Contributor: Jennifer Smith, RD, LD, CDE
In partnership with
I never thought much about aging until I saw the health issues my parents and in-laws have started dealing with in the past 5 to10 years. Kind of a light bulb moment! I’m getting older right along with them! They do not have diabetes, so it made me consider how the body changes over time. Since I live with type 1 diabetes (30+ years), my management today can help prevent or delay a new diagnosis of heart disease and potentially kidney disease down the road. I realize that none of this is pleasant to think about. However, knowing is half the battle. You want to do all you can to ensure these things don’t happen to you!
If you are a woman with diabetes, you may have heard about heart disease as well as kidney disease. But it is probably not the most important thing on your mind in your day to day life! Did you know there is a connection between heart disease and kidney disease? Understanding how diabetes plays into both of these complications is essential.
Let’s take a look at cardiovascular disease first, as it will make understanding kidney disease a lot more clear.
Did you know that as a woman with diabetes you are more likely to have a heart attack at a younger age than a woman without diabetes? Management of blood glucose levels (in both type 1 and type 2) plays a significant role in the development of cardiovascular complications. The death rate from cardiovascular disease is about 1.7 times higher among adults with diabetes over 18 years of age than for those without diabetes.
Why is there a higher prevalence when living with diabetes?
The connection starts with blood sugar levels. Surprised? Over time, higher than normal glucose in the bloodstream causes damage to the arteries. This makes vessels a lot less flexible (think of a thin flexible rubber tube vs. a steel tube). The body is a hard-working machine, it was meant to fix and repair damage as you age. However, the more damage in the vessels from high glucose levels (kind of like rust on a car), the more the body works to patch this damage. This is what causes the blood vessels to eventually get hard – a condition we call atherosclerosis. The patches also build up over time – kind of like putting a Band-Aid on top of another Band-Aid. As the body patches the damage, the inside of the vessels get narrower, which will cause blood pressure to rise as the heart has to pump harder to push blood through the smaller space. Eventually, a vessel can get blocked, and this can lead to a stroke or heart attack (blocked vessel in the brain or heart).
Now that you know a bit about how diabetes can affect heart health let’s look at how they both play a role in the health of your kidneys.
The two leading causes of kidney disease are high blood pressure and diabetes. Surprise, surprise.
Your kidneys are fantastic organs that help to act as filters to get rid of the waste in your blood from digesting the protein we eat. They contain millions of little vessels that are the filters. The waste gets removed from our body when we go to the bathroom, and our body holds onto the good protein and puts it back into the blood.
Kidney disease occurs when these filters/vessels get damaged. This prevents removal of the waste in our blood. As blood sugar gets too high and the body tries to get rid of the extra sugar, you get thirsty, you go to the bathroom more, and the kidneys work harder. After doing this high level of work, over time, the filters in the kidneys get damaged and start to leak protein into the urine instead of keeping it in the body. Your doctor may do a test called microalbumin – this tests for protein in your urine and can show early signs of kidney disease.
High blood pressure also contributes to kidney disease. It can start with the increase in glucose levels which, as mentioned before, causes damage in the vessels. This in part then leads to an impact on the health of your kidneys. The harder and more narrow the vessels around the kidney become, the harder it is for the vessels to deliver enough blood to the kidneys to do their job in filtering the waste. Damaged kidneys can also make regulation of blood pressure difficult. A healthy kidney makes a hormone (aldosterone) that helps to keep blood pressure in range. As the kidneys get damaged, it disrupts not only the filtering of waste but also the appropriate production of this hormone. It is a vicious cycle – each impacting the health of your heart and kidneys.
The best defense is a good offense. How does keeping things in check help in prevention?
There are multiple ways to modify your risk! Most of the risk factors are things that you can control through lifestyle adjustment. These lifestyle modifications can help with the full list of complications (eyes, nerves, digestion, etc.) that could occur down the road from life with diabetes. This is where you have the most power to prevent. The major risk factors are: Smoking, Diabetes, Blood Pressure, Cholesterol, Stress, Activity, and Body Weight.
The ABCs of diabetes management are key. Evaluate your blood glucose control (A is for A1C) and learn what target is healthy and how to keep things on target. If you smoke, make it a goal to quit. If you are sedentary, add a daily activity you like. If your blood pressure or cholesterol is too high, make lifestyle changes with food and activity to keep these in check. (This is the B – blood pressure and C – cholesterol). If you have a lot of stress, evaluate where it comes from and learn stress management techniques.
Managing multiple risk factors at once can help a lot—it leads to significant risk reduction. For example, getting active helps to lower and maintain healthy blood pressure and cholesterol levels. Daily movement also helps to manage blood glucose levels while helping you to lose or maintain weight, and it also helps keep stress contained. With one lifestyle change, you can manage a lot of the risk factors with a non-drug intervention - and a walk outside or around the local mall is FREE!
Another way to reduce risk factors and prevent complications is to eat a healthy, heart-smart diet. No fancy diet is needed, really! Healthy intake includes consuming a variety of fruits and vegetables, whole and low glycemic grains, lots of fiber, lean proteins, plant-based fats, and low sodium. A key in this is portion control and balance or variety. To get started on cleaning up your intake, try to get a cookbook that has some new recipes – look for some that are all-inclusive, so you have most of the food groups in the recipe. Shop the perimeter of the grocery store for fresh produce, lean meat/fish, and look for hearty whole grains that are unprocessed like quinoa, wild rice or old fashioned oats. Aim to visit the aisles for seasonings, rather than packaged and processed foods. If your area has a farmer’s market, shop for seasonal veggies and fruits. Aim to have half of your plate covered with vegetables, and the other half with lean meat and a small serving of grain and fruit.
People with diabetes can live healthfully into old age by taking action early on to prevent complications. If you don’t know where to begin, ask for help. You are not alone! Diabetes educators are skilled at getting you pointed in the right direction, and we’re more than happy to help.
Jennifer Smith, RD, LD, CDE, holds a Bachelor’s Degree in Human Nutrition and Biology from the University of Wisconsin. She is a Registered (and Licensed) Dietitian, Certified Diabetes Educator, and Certified Trainer on most makes/models of insulin pumps and continuous glucose monitoring systems. She is an active member of the American Diabetes Association and the American Association of Diabetes Educators. She co-authored and published a book on management of type 1 diabetes through pregnancy – Pregnancy with type 1 Diabetes: Your Month-to-Month guide to Blood Sugar Management. She is a contributing author for DiabetesSisters, Insulin Nation and Byron Medical Supply, and has presented at national and international conferences on various topics.
Jennifer has lived with type 1 diabetes since she was a child, is a long distance runner, 70.3 triathlete, and mother of two boys. She works as the Director of Lifestyle and Nutrition for Gary Scheiner at Integrated Diabetes Services, which serves to provide in-depth, real-life education to people with diabetes around the globe. All of this has brought a deeper understanding and first-hand knowledge of the day-to-day events that affect diabetes management and allows her to work seamlessly with clients to achieve their management goals. For more, follow Integrated Diabetes Services on Facebook and using the hashtag #integratedDiabetes