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Diabetes is a medical condition that impacts the entire body, not just your blood sugar! 

Diabetes affects every system in our body – and long-term uncontrolled diabetes will result in significant damage to many organs. In this article, we will discuss the relationship between diabetes, diabetic nephropathy (or kidney disease), and fluid retention. 

What is Diabetes?

For those who may not be as familiar, diabetes is a medical condition that impacts the body’s ability to create or respond to insulin. Our pancreas produces insulin (the hormone responsible for moving sugar from our bloodstream into storage in the body). When our body does not create enough or does not respond adequately to insulin, blood sugar levels remain high – which can be incredibly damaging to the rest of our organs in the body, which produces negative side effects on overall health.

The Impact of Diabetes on the Kidneys

As we discussed, diabetes impacts the entire body when not properly managed, including our kidneys. Prolonged exposure to elevated blood glucose levels can damage the filtration system in our kidneys, resulting in many health issues and eventual kidney dysfunction. Without proper kidney function, water retention will begin as the kidneys are unable to properly filter out the excess fluid. Swelling in the lower limbs (edema) is a symptom of water retention. 

Kidney damage caused by uncontrolled diabetes is called diabetic nephropathy (“nephro” meaning kidney, “pathy” meaning disorder). In this article, we will shine some light on diabetic nephropathy, and discuss its causes, symptoms, and connection to body composition.

What is Diabetic Nephropathy?

Diabetic nephropathy (or diabetic kidney disease) is the result of long-standing mismanaged diabetes. Kidney failure is a very serious medical emergency and can be fatal if not corrected. Chronically low kidney function results in fluid retention (edema) in the body, inability to filter out metabolites and waste from the blood, and increased risk of infections.

So, what causes diabetic kidney disease in the first place, and how can we manage and prevent diabetic edema?

The Relationship Between Diabetes, Your Kidneys, and Water Retention

To properly understand how diabetes impacts water retention, we must first understand the science behind diabetes.

Diabetes mellitus is an endocrine condition associated with insulin resistance or insufficient insulin creation. Insulin is a hormone created in the pancreas. When functioning correctly, insulin enters the bloodstream after a meal to move the extra glucose into cells. If the body does not produce enough insulin or has become resistant to insulin, the body is subjected to chronically high blood glucose levels. 

As mentioned above, having chronically high blood glucose levels results in damage to the nervous system, eyes, kidneys, and heart. Chronic high blood sugar acts like a sticky coating on the organs and blood vessels. Blockages in the blood vessels cause high blood pressure, impair nerve message transmission, and slows down the function of the kidneys. Long-term exposure to high blood sugar levels can result in significant damage and can even become fatal if not properly treated.

What Causes Diabetic Nephropathy?

Think of our kidneys as a water filter – passing all of our blood through their many vessels to filter out metabolites and waste. Through chronic exposure to high blood glucose levels, the nephrons (filtration systems within the kidneys) become damaged and less efficient at their job. Repetitive damage to the kidneys results in reduced function and an increase in fluid retention in the body.

Diabetic nephropathy is caused by poor glycemic control, as the excess glucose in the blood damages the microvessels in the kidneys. Additional causes for diabetic kidney disease include high cholesterol, smoking, environmental factors, and a person’s genetic makeup. 

What are the Early Signs of Diabetic Nephropathy?

Diabetic nephropathy comes in stages, as the kidney’s ability to function continues to decline due to chronic damage. Early signs of diabetic kidney disease include:

  • elevated levels of creatinine in the urine
  • elevated levels of albumin in the urine
  • decreased glomerular filtration rate (GFR, the rate at which the kidneys clean our blood)

Body composition also plays a factor in the early stage of diabetic nephropathy. Factors such as total body fat, visceral fat (VF), and subcutaneous fat (SF) play a role in managing blood glucose. Adipose (fat) cells are more resistant to insulin than other tissues in the body. It is important for people with diabetes to monitor their total body fat composition, as elevated amounts of adipose tissue will make managing diabetes more difficult.

In patients with elevated total body fat levels, it is common to find lower amounts of skeletal muscle mass. Elevating the amount of skeletal muscle present through regular activity helps improve the management of diabetes.

Other important body composition markers to watch for include fasting blood glucose levels and A1C testing (percentage of hemoglobin covered in glucose). These values are connected directly to blood glucose levels and are important values to monitor for proper diabetes management. 

The less controlled all of the above-mentioned values are, the more likely diabetic nephropathy will occur (and will progress rapidly). Late-stage kidney disease results in fluid retention, or edema, difficulty breathing, impaired cognition, and eventual death. Thankfully, with proper management, these conditions can be avoided.

How Common is Diabetic Nephropathy?

Unfortunately, diabetic nephropathy is a relatively common condition. Globally, it is estimated that 20-40% of people with diabetes develop diabetic nephropathy. As the number of people diagnosed with diabetes each year increases, more people are experiencing the symptoms of chronically poorly controlled blood sugar levels.

A diagnosis of diabetes does not automatically mean a person will experience kidney-related issues. We all have different bodies and different body composition that makes us more or less likely to develop kidney issues. But, regardless of personal differences, it is important to understand what symptoms are connected to diabetic nephropathy, to help people identify early-onset diabetic nephropathy. 

Common Symptoms of Diabetic Nephropathy

Common symptoms of diabetic kidney disease include:

  • Increased blood pressure – This is due to increased stress on the body, as the kidneys are no longer able to filter out all of the metabolites and excess fluid needed to keep the blood pressure at a stable level.
  • Proteinuria (protein in the urine) – Chronic kidney damage results in the protein being excreted in our urine. This is not a normal finding!
  • Fatigue – Poor kidney function impacts every other organ in the body, as they work harder to compensate, leading to fatigue and low levels of energy.
  • Lower extremity edema – Fluid retention due to poor kidney function often occurs in the lower extremities. Puffy, swollen ankles and legs that appear shiny or waxy are common in people who suffer from severe diabetic nephropathy.
  • Shortness of breath – As the fluid builds up in the body from poor kidney function, additional weight can be stored on and around the lungs. This can make breathing very difficult when lying down or during physical activity.
  • Impaired cognition – Left unfiltered, metabolites in the blood can cause damage to the brain. Memory loss, mood changes, and loss of consciousness can occur due to poorly filtered blood.

What Happens if Diabetic Nephropathy is Left Untreated?

If left uncontrolled, diabetic kidney disease will continue to worsen and cause more severe symptoms. Diabetic nephropathy is the leading cause of kidney disease patients requiring extensive replacement therapies or kidney transplants.

It is important to note that uncontrolled diabetes does not just affect the kidneys. So, while all of the debilitating symptoms of diabetic nephropathy are occurring, a person may also be experiencing severe symptoms of heart disease, retinopathy, and neurological changes. 

All of these comorbidities can be avoided or significantly reduced through proper management. Better yet, understanding more about your unique body composition can lead to more effective diabetes management. Let’s explore the world of body composition and its many benefits for managing diabetes and diabetic nephropathy.

Managing Diabetes by Monitoring Your Body Composition

Understanding our body composition is a great starting point for managing diabetes. There are many biological markers within the body that can act as indicators for possible dysfunction.

Plasma volume, albumin, and glomerular filtration rate change due to chronic kidney damage – so monitoring fluid retention is a great way to gain insight into the internal health of your body. Bloodwork and urinalysis testing can also be done to collect the needed diagnostic information – annual testing can help identify health trends and manage fluid retention.

Regular monitoring of blood pressure is another fantastic way to check-in with your health. Daily blood pressure monitoring can help map out trends, develop a baseline, and provide information into the possible need for medication management for hypertension.

Additional body composition monitoring such as evaluating BMI and total body fat, fasting blood glucose levels, and A1C testing can be very helpful for understanding the risk for diabetic nephropathy progression. Having excessive fat and high blood glucose levels indicates poorly managed diabetes, and are known to be markers for increased risk for diabetic nephropathy. 

Muscular wasting is also connected to uncontrolled diabetes. Sarcopenia, or the loss of muscle mass and strength, can make symptoms of diabetes more profound. Loss of muscle mass (leg lean mass, total muscle mass, etc.) contributes to an increase of adipose fat tissue growth. Increased fat tissue in the body increases diabetic insulin resistance, causing an increased risk for progression of diabetic nephropathy. 

Regular monitoring of these body composition values can be preventative care for diabetics. Assessment of body composition helps guide treatment – the more information, the more specific the care. Now that we understand the importance, let’s discuss some additional preventative measures for diabetic nephropathy.

Prevention of Diabetic Nephropathy

People with diabetes can live healthy and happy lives – so long as they manage their disease. Treatment options for diabetics to reduce their risk of developing diabetic nephropathy include:

  • Monitoring blood glucose levels – Daily assessment of blood glucose levels is an essential step in preventing diabetic nephropathy. Taking readings via the finger needle method or using implanted glucose monitors in the body are both available options to monitor blood sugar. Keeping blood glucose levels within the healthy range will prevent organ damage and additional fluid retention!
  • Lifestyle and diet changes – When safe, increasing daily activity and changing dietary habits to include less refined sugar can be disease-altering treatments. For those with type II diabetes, lifestyle changes can be enough to eliminate insulin resistance altogether.
  • Insulin therapy – For type I diabetics, insulin replacement therapy is essential for proper health. Using injectable insulin after meals or using basal insulin pumps are both available options to reduce massive spikes and drops in blood glucose.
  • Smoking cessation – Smoking increases blood pressure and adds additional stress to the body. Diabetics who stop smoking notice positive changes in their symptoms.
  • Monitoring blood pressure – As mentioned above, regular monitoring of blood pressure will provide insight into the internal health of the body and reduce the risk of developing diabetic kidney disease.
  • Fluid management – If diabetic nephropathy symptoms have already begun, fluid retention treatment is necessary to reduce the severity. Taking diuretic medications to remove excess fluids and reducing daily fluid intake can help reduce the severity of diabetic edema.
  • See a professional – When in doubt, get checked out! If you or someone you love has diabetes and is unsure about changes to their body – see a health professional. Reaching out for help and further education about diabetes management will reduce the risk of developing severe symptoms of poorly controlled diabetes.

Treatment for diabetes looks different for everyone. We all differ in body composition – individual genetic and health factors require specific treatment options that vary from person to person. Collecting the necessary information about our unique body compositions will make a great difference in the treatment of diabetic kidney disease.

Putting It All Together

Diabetes is an endocrine disease that affects every organ in the body if not properly managed. Diabetic kidney disease is a severe side-effect of mismanaged diabetes – and nephropathy leads to many poor health outcomes.

Kidney failure comes in stages and may not be detected in the early stages. Regular health assessments of your body composition can reduce the risk of this stage going undetected and lead to earlier and more successful treatment. 

Diabetic nephropathy causes fluid retention in the body, especially in the lower extremities. Severe kidney damage from chronically high blood glucose levels results in insufficient blood filtering. Longterm, this leads to fluid retention, hypertension, fatigue, and many more negative health outcomes.

Understanding the importance of education about body composition is an essential step to successful treatment and prevention of diabetic nephropathy. Regular blood work, urinalysis, and blood pressure monitoring are crucial aspects of diabetes health monitoring.

Treatment options vary from patient to patient – but there are many ways to successfully manage diabetes. Regular blood sugar checks, using modern diabetes technology, making lifestyle changes, and getting educated about diabetes and body composition are great options for promoting lifelong diabetic health.

Overall, diabetes is a complex disease that can greatly limit a person’s health and lifestyle if not adequately managed. Becoming aware of your individual body composition and the plethora of health information it can provide will keep you on track to living life as the healthier version of you!

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Claire is a registered nurse based in Alberta, Canada. She is a certified operating room nurse and enjoys creating educational content for her patients.

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