Signs of Worsening Diabetes: Protecting Your Kidney

When blood glucose remains persistently high, it poses significant risks and can harm the kidney glomeruli, leading to diabetic nephropathy. If you notice the following six signals, it often indicates that diabetes is deteriorating:

1. General Fatigue and Excessive Sweating:

   • Abnormal sweating in diabetes patients is a crucial sign related to autonomic neuropathy. Due to disrupted autonomic nervous system function, sympathetic nerves become overactive, leading to increased sweat gland secretion. Some individuals experience excessive sweating even during meals.
   • If you’re sweating profusely without hot weather or vigorous exercise, be cautious—it could signal worsening blood sugar levels.

2. Skin Redness (Erythema):

   • Poorly controlled blood sugar and prolonged hyperglycemia can cause microvascular changes. Deposits of glycated proteins in small blood vessel walls lead to gradual vessel occlusion and tissue necrosis, resulting in skin erythema or even blister-like lesions.
   • These blisters contain clear fluid and lack redness around the edges. They may recur and sometimes cause itching.

3. Edema (Swelling):

   • Edema is an adverse sign, indicating kidney disease progression. Mild edema suggests early kidney involvement, while severe edema may indicate advanced diabetic nephropathy.
   • Pressing on the swollen skin will leave an indentation that doesn’t bounce back easily.

4. Xanthomas (Yellowish Nodules):

   • Diabetes patients may develop clusters of yellow-orange nodules or papules on the limbs, buttocks, neck, or knees. These lesions are symmetrically distributed and mildly erythematous. They can appear suddenly and cause itching.
   • Xanthomas result from hyperglycemia-induced vascular changes.

5. Neck Inflammation:

   • Folliculitis in the neck area can lead to pustular inflammation resembling heat rash. If left untreated, it may progress to small abscesses or cellulitis. Although the pus eventually drains and heals, it tends to recur.

6. Proteinuria (Presence of Protein in Urine):

   • Early diabetic nephropathy primarily manifests as increased urinary microalbumin levels. Initially, protein leakage may be mild and requires urine testing. As the condition worsens, proteinuria becomes more pronounced, indicating severe kidney damage.
   • If you experience swelling, promptly undergo routine urine analysis and 24-hour urine protein quantification. Visit a urologist for these tests.

Remember, uncontrolled diabetes can lead to kidney failure. Besides following your doctor’s treatment plan, consider the following kidney-protective measures:

1. Blood Pressure Control:

   • Did you know that 60% of diabetes patients also have hypertension and/or lipid metabolism disorders? Only 5.6% achieve simultaneous control of blood sugar, blood pressure, and lipid levels.
   • Maintain blood pressure below 130/80 mmHg.

2. Reduce Salt Intake:

   • Aim for daily salt intake below 6 g (or <4 g if you have hypertension).

3. Quit Smoking:

   • Smoking slows blood flow to the kidneys, impairing their function.

4. Regular Exercise:

   • Exercise enhances metabolism and kidney function. Regularly massage your lower back to relax the area and protect your kidneys.

5. Low-Protein Diet:

   • If proteinuria is present, limit protein intake. Opt for high-quality proteins (e.g., fish, meat, eggs) and consume 0.6–0.8 g/kg/day.

6. Hydration:

   • Maintain daily water intake between 1500–2000 ml to aid waste elimination. Adjust water intake if edema occurs.

Remember, early detection and prevention are crucial. Regular check-ups for blood, urine, nerves, blood pressure, and lipids are essential after diabetes diagnosis. By taking these steps, we can keep diabetic nephropathy at bay.