Q: I have diabetes, and recently my doctor told me that I have kidney disease as well. What does that mean?
Dr. Kristen Tamura, Nephrologist, Kristen Tamura, MD (Maui Memorial Medical Center Outpatient Clinic): Diabetes is a major risk factor for chronic kidney disease (CKD) and a third of people with diabetes go on to develop CKD. This happens because diabetes can damage the small blood vessels in the kidneys, making it harder for the kidneys to work properly. When the kidneys start to fail, they can no longer clean your blood the way they should which leads to water, toxin and acid building up in your body.
Treatment to prevent diabetic kidney disease should begin early — before kidney damage develops. Blood pressure control and strict control of blood sugar levels is very essential in preventing kidney damage.
In the early stages of chronic kidney disease (stages 1-3), you may not notice anything at all, or sometimes your blood pressure may be high, and your ankles may be swollen. Symptoms of later-stage kidney disease (stages 4-5) include fatigue, anemia, loss of appetite, morning sickness, itching, a metal taste in your mouth, trouble sleeping, feeling extremely tired or trouble breathing properly. You may find that your sugar is lower and need less insulin, since your kidneys are not functioning well enough to get rid of insulin you are using.
Once you are diagnosed with CKD, your doctor will work with you to keep your kidneys healthy for as long as possible by controlling your diabetes and blood pressure, and treating any urinary tract infections. You will also need to follow a special diet, called a renal diabetic diet, which is low in sodium as well as potassium, phosphorous and protein — nutrients that can build up in your blood when you have CKD.
If your kidneys stop working and are no longer able to keep you healthy, this is called end stage renal failure. At this point, you will need a kidney transplant or dialysis in order to stay alive.
Q: What causes epilepsy?
Dr. Travis Glenn, Family Medicine, Glenn Family Medicine: Epilepsy is a neurological disorder that causes people to have seizures. It’s caused by a problem with the brain’s structure or electrical activity. Scientists know some of the things that may cause a person to have epilepsy, but sometimes the cause is unknown.
In some cases, epilepsy may be genetic. Epilepsy may run in families, and it’s possible to have genes that make a person sensitive to certain things that trigger seizures. Some people are born with abnormality in their brain that causes epilepsy, and sometimes head trauma, such as from a car accident or traumatic brain injury, can cause someone to start having seizures. Certain infections, like meningitis, can also cause someone to develop epilepsy.
There are many different types of epilepsy, and so symptoms, including seizures, may be different for different people. During a seizure, the person may be confused, freeze and become stiff, twitch, jerk uncontrollably or lose consciousness. They may have a strong psychological reaction like anxiety or a sense of deja vu.
Treatment is available and can help control or prevent seizures from happening. In most cases, epilepsy can be treated with medication and/or surgery.
Seek immediate medical care if someone with epilepsy has a seizure that lasts longer than five minutes, if they do not regain consciousness after a seizure, if a second seizure follows quickly after the first or if the person injures themselves during the seizure. You should also seek medical care if the person having the seizure is pregnant, has diabetes or has a high fever.
The bottom line is that epilepsy is a serious disorder, but it is treatable. Talk with your doctor if you think you or a loved one might have epilepsy.
* Physicians, providers and administrative staff who practice at Maui Health hospitals and clinics answer questions from the public in Healthwise Maui, which appears on Thursdays. Maui Health operates Maui Memorial Medical Center, Maui Memorial Medical Center Outpatient Clinic, Kula Hospital & Clinic and Lana’i Community Hospital and accepts all patients. To submit a question, go to the website at mauihealth.org/healthwise.