The most effective way to prevent uremia in diabetes

The most core method of preventing uremia in diabetes is actually not that mysterious: keep blood sugar within the target range for a long time, regularly screen for early damage indicators of kidney function every year, and do not take drugs and health care products that damage the kidneys. If these three things are done properly, more than 90% of people with diabetes can avoid the stage of uremia.

Uncle Zhang, an old patient who I followed up in the endocrinology department two years ago, has been suffering from type 2 diabetes for 11 years. In the past few years, he relied on the fact that he did not feel any discomfort and took anti-diabetic drugs only when he remembered. His fasting blood sugar often rose above 10mmol/L. He also asked someone to buy imported health products that are said to "protect the kidneys and nourish the liver" and take them every day. It wasn't until last year's work unit physical examination that protein 2+ was detected in the urine routine. Further tests showed that the urine microalbumin had reached 280mg/g. The doctor said that if he had come half a year later, he might have entered the irreversible clinical renal disease stage, which made him panic. Later, I adjusted my blood sugar-lowering plan and strictly controlled sugar and salt. After half a year, the index dropped to the normal range of less than 30mg/g. Now I tell everyone I know I knew better than to mess around.

Speaking of this, some people may ask, I have a diabetic who has good blood sugar control, but how come he still has kidney damage? In fact, the current academic circles have different emphasis on the idea of ​​protecting kidneys in diabetes. One group is the "sugar control first" group, which believes that as long as the glycated hemoglobin is stabilized below 7% for a long time, the damage to the kidneys caused by high blood sugar can be cut off. It is suitable for patients who have just been diagnosed with diabetes, are young, and have no other underlying diseases. Such people can even reduce glycated hemoglobin to below 6.5%, leaving enough safe space for the kidneys. The other group is the "kidney protection priority group". They believe that for the elderly who are over 70 years old, have been ill for more than 20 years, and have underlying diseases such as coronary heart disease and cerebral infarction, it is not necessary to focus on reaching blood sugar standards. It is more important to avoid hypoglycemia. At this time, the focus should be on paying attention to the early signs of kidney damage. When necessary, even if the blood sugar is slightly higher, drugs with renal protection should be used in advance. Oh, yes, in fact, neither of these two factions is right or wrong. They are just adjusting priorities according to personal circumstances. There is no need to compete.

Don’t underestimate the importance of regular screening. The kidneys are like the sewage filter at home. They have a very strong compensatory capacity. As long as 30% of the nephrons can still work, the blood creatinine test will be normal. When you really find that the creatinine is elevated, it means that the filter has been blocked by 70%. At this time, it will be too late to intervene. The early signal of damage is actually the urinary microalbumin/creatinine ratio, which can be checked by leaving a morning urine test without drawing blood. It is much more accurate than ordinary urine. It can be checked once a year. If intervention can be done when the indicator just exceeds 30mg/g, it can be almost completely reversed. I have met several people with diabetes, and their annual physical examination and urine routine were negative for protein. When I checked specifically, the ratio was already twice as high. Fortunately, they were discovered early and no major problems occurred.

There is another trap that many people step on, which is taking medicine indiscriminately. Previously, an aunt heard from a patient that metformin hurts the kidneys, so she stopped taking metformin for five or six years and replaced it with "Pure Chinese Medicine Hypoglycemic and Kidney Protecting Pills" purchased on WeChat Moments. After taking it for three months, her blood sugar soared to 18, and she also developed edema. When she came to the hospital, she was diagnosed with stage III kidney disease. To be fair here, metformin itself does not harm the kidneys at all. It is just that people with poor kidney function have a slow metabolism and need to adjust the dose. Stop labeling it as "kidney-damaging." There are also those health care products and folk remedies that claim to "cure diabetes" and "repair kidney function". Those that claim to be 100% effective are all IQ taxes. Not only are they useless, but they may also increase the metabolic burden on the kidneys and cause problems. Oh, yes, the currently commonly used antihyperglycemic drugs of the gliflozin type, such as dapagliflozin, empagliflozin, and antihypertensive drugs of the Sartan/Privacy type, have been confirmed by a large number of studies to have a clear renal protective effect. As long as there are no contraindications, diabetic patients with proteinuria can definitely find a doctor to adjust the plan. Using these drugs will be more effective than any number of health supplements.

As for diet, there is no need to go to extremes. Many people with diabetes eat whole grains all the time in order to control their sugar. However, if proteinuria has already occurred, the amount of whole grains with high plant protein content such as beans and buckwheat must be appropriately reduced, otherwise it will increase the filtration burden on the kidneys. At this time, they should eat more high-quality low protein such as eggs, milk, and lean meat, and drink less Laohuo soup and high-salt pickled products. Of course, some nutritionists believe that whole grains are good for overall metabolism. This is also true. The premise is that your kidney function is completely normal. If there is damage, you must make flexible adjustments and not stick to the diet.

In fact, to put it bluntly, there is really no magic secret to prevent diabetes from uremia. It’s just don’t be lazy. Test your blood sugar on time. Don’t put off the indicators that need to be checked. Don’t stop taking the medicines you need. Don’t rely on random folk remedies. I have seen old people who have had diabetes for more than 30 years and still have good kidney function, and I have also seen young people who have developed diabetes and kidney disease 5 years after being diagnosed. The difference is actually the attitude of "taking care but not worrying blindly". There is no need to be anxious when you hear that diabetes will develop into uremia. As long as it is managed properly, most people will not reach that point.