1. 1 Diabetes Education Teaching Guide Kidney Health

2. 2 Question #1 True or False? Diabetes is the number one cause of chronic kidney failure in the United States. Pre-Test Kidney Health

3. 3 Answer #1 Pre-Test Kidney Health True or False? Diabetes is the number one cause of chronic kidney failure in the United States. True

4. 4 Question #2 Kidney Health Pre-Test Up to ___ of people with diabetes have high blood pressure. A.30% B.65% C.5%

5. 5 Answer #2 Pre-Test Kidney Health Up to ___ of people with diabetes have high blood pressure. A.30% B.65% C.5%

6. 6 Question #3 Pre-Test Kidney Health High blood pressure is also called: A.Hypothyroidism B.Hyperactivity C.Hypertension

7. 7 Answer #3 Pre-Test Kidney Health High blood pressure is also called: A.Hypothyroidism B.Hyperactivity C.Hypertension

8. 8 Question #4 Pre-Test Kidney Health Microalbumin is a: A.Carbohydrate B.Period table element C.Protein D.Kind of nail fungus

9. 9 Answer #4 Pre-Test Kidney Health Microalbumin is a: A.Carbohydrate B.Period table element C.Protein D.Kind of nail fungus

10. 10 Diabetes is the number one cause of chronic kidney (or renal) failure in the U.S. and kidney disease among people with diabetes has more than doubled in the past decade. According to the National Kidney Foundation, approximately 30% of people with long-term diabetes (about one in three) will develop kidney disease. The good news is that with early detection and proper treatment, kidney disease can be slowed and, in some cases, reversed. The kidneys are the waste management system of the body, removing excess fluid and toxins from the blood stream and filtering them into the urine. The role they play is vital; if kidney function is significantly reduced and a patient develops end-stage renal disease (ESRD), the situation is life-threatening and a kidney transplant or regular dialysis treatments are the only options. One of the reasons why people with diabetes are at a higher risk for kidney disease (also called nephropathy) is because of their increased incidence of high blood pressure. The stress of long-term hypertension can cause damage to the blood vessels of the nephrons, the functional filtering units of the kidney. Up to 65% of people with diabetes have high blood pressure; controlling it is essential to preventing diabetic kidney disease. Talking Points Kidney Health

11. 11 Talking Points Kidney Health Traditionally, kidney disease has been considered an irreversible and progressive condition that will eventually lead to renal failure. But recent research shows that early detection can actually save kidney function. A 2003 study in the New England Journal of Medicine found that if the earliest sign of kidney disease – microalbuminuria (or minute amounts of protein in the urine) – is detected, it could be reversed if treated properly. Over half of type 1 patients with microalbuminuria in the study recovered their kidney function with a treatment plan designed to achieve good blood glucose control, normal blood pressure, and lower cholesterol levels. However, early detection remains key to slowing the progression of diabetic kidney disease. Familiarize yourself with the signs and symptoms: Frequent urination Blood and/or protein in the urine Burning during urination Puffiness and swelling (edema) in the face, hands, and feet High blood pressure Skin itching Nausea and vomiting Weakness

12. 12 Talking Points Kidney Health The American Diabetes Association recommends that people with type 1 diabetes should get a urine test for albumin (a protein) starting at puberty and/or five years after diagnosis of the disease (more frequently if there are additional risk factor for kidney disease). Other measures of kidney function include blood tests for creatinine and blood urea nitrogen (BUN). Creatinine is a metabolic byproduct of creatine, the acid that supplies energy for muscle contractions, and BUN is an end- product of protein metabolism formed in the liver. Both urea and creatinine are filtered out of the bloodstream by the kidneys; high amounts of these substances in the bloodstream indicate renal impairment. You may have reduced kidney function if: Your microalbumin levels are >30mg in a 24-hour urine test. Your blood creatinine is >1.2 (women) or >1.4 (men). (Note: this is a different test and measurement than urinary creatinine.) Your BUN levels are >8. Your healthcare provider can help you interpret your lab test results.

13. 13 Question #1 Name three symptoms of diabetic kidney disease. Post Test Kidney Health

14. 14 Answer #1 Post Test Kidney Health Name three symptoms of diabetic kidney disease. 1.Frequent urination 2.Blood and/or protein in the urine 3.Burning during urination 4.Puffiness and swelling in the face, hands, and feet 5.High blood pressure 6.Skin itching 7.Nausea and vomiting 8.Weakness

15. 15 Question #2 True or False? Early detection and treatment of kidney disease can save kidney function. Post Test Insulin Pumping

16. 16 Answer #2 Post Test Kidney Health True or False? Early detection and treatment of kidney disease can save kidney function. True

17. 17 Question #3 Post Test Kidney Health According to the American Diabetes Association, microalbumin levels should be: A.30 mg B.55 mg C.120 mg

18. 18 Answer #3 Post Test Kidney Health According to the American Diabetes Association, microalbumin levels should be: A.30 mg B.55 mg C.120 mg

19. 19 Question #4 Post Test Kidney Health Another test to measure kidney function is BUN, which stands for: A.Badly Undernourished Neurons B.Blood Urea Nitrogen C.Bleeding Until Noticed

20. 20 Answer #4 Post Test Kidney Health Another test to measure kidney function is BUN, which stands for: A.Badly Undernourished Neurons B.Blood Urea Nitrogen C.Bleeding Until Noticed

21. 21 Related Activities Kidney Health 1.Invite a registered dietitian to visit the group and discuss diet tips for people with diabetes and kidney disease. Discuss a “kidney-friendly” menu that includes tips on avoiding high sodium content, phosphorus, and potassium, but still includes some tasty meals. 2.Teach the group how to calculate their glomecular filtration rate, or GFR, based on their serum creatinine lab values. Explain the significance of their GFR as a measure of kidney function. If you have other activities you’d like to share, email us at ercc@dlife.com.ercc@dlife.com Additional Resources Find more information about diabetes and kidney health on dLife.com http://www.dlife.com/dLife/do/ShowContent/type1_information/preventing_complications/kidney. html