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Sunday, December 30, 2012
Quality Health Care and You - Diabetes
Diabetes/ Kidney Leakage
My husband was diagnosed with type 2 diabetes 10 years ago. He is now 59. He also had triple bypass heart surgery 10 years ago. I have done the genealogy on his family and on both parents sides the family is riddled with diabetes, yet all lived long lives. He is obese 5`6" and 210 lbs, all in his belly. His belly is rock hard and when he burps it smells like rotten eggs. My husband doesn`t check his blood sugar very often (maybe every week). He doesn`t exercise at all. He has seen his doctor regulary but fails to heed his advice. His medication has been increased over the years from pills to daily shots and pills. He now shows signs (in his blood tests) of kidney leakage. He still eats whatever he wants: ice cream, cookies, candy. He is also impotent, depressed (on meds for that too, 3 pills a day). He has eczema, toe nials and finger nails that bleed and look terrible.He bites his finger nails constantly. He doesn`t smoke cigarettes or drink alcohol but he spent about twenty five years addicated to pot. He stopped after the heart surgery. He is under huge stress at work, and has mood swings. My question is how long can a person live like this. I am preparing to be a widow and would like an honest answer to how long he can last if he doesn`t change. Obviously you can`t say for sure but I just want to know in general how long a human body can take this kind of abuse? His test scores (just the high ones) are: Comprehensive Met Panel: Glucose 277 A1C 9.0% Microalb/Creat 394.3 ug/mg Cr Urinalysis Glucose 1000 mg/dl Protein 30 mg/dl Urinalysis, Microscopic Crystals-Mod Calcium oxalate crystals Please help me to understand what is happening. I Have my life to plan for and since he obviously isn`t planning on being here I need to have some idea of how long his body can put up with this?
This question has been forwarded by Kidney Diseases:
Kidney Disease Expert - Mildred Lam, MD
Since I am a kidney doctor, I feel best able to address your husband's kidney problems. However, here are some general thoughts which I hope will be helpful: For sure, the human body can fool and amaze us. As doctors, we see many, many examples of people who do nothing but abuse their bodies with obesity, lack of exercise, smoking, alcohol, horrible diets, and failure to take medicines to control their diabetes, hypertension, and cholesterol . . . and yet live long (though not necessarily happy) lives. Your husband has the right genes, apparently; but the things that are working against him are his poor diabetic control, coronary artery disease at an early age, obesity, sedentary lifestyle, and stressful work environment.
As for his kidneys: I assume that by "kidney leakage" you mean leakage of protein from his body out through his kidneys, which is the earliest sign of diabetic kidney disease. Judging from the levels of urine microalbumin and protein that you give, he's not leaking very much protein yet (a lot would be more than 1000 microalbumin or more than 300 protein), but he's certainly showing the first signs of kidney damage and eventually may end up losing his kidney function and needing dialysis (artificial kidney treatments). The calcium oxalate crystals in his urine are probably of no significance, because they can be seen any time someone eats foods that contain oxalate (such as tea, coffee, chocolate, nuts, spinach).
However, the biggest risk that he currently appears to have is atherosclerosis (hardening of the arteries with deposits of cholesterol in the walls of arteries, causing conditions like coronary artery disease, which he already has experienced). This process can be worsened by poorly-controlled diabetes, high blood pressure, smoking, and/or high blood cholesterol. I am also concerned about his mental state: it sounds like he's under a lot of stress, is angry and/or depressed, and has given up trying to take care of himself, perhaps because he figures it won't help and won't change the problems he's already experienced. I hope, for his sake and yours, that he is under the care of a good internist and that he has a good relationship with his doctor. If not, he should consider changing doctors. Best wishes to both of you, and I hope that he will take care of himself and try to make the most of the time he has left, which could be quite a few years.
Kidney Disease Expert - Philip Hall, MD
I urge you to get your husband to see a board certified nephrologist as quickly as you can. If he refuses you need to consult an appropriate diabetic social worker. Contact your primary physician very quickly. That person should be able to direct you to the appropriate person to help you. Use the web and search for diabetes help.
Diabetes Expert - Robert Cohen, MD
I agree with the Kidney Diseases expert that this is a worrisome situation. The major message for your husband is that he needs to realize he has a lot of risk factors for bad outcomes AND HE HAS THE ABILITY TO MAKES CHANGES THAT WILL LIKELY IMPROVE HIS OWN OUTCOME.
My suggestion is to show your husband this response as a form of wake up call. Think about who is able to influence your husband's thinking: perhaps a brother or sister or a clergy person or a close friend or somebody else that he respects can speak to him in a way that he will hear that the time has come for some action. He is getting advice - now he needs to hear the advice.
Robert M Cohen, MD
Professor of Clinical Medicine
College of Medicine
University of Cincinnati