HEALTH Q&A

Question: I have a history of diabetes and my doctor prescribed me Metformin. I have heard this is bad for your kidneys. Why is my doctor still giving this medication to me? I personally do not have any issues with my kidneys, but I am worried that this could cause kidney issues for me.

Answer: Metformin is a common medication often prescribed to people with Type 2 Diabetes. It is important to remember that every medication can have side effects, and starting a medication involves weighing the risks versus the benefits. Diabetes results from the inability of the body’s cells to respond to insulin, leading to elevated sugar levels. When sugar builds up in your body, it can cause many problems (like kidney disease). If you have healthy kidney function, Metformin can be a safe medication to control glucose levels.

Millions of Americans safely use this medication, sometimes multiple times a day. Metformin mostly exits via urine from the body. If you have kidney disease, you should talk to your doctors for further recommendations or adjustments.

Question: I have been a Type 2 Diabetic for many years now taking Metformin. My blood sugars have been poorly controlled over the past 5-6 years, and I have not been following up with my primary care doctor. I thought that I could control my sugar levels by eating and drinking less sugar, but they continue to be elevated. I recently followed up with my primary care doctor and found out that I have some chronic kidney disease, are these related?

Answer: Yes, diabetes and chronic kidney disease (CKD) are often related. Poorly controlled blood sugar levels over time can damage the blood vessels in your kidneys, leading to diabetic nephropathy, a common cause of CKD. This condition results from high blood glucose levels, causing the kidneys to work harder to filter the blood, leading to damage and reduced kidney function.

Since you have had poorly controlled blood sugars over the past several years, it is likely that this contributed to the development of your chronic kidney disease. It is essential to work closely with your primary care doctor or a specialist to manage both your diabetes and kidney function. This may involve adjusting your medications, dietary changes, and more frequent monitoring of your blood sugar and kidney function. Proper management can help slow the progression of kidney disease and improve your overall health.

Question: What are some dietary changes I can make to better control my diabetes?

Answer: If you have diabetes, the following dietary recommendations can help manage your blood sugar levels and overall health:

1. Balanced meals:

– Focus on a diet rich in vegetables, fruits (to a degree), whole grains, lean proteins, and healthy fats.

– Aim for a balance of macronutrients: carbohydrates, proteins, and fats.

2. Carbohydrate management:

– Choose complex carbohydrates such as whole grains, beans/legumes, and vegetables over simple sugars and refined carbs (like canned and processed foods).

– Monitor carbohydrate intake to maintain stable blood sugar levels – (carbs turn into sugars!).

3. Fiber-rich foods:

– Include plenty of fiber-rich foods like vegetables, fruits, legumes, and whole grains.

– Fiber helps slow the absorption of sugar and improves blood sugar control.

4. Healthy fats:

– Opt for healthy fats such as those found in nuts, seeds, olive oil, and fatty fish like salmon.

– Limit saturated and trans fats found in processed foods, fried foods, and fatty meats.

5. Lean proteins:

– Include lean protein sources such as poultry, fish, tofu, legumes, and low-fat dairy products.

– Protein helps with satiety and can aid in blood sugar management.

6. Portion control:

– Be mindful of portion sizes to avoid overeating and to help manage blood sugar levels.

– Using smaller plates and measuring portions can be helpful.

7. Regular meals and snacks:

– Eat regular meals and snacks to prevent extreme fluctuations in blood sugar levels.

– Avoid skipping meals, which can lead to low blood sugar followed by overeating.

8. Limit sugary drinks and snacks:

– Avoid sugary beverages like sodas, fruit juices, and sweetened teas.

– Choose water, unsweetened teas, or sparkling water instead.

9. Low Glycemic Index (GI) foods:

– Choose foods with a low glycemic index, as they have a slower effect on blood sugar levels.

– Examples include whole grains, legumes, non-starchy vegetables, and most fruits.

10. Sodium intake:

– Reduce sodium intake to help manage blood pressure, which is important for kidney health.

– Avoid processed and packaged foods high in sodium.

Consulting a registered dietitian can provide personalized dietary advice based on your specific health needs and preferences. Regular monitoring of blood sugar levels and adjusting your diet as needed is very important in managing diabetes.

Dr. Ishan Sahu, MD, is a third-year Family Medicine Resident at UNC Health Southeastern in Lumberton. Send questions for consideration to unchsoutheasterninfo@unchealth.unc.edu .