Blood pressure meds are best defense against renal failure
Cops wear bullet-proof vests for a good reason: They might get shot at. Soldiers wear flack vests because things blow up around them. Even bull riders wear horn-proof gear to avoid the obvious occupational hazard.
As a diabetes patient, I've never been shot at, bombed, or gored by a bull. (Thank goodness.) So what's my biggest risk? Well, right at the top of the list of diabetes occupational hazards is kidney damage. Nothing scares dFolks more than the specter of kidney damage, and for good reason. In this crappy economy there's an unexpected construction boom: The building of dialysis centers is proceeding full-tilt. More than 40,000 of us a year suffer kidney failure.
I'd bet most of us would rather be shot at, bombed, or gored than end up at a dialysis center. At least you can (hopefully) recover from any of those acute injuries. But dialysis is a one-way street. It's too bad we don't have a protective vest that can shield our kidneys from the harmful side effects of elevated blood sugar.
We do have a bullet-proof, flack-proof, horn-proof vest for our kidneys. It's a pill called an ACE inhibitor. Its armor for our kidneys.
ACE-a-whats, you ask? ACE stands for angiotension converting enzyme inhibitor. ACEs are a class of pills that reduce the activity of the renin angiotensin aldosterone system. Good, I'm glad we got that cleared up! Don't freak on me. In plain English, these are pills that lower your blood pressure by making your blood vessels dilate—open wider—thereby taking pressure off of the system.
Larger pipes = less fluid pressure. Smaller pipes = more fluid pressure. It's that simple.
Why does this matter in diabetes? Well, as it so happens, a great many people with diabetes also have high blood pressure, and there's an entire medicine cabinet full of choices for doctors when it comes to how to treat that. Over time, however, clinical scientists noticed something odd. dFolks who happened to be prescribed the ACE inhibitor class of blood pressure meds, rather than some other sort, were having better kidney outcomes. Less chronic kidney disease. Less chronic renal failure.
As it turned out, an unexpected positive side effect of ACE inhibitors is that they have a shielding effect on the kidneys, protecting them from high glucose. Remember that diabetes by itself is not the cause of kidney failure in people with diabetes, it's high blood sugar from out-of-control diabetes that can trash your kidneys. Independent of glucose control, research showed folks on ACE inhibitors were doing better, kidney-wise, than the folks who were getting different types of meds for their elevated blood pressure. Somehow the ACE inhibitors were protecting the kidneys from the blood sugar.
How were they doing that? Well, no one knows for sure. But who cares? We don't know how a lot of stuff really "works." I don't know how my carburetor works, but I can drive my car just fine. Actually, come to think about it… I don't know if my car even has a carburetor. It might be one of those new-fangled fuel injection jobs.
But I digress.
At any rate, the evidence for the usefulness of ACEs in protecting kidneys was so strong that prescribing them to all dFolks is now part of the Standards of Care for diabetes. If your blood pressure is high, you'll be given a large dose, or perhaps even a whole handful! If your blood pressure is only a little elevated, you'll be given a medium dose. If your blood pressure is normal, you'll still be given a small dose to protect those precious kidneys. And if your blood pressure is actually low, they make a "baby dose" of ACE inhibitor that will still protect your kidneys without making you pass out from having your blood pressure lowered more too much.
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Gone are the days of repelling Mission Impossible-like from the hospital ceiling to retrieve Charlie's medical files before the CDE entered our exam room. It's not that I don't care anymore about his A1c. Of course I care. Maybe in the past I was more consumed by it. For a very long time I so desperately wanted to see an A1c below 8. Now that we've been comfortably in the low to mid-7s for the last couple of years, there's just an expectation. It's become a little anticlimactic....