THE World Diabetes Day is a tool to create global awareness about diabetes. It is an occasion to draw public attention to the causes, symptoms, complications and treatment of this serious disorder, which is steadily rising all over the world. This year the theme is, “Diabetes could cost you your kidneys : Act Now!”
According to Who estimates, there are presently more than 177 million people with diabetes worldwide. It is anticipated that by 2025 this figure will rise to 300 million, if no intervention is done. The developing countries will contribute mainly to the increase, as seventy-five per cent of these subjects will belong to them. By 2025 Pakistan will have 14.5 million.
One of the main complications of diabetes is kidney disease, called diabetic nephropathy. Kidneys millions of filtering units called Glomeruli. Each glomerulus is composed of a tuft of tiny capillaries. Blood flows through these capillaries and waste substances are filtered out along with water in the form of urine into the urinary bladder and excreted out.
Kidneys also regulate the levels of water and different minerals needed by the body to maintain good health. They produce hormones that control other body functions. Diabetic nephropathy sets in due to damage of the capillaries of the kidneys. The cause is mainly high levels of blood glucose. When these tiny blood vessels get affected, their function is deranged. Filtration becomes improper and waste material is retained in the body, whereas valuable substances as proteins leak out into the urine. If this progresses, kidney damage turns into kidney failure also called End Stage Renal Disease. Kidneys almost completely stop functioning and waste material accumulates in the blood to poisonous levels and can cause death. There are often no symptoms of diabetic kidney disease until the kidneys fail completely. Small amounts of protein in the urine (microalbumin), high-blood pressure, swelling and cramps in the legs, increased urination especially at night, declining kidney function, decrease need for insulin or anti-diabetic tablets, nausea, vomiting, weakness, pallor and anaemia.
Treatment of diabetic kidney disease depends on its stage. In the early phase, blood sugar, blood pressure and body weight needs to be well controlled. Smoking has to be stopped and a balanced diet with exercise instituted in the daily regime. If the kidneys have completely failed, then the two options are dialysis or kidney transplantation. Dialysis is of two types, peritoneal and haemodialysis. In the latter, the patient is attached to a dialysis machine for several hours, two to three times weekly. The blood circulates around an artificial filter in the dialysis machine, so that toxins and waste products are removed and the clean blood is returned to the patient. The optimal treatment for End Stage Renal Disease patients is a kidney transplant.
A healthy kidney from either a living donor or a brain dead person, is transplanted into the patient. Donors are usually living related. Cadaver donors are people becoming brain dead due to severe head injuries. For saving the transplanted organ from rejection by the body’s immune system, this patient has to take immunosuppressive drugs life long. Both dialysis and kidney transplantation are very expensive modalities.
In Pakistan the cost of haemodialysis is approximately Rs25,000/- per month, whereas transplant costs around Rs350,000/-. Every person with diabetes can enjoy a normal life but certain rules have to be followed. It is basically adopting a healthy lifestyle. Educating oneself on various aspects of diabetes will provide better self-care. A balanced and nutritious diet, exercises, regular check ups and intake of medication are must. Relaxation with family members and friends will help relieve stress and maintain general health in an excellent form. It should be remembered that though diabetes is not curable, it is preventable. If it does manifest itself, the complications can be prevented.
Education and awareness are an important aspect of prevention. World Diabetes Day is a day to create awareness and calls for participation by all people, including children and adults, the media, policy makers, health providers and all people with diabetes. It is a day to defeat diabetes and provide a healthy life for every person with or without diabetes.
