Diabetic Nephropathy: Therapy

General measures

  • Avoid chronic hyperglycemia.
  • Blood pressure should be optimally adjusted.
  • Blood lipids (blood fats) should be controlled and, if necessary, brought to a low level.
  • Any concomitant medical conditions should be carefully monitored and treated.
  • Nicotine restriction (abstaining from tobacco use).
  • Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day), as alcohol can lead to hypoglycemia (low blood sugar).
  • Aim for normal weight!Determination of BMI (body mass index, body mass index) or body composition by means of electrical impedance analysis and, if necessary, participation in a medically supervised weight loss program (weight reduction causes a decrease in proteinuria / increased excretion of protein with urine)Optimal target BMI 20-25 kg/m 2 KÖF.
  • Regular examinations of the feet and footwear (foot care).
  • Review of permanent medication due topossible effect on the existing disease (potentially nephrotoxic substances: eg, non-steroidal anti-inflammatory drugs (NSAIDs); see below Chronic renal failure / pathogenesis – etiology / medication).
  • Avoidance of psychosocial conflict situations:
    • Bullying
    • Mental conflicts
    • Stress
  • Avoidance of environmental stress:
    • Nitrosamines (carcinogenic substances).
  • It is important for affected individuals to know that X-ray examinations that use contrast agents should be avoided.

Conventional non-surgical therapy methods

Surgical therapy

  • In severely obese patients, gastric bypass (artificially reduced stomach) may be indicated in terms of metabolic surgery (bariatric surgery/bariatric surgery). According to a study by Schauer et al. 42 percent of diabetics have a normal HbA1c after surgery (laboratory parameter for determining blood glucose over the past days or weeks/HbA1c is, so to speak, the “blood glucose long-term memory“). In another study by Mingrone even 75% of patients achieved remission of diabetes mellitus.
  • Kidney transplantation (NTx, NTPL) – surgical transfer of a kidney; this is, in addition to dialysis, a treatment option in renal replacement therapy wg, terminal renal failure (definitive renal failure).

Vaccinations

The following vaccinations are advised:

  • Flu vaccination
  • Hepatitis B
  • Pneumococcal vaccination

Regular checkups

  • Regular medical checkups

Nutritional medicine

Nowadays, the diet for a person suffering from diabetes is not as strict as it was a few years ago. It is also allowed to eat sugary foods.

  • Nutritional counseling based on a nutritional analysis.
  • The goal of the dietary change must be weight reduction to normal weight!
  • Observance of the following special dietary recommendations:
    • In diabetic nephropathy, special care should be taken to ensure that protein intake (protein intake) does not exceed 0.8 to 1.0 g/kg body weight per day.
      • For GFR (does not apply to dialysis patients).
    • Avoidance or reduction of monosaccharides (simple sugars) and disaccharides (double sugars) and high intake of complex carbohydrates.
    • Low cholesterol
    • Diet rich in fruits and vegetables and marine fish (due toOmega-3 fatty acids).
    • A diet low in sodium chloride (< 6 g/day; 1 teaspoon equals 4 g) should also be followed.
    • Daily drinking amount: 3 liters to be able to eliminate urinary substances and avoid dehydration (fluid deficiency) (Warning: does not apply in cases of edema (water retention), manifest nephrotic syndrome and heart failure (cardiac insufficiency)). In addition, if advanced renal insufficiency (kidney weakness) is present, the following recommendations apply:
  • Selection of suitable food based on the nutritional analysis
  • See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
  • Detailed information on nutritional medicine you will receive from us.

* CKD = chronic kidney disease

Sports medicine

  • Endurance training (cardio training) and strength training (muscle training).
  • Physical activity: > 30 min of physical exertion at least 5 times a week.
  • Physical activity lowers blood glucose levels and improves insulin sensitivity. However, since diabetics may experience blood glucose fluctuations during and after exercise, blood glucose monitoring before and after exercise is important.
  • Preparation of a fitness or training plan with suitable sports disciplines based on a medical check (health check or athlete check).
  • Detailed information on sports medicine you will receive from us.

Training

  • Every diabetic should attend special diabetic training courses that explain the diagnosis and therapy of the disease in detail, in order to be able to live as independently and as safely as possible with diabetes. Above all, those affected are shown the correct use of insulin, the importance of blood glucose self-monitoring and the adapted diet. They also learn how to avoid complications as far as possible. Furthermore, in such groups, a mutual exchange of experience can take place.