Kidney Damage (Continued)
But if you dive under the surface, the kidneys reveal themselves as incredibly complex networks of pumping, piping, tubing, and filters. And as much as I love to yack about the wonders of anatomy, I'll keep it simple today. Each kidney has a staggering one million delicate filters called nephrons. Two hundred quarts of blood pass through your two million nephrons every day, and they remove two quarts of waste products and extra water, converting them to urine. But these staggering workhorses are some of the most fragile structures in your body. High levels of sugar wreak havoc on them in a big way. And unlike many other structures in your body, if Black Bart Glucose runs the nephrons out of town, they don't come back. Ever. Kidneys can't regenerate.
Oh. And there's one other thing. Nephrons are not only delicate, they're sensitive, too. They don't work well under pressure. If fact, high blood pressure is almost as damaging to your kidneys as high blood sugar is. So much so, that if you had perfect blood sugar all the time, but have untreated high blood pressure, you could still end up in Tombstone. Not the tourist-circus one. The creepy one we started off with. There you go, high sugar and high pressure — the leading causes of kidney failure.
So this is where I have to talk to you about getting your posse together. (You really didn't think I'd be able to sustain the Hollywood Western theme this long, did you?) And your posse should include your doctor, your pharmacist, your blood glucose meter, and a blood pressure cuff. Yep. You only need a posse of four to take on the Hole in the Kidney Gang. For guns look to the Colt 45 ACE inhibitor. OK. Sorry. I let my creative side run away with me. Colt doesn't make an ACE inhibitor and they don't come in 45 milligram pills. An ACE is a type of blood pressure pill that comes in 2.5-, 5-, 10-, 20-, 30-, and 40-milligrams. They generally have names that end in "pril," like enalapril, lisinopril, and ramipril.
ACEs have two aces up their sleeves. First, they lower blood pressure, so that's good for the kidneys right there. Second, they seem to have some sort of magical properties of their own that help protect the kidneys from sugar damage. You got it, the ACE inhibitor is riding shotgun to get your kidneys through hostile territory. Most dFolks have high blood pressure, and most high blood pressure takes more than one pill to rein in. That being the case, one should be an ACE.
The protective attributes of ACE inhibitors are so well regarded that, in fact, the medical standards of care for diabetes state that everyone with diabetes should take one #151 even if their blood pressure is perfect. Of course, if your pressure is perfect, you'd take a very small dose. And if even that dose makes you dizzy, your doc will have you take it at bedtime. It's that important. Keeping our Western theme alive, you could picture your ACE inhibitor as your leather chaps, keeping your legs from getting full of cactus thorns on the cattle drive.
But despite the rosy picture I've tried to paint here, the truth is that Tombstone isn't a podunk Western town. It's a major city with hundreds of thousands of residents. And every year 50,000 people with uncontrolled diabetes move into town and start dialysis. Uncontrolled diabetes is the number one cause of kidney failure, and high blood pressure is a close second. Of course, as we talked about, many people with uncontrolled diabetes also have uncontrolled blood pressure.
I guess the Wild, Wild West isn't getting tame anytime soon.
Wil Dubois is the author of four multi-award-winning books about diabetes. He is a PWD type 1, and is the diabetes coordinator for a rural non-profit clinic. Visit his blog, LifeAfterDX.
NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.
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