diabetes?

• inability to concentrate
• irritability
• fatigue
• frequent urination
• increased thirst

Your risk of diabetes is even higher if you have

• a BMI over 25
• a sedentary lifestyle
• a family history of diabetes
• hypertension
• elevated cholesterol levels

How is Diabetes Treated?

Diabetes is first treated as minimally as possible. First diet modification, exercise and weight loss are recommended. If this does not adequately lower blood sugar levels, then a medication may be added such as insulin.

What are the types of Diabetes?

Type 1 is a chronic disease that develops because the pancreas stops producing adequate levels of insulin. While this is rarely reversible, it is relatively easy to treat via artificially providing insulin.

In contrast, Type 2 diabetes develops commonly because of lifestyle choices such as being sedentary. As such, it is more reversible. On the other hand, it is also less treatable when it does develop.

The problem with Type 2 is not that the pancreas stops producing adequate amounts of insulin. Instead, the body starts to become resistant to it. That means that it has to produce ever-increasing amounts of insulin to get the body to digest sugar properly. And injecting insulin artificially doesn’t do as much to help because the body is already resistant to it.

As such, it’s very important to recognize when someone has elevated levels of blood sugar and is at risk of developing Type 2 Diabetes. Very often with appropriate lifestyle changes, and possibly medication, the diabetes can be avoided altogether.

Sources:

Prediabetes
Diabetes Update 2009