Common Misconception Blamed for Renal Failure: Diabetes Medications Under Scrutiny
Diabetes is a noncommunicable disease (NCD) with myriad complications. The most common one is chronic kidney disease or diabetic nephropathy and renal failure.
Many misconstrue that it is due to the scores of diabetic medications they have been taking. As a result, they are afraid of diabetes medications and decide to stop taking them. This decision can worsen the symptoms and lead to more complications. In this article, Dr Jing or Dr Sasipas Chontong, a physician specializing in Diabetes Mellitus and Metabolism, provides facts and advice for diabetic patients on how to take care of themselves and cope effectively.
Is it true that diabetes causes kidney failure?
The first thing everyone should understand is that diabetic patients develop chronic kidney disease or diabetic nephropathy due to diabetes progression, not the effects of diabetes medications. Diabetes denotes sweet urine, which occurs when blood sugar exceeds 180 milligrams per deciliter.
“In people with normal nephron function, the nephrons reabsorb all filtered glucose, and none will be present in the urine. However, in diabetes patients, their blood sugar levels are high due to insufficient insulin or insulin resistance; renal glucose spillage occurs when the filtered glucose exceeds the renal reabsorption threshold. Therefore, some glucose will leak into the urine.”
“The underlying cause of high blood sugar levels and kidney dysfunction is chronic inflammation of the blood vessel, in particular. When blood vessels are inflamed, injuries to their lining occur. The repair process causes plaque build-up and deposits in the vessel wall, damaging and blocking the blood vessels and capillaries, including those nourishing the kidney. Once they become narrowed, blood pressure increases, adversely affecting the nephrons. In the early stages, the kidneys may continue to function adequately, although some protein will leak into the urine. As the condition advances, the kidneys can deteriorate and ultimately lead to failure.”
Prolonged protein leakage into the urine can lead to the death of nephrons and surrounding cells. This results in reduced urinary waste excretion, leading to diabetic nephropathy.
When everyone blames diabetes medication
In cases where patients with diabetes develop chronic kidney disease or kidney failure, a physician may choose to modify the medication regimen. This adjustment is necessary because the kidneys are the main route of eliminating many diabetes medications, leading to a common misconception that diabetes drugs cause kidney failure. In truth, diabetes medications aim to lower blood sugar levels, thereby reducing the risk of kidney disease.
“Physicians need to adjust medications because the body excretes certain drugs through the kidneys. We understand that when patients have kidney disease, their kidney function decreases due to poorly controlled diabetes, which results in patients experiencing higher-than-normal adverse side effects from such medications, such as low blood sugar levels and acidosis. In essence, physicians adjust medication not out of fear that the medicine might cause kidney failure but because the kidneys are not functioning properly, leading to an increased likelihood of medication side effects.”
Diabetes medications do not harm the kidneys. On the other hand, these medications reduce blood sugar and lower the risk of hypertension in the long term, preventing the damaging effect of high blood pressure on the kidneys.
New classes of medications have been researched and proven effective in preventing kidney disease. An example of such medications is the SGLT2 inhibitors, a class of drugs that not only reduce blood sugar levels but also promote glucose excretion through the kidneys and cause the blood vessels leading to the kidneys to constrict. This mechanism helps protect the kidneys from the effects of high blood pressure and, in turn, prevents kidney failure.
“Regarding the long-term effects, research on individuals using this class of medications has shown that, in addition to lowering blood sugar levels, these drugs also reduce protein leakage in the urine. Another example of such medications is GLP-1 agonists, a newer class of diabetes drugs with the potential to reduce protein leakage.”
“Currently, both groups of medications are relatively expensive. However, the Comptroller General Department provides coverage for the cost of these medications when there are indications for prescribing them to patients with renal failure and proteinuria. Furthermore, both overweight patients and those with pulmonary edema can benefit from both classes of medications. In the case of GLP-1 agonists, they are also suitable for patients with coronary artery or cerebral artery stenosis.”
While diabetes medications do not typically impact kidney function as commonly believed, it is crucial to note that other classes of medications can indeed affect kidney function. However, people may sometimes overlook these risks or purchase these medications without a prescription. Examples include NSAIDs, specific antibiotics, traditional remedies, decoctions, bolus pills, and herbal medicines. Unfortunately, these medications can often lead to kidney problems that patients may not be aware of.
When patients stop taking medications, complications haveten.
“A significant number of patients discontinue their medication due to the misconception that diabetes medications are responsible for causing kidney disease. There is a pressing need for a change in belief to help patients comprehend that deteriorating kidney function is a result of ceasing their medication or uncontrolled diabetes, and not the fault of the diabetes medications themselves.”
Self-discontinuation of diabetes medication elevates blood sugar, leading to frequent thirst and urination, weight loss, weakness, and fatigue because the body cannot sufficiently utilize glucose due to insulin resistance.
“Some individuals intentionally allow their blood sugar levels to increase to achieve weight loss. However, this approach is more detrimental than advantageous. It can be outright dangerous, particularly when blood sugar levels become exceedingly high, resulting in acidosis, electrolyte imbalances, and a host of adverse effects such as fatigue, confusion, dehydration, and even kidney failure.”
- Dangers to the eyes
As is well-established, elevated blood sugar levels lead to inflammation of blood vessels. The retina, an organ nourished by minuscule blood vessels, is particularly susceptible to damage under these circumstances, resulting in gradual degeneration. Consequently, vision gradually worsens, with sudden loss of vision a possibility. However, in most cases, the deterioration is gradual, and patients may not recognize the symptoms until their retina has significantly degenerated, a vitreous hemorrhage occurs, or they have already experienced a loss of vision.
- Extremities numbness
Elevated blood sugar levels can also harm peripheral nerves, resulting in numbness in extremities. Furthermore, certain patients may experience symptoms associated with the autonomic nervous system, such as palpitations, fainting, dizziness, absence or excessive sweating, hair loss, and cold hands and feet.
- Inflammation of large arteries
We are well-acquainted with certain types of these arteries, namely coronary and cerebral arteries. Inflammation due to elevated blood sugar levels can lead to stenosis. Furthermore, the presence of other risk factors, such as high cholesterol levels, hypertension, and smoking, can significantly elevate the risk of developing coronary artery stenosis. Additionally, cerebral artery stenosis can contribute to cerebrovascular accidents.
Diabetes can lead to amputations.
The legs can also be adversely affected by damage to their blood vessels. When peripheral arteries narrow, it can result in pain during physical activity, particularly while walking. Elevating the leg can exacerbate the discomfort, as it can further restrict blood flow to the legs, intensifying the pain experienced by the patient.
“Nerve damage induced by elevated blood sugar levels can render some diabetes patients unaware of foot wounds. Moreover, high blood sugar can impair the immune system, making the individual more susceptible to infections and prolonging the healing process. Not knowing the existence of these wounds further compounds the problem, causing their condition to deteriorate. Additionally, stenosis restricts blood supply to these wounds, leading to their enlargement and the spread of infection. Consequently, when patients finally become aware of the wound, it may have progressed to a point where foot amputation becomes necessary.”
The cause of uncontrolled diabetes
“Most diabetes patients come to hospitals due to symptoms of uncontrolled diabetes, often because they are unaware of their condition,” Dr Jing responded. “Patients fail to control diabetes because they do not realize they have it, and by the time they do, complications have already begun to set in.”
“At times, patients may sense something is amiss, but they endure it and avoid addressing the issue, assuming that no testing equates to no disease. The fear of a health checkup may lead them to forgo annual checkups, leaving them unaware of their current health status or any changes in their overall well-being.”
Diabetes can often present with no noticeable symptoms. The underlying pathological conditions of the disease may be in progress for as long as ten years before patients receive a diabetes diagnosis. Consequently, avoiding health checkups deprives patients of the opportunity to detect diabetes early on. By the time they do become aware of the condition, the ravages of the disease may have already caused significant damage to their body.
Additionally, some individuals with diabetes turn to herbal medicines, which might unknowingly contain steroids. These herbal remedies often make people feel better, with increased energy, improved skin complexion, pain relief, and enhanced appetite, seemingly like a panacea. Discontinuing these medicines can result in sudden fatigue. However, relying on such medications for an extended period carries substantial health risks, including elevated blood sugar levels, high blood pressure, and the potential for kidney failure.
“Another persistent issue lies in eating habits. It is well-established that in diabetes, despite elevated blood sugar levels, there is insufficient sugar uptake into our cells for energy. Consequently, diabetes patients often feel the urge to clandestinely consume more desserts, contributing to the challenge of controlling their diabetes. This paradoxical behavior is one of the underlying reasons for uncontrolled diabetes, as, despite high blood sugar levels, the cells in various organs continue to suffer from a deficiency of sugar,” Dr Jing explained.
Why take medication to control blood sugar levels?
Elevated blood sugar levels not only contribute to the inflammation of arteries and various complications but also exert toxicity on pancreatic beta cells, impairing their ability to secrete insulin effectively. When glucose cannot enter cells and remains in the bloodstream, it exacerbates arterial inflammation and the advancement of diabetes. However, when patients successfully lower their blood sugar levels to the normal range, whether through medication or dietary control, the pancreas has the potential to recover its functionality as the detrimental effects of glucose toxicity diminish.
“The primary goal of treating diabetes patients is to make every effort to assist their body in utilizing glucose as close to normal as possible,” Dr Jing emphasized.
Comprehensive checkups are required when diagnosed with diabetes.
“It is crucial to be diagnosed and receive treatment as early as possible.”
Dr Jing recommended that once a diagnosis of diabetes is confirmed, it is advisable to undergo comprehensive checkups to monitor for complications and concurrent conditions, assess the progression of diabetes, and measure the average blood sugar level.
Furthermore, diabetes patients should regularly monitor their blood cholesterol and blood pressure levels, as well as assess the functionality of their kidneys and liver. It is also crucial to undergo a diabetic retinal eye exam, a comprehensive evaluation for cerebral artery stenosis, and the presence of symptoms indicating coronary artery stenosis. Most importantly, foot examinations are essential to assess the risk of developing diabetic ulcers.
“What is often overlooked but essential is vaccination. Diabetes patients commonly experience weakened immunity due to elevated blood sugar levels, rendering them more vulnerable to severe infections when they contract diseases like influenza or pneumonia.”
“Vaccination can significantly lower the risk of such infections and reduce their severity. It also diminishes the rates of hospitalization and the need for intubation. The recommended vaccines for diabetes patients are the annual influenza vaccine and the pneumococcal vaccine, administered every five years.”
Appropriate treatment is beneficial
When it comes to diabetic patients, a physician will evaluate their specific conditions by considering individual symptoms, the progression of diabetes, and any associated complications. For instance, if a patient presents with proteinuria, the physician will prescribe diabetes medications designed to reduce proteinuria. Similarly, for patients with coronary artery stenosis, medications aimed at addressing stenosis will be recommended.
“If you are diagnosed with diabetes at a young age, commencing treatment early increases your chances of achieving remission. With proper management, it is possible to discontinue diabetes medications for an extended period as long as you can consistently maintain healthy blood sugar levels,” Dr Jing emphasized.
Regular annual health checkups and diabetes screenings are essential if you fall into high-risk categories characterized by the following risk factors:
- BMI over 23 (Overweight)
- A family history of diabetes
- Suspected symptoms of diabetes
- A history of gestational diabetes
- Comorbid conditions like hypertension, high triglyceride levels, coronary artery, and intracranial artery stenosis.
“MedPark hospital is staffed by teams of dedicated physicians and skilled medical professionals who are always ready to provide consultations and care. We possess advanced medical technology and a range of medications to assist diabetes patients in managing and maintaining healthy blood sugar levels. In a nutshell, we are fully prepared to offer assistance and prescribe necessary medications. Patients should prioritize regular health checkups and not neglect them. If you experience unusual symptoms or are at a high risk of developing diabetes, do not hesitate to seek medical attention without delay.”
While diabetes can give rise to a multitude of complications, it is essential to remember that early warning signs are detectable. Therefore, do not hesitate to consult with a physician. Furthermore, it is crucial not to overlook the importance of taking medications, as they play a vital role in maintaining healthy blood sugar levels and ultimately contribute to a good quality of life.
