Question:  How to prevent Diabetic Kidney Disease ?
Answer: People can prevent or slow the progression of diabetic kidney disease by
                
- taking medications to control high blood pressure  - managing blood glucose levels  - making changes in their eating, diet, and nutrition  - losing weight if they are overweight or obese  - getting regular physical activity
                
People with diabetes should see a health care provider who will help them learn to manage their diabetes and monitor their diabetes control. Most people with diabetes get care from primary care providers, including internists, family practice doctors, or pediatricians. However, having a team of health care providers can often improve diabetes care. In addition to a primary care provider, the team can include
                
- an endocrinologista doctor with special training in diabetes  - a nephrologista doctor who specializes in treating people who have kidney problems or related conditions  - diabetes educators such as a nurse or dietitian  - a podiatrista doctor who specializes in foot care  - an ophthalmologist or optometrist for eye care  - a pharmacist  - a dentist  - a mental health counselor for emotional support and access to community resources
                
The team can also include other health care providers and specialists.
                
Blood Pressure Medications
                
Medications that lower blood pressure can also significantly slow the progression of kidney disease. Two types of blood pressure-lowering medications, angiotensinconverting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), have been shown to slow the progression of kidney disease. Many people require two or more medications to control their blood pressure. In addition to an ACE inhibitor or an ARB, a health care provider may prescribe a diuretica medication that helps the kidneys remove fluid from the blood. A person may also need beta-blockers, calcium channel blockers, and other blood pressure medications.
                
People should talk with their health care provider about their individual blood pressure goals and how often they should have their blood pressure checked.
                
Managing Blood Glucose Levels
                
People manage blood glucose levels by
                
- testing blood glucose throughout the day  - following a diet and physical activity plan  - taking insulin throughout the day based on food and liquid intake and physical activity
                
People with diabetes need to talk with their health care team regularly and follow their directions closely. The goal is to keep blood glucose levels within the normal range or within a range set by the persons health care team. More information about diabetes is provided in the NIDDK health topics:
                
- National Diabetes Statistics Report, 2014  - Diagnosis of Diabetes and Prediabetes
                
Eating, Diet, and Nutrition
                
Following a healthy eating plan can help lower blood pressure and control blood sugar. A health care provider may recommend the Dietary Approaches to Stop Hypertension (DASH) eating plan. DASH focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and lower in sodium, which often comes from salt. The DASH eating plan
                
- is low in fat and cholesterol  - features fat-free or low-fat milk and dairy products, fish, poultry, and nuts  - suggests less red meat, and fewer sweets, added sugars, and sugarcontaining beverages  - is rich in nutrients, protein, and fiber
                
Read more about DASH at www.nhlbi.nih.gov/health/health-topics/topics/dash.
                
People with diabetic kidney disease may need to limit sodium and salt intake to help reduce edema and lower blood pressure. A dietitian may also recommend a diet low in saturated fat and cholesterol to help control high levels of lipids, or fats, in the blood.
                
Health care providers may recommend that people with CKD eat moderate or reduced amounts of protein, though the benefits of reducing protein in a persons diet are still being researched. Proteins break down into waste products the kidneys must filter from the blood. Eating more protein than the body needs may burden the kidneys and cause kidney function to decline faster. However, protein intake that is too low may lead to malnutrition, a condition that occurs when the body does not get enough nutrients. More information about diabetes and diet is provided in the NIDDK health topics:
                
- What I need to know about Eating and Diabetes and What I need to know about Carbohydrate Counting and Diabetes  - Make the Kidney Connection: Food Tips and Healthy Eating Ideas and Eating Right for Kidney Health: Tips for People with Chronic Kidney Disease.
                
Weight Loss and Physical Activity
                
Health care providers recommend that people who are overweight or obese lose weight to improve their bodies ability to use insulin properly and lower their risk for health problems related to high blood pressure. Overweight is defined as a body mass index (BMI)a measurement of weight in relation to heightof 25 to 29. A BMI of 30 or higher is considered obese. People should aim to keep their BMI lower than 25.4
                
Experts recommend physical activity as an important part of losing weight, keeping sensitivity to insulin, and treating high blood pressure. Most people should try to get at least 30 to 60 minutes of activity most or all days of the week. A person can do all physical activity at once or break up activities into shorter periods of at least 10 minutes each. Moderate activities include brisk walking, dancing, bowling, riding a bike, working in a garden, and cleaning the house. More information is provided in the NIDDK health topic, What I need to know about Physical Activity and Diabetes.