Scott Webb (Host): Our kidneys serve essential functions in our bodies, like filtering blood, regulating blood pressure, and removing waste. Diabetes, and high blood pressure can greatly affect the kidney's ability to perform these essential tasks. And here to explain further and help us to keep our kidneys healthy is Megan Henderson. She's a Board Certified Family Medicine Nurse practitioner, Practicing at Franciscan Health.

 This is the Franciscan Health Doc Pod. I'm Scott Webb. Megan, it's great to have you here today. We're going to talk about diabetes, blood pressure, kidneys, you know, how they all sort of relate to each other, interact with each other, and I've got a bunch of questions for you. So let's start here. How does diabetes affect blood pressure and kidneys?

Megan Henderson, NP: Diabetes affects more than 10% of adults in the United States, so it's definitely a very important thing to talk about. But, how diabetes increases or affects your blood pressure and kidneys, is that, number one, diabetes increases your risk for hypertension and kidney disease. People with diabetes may have obesity, high fat diets, chronic inflammation, you know, inactivity that can contribute to high blood pressure. Uncontrolled diabetes and hypertension then affect the kidneys. So high sugar levels will damage the kidneys as well as structurally damage and that's caused by the uncontrolled hypertension. So essentially diabetes and hypertension, substantially increased the risk of cardiovascular and kidney disease. Effective treatment of both, will reduce the patient's overall cardiovascular risk.

Host: Yeah. And I think it is important to have this conversation because I don't know that it's something that we would all, lay people would connect, right? Okay. How does diabetes affect these things? Right? So, why is it important that we have these conversations and what do you want patients to know, if they do have diabetes, like it's not just the diabetes we're trying to control, it's the sort of fallout, if you will, to blood pressure, kidneys and other things, right?

Megan Henderson, NP: Right, because they all kind of interconnect. So, patients really need to understand that uncontrolled, you know, blood pressure and diabetes does damage their kidneys over time. And the kidneys are a very important part of our body. They work as the filtration system in our body. They help regulate the blood pressure, maintain your electrolytes like your potassium, your sodium, your calcium, all those things. They produce hormones that help for red blood cell production. So it helps to regulate the body's salt content. So it's important because uncontrolled diabetes and blood pressure can lead to kidney failure.

Host: Sure. Yeah. And kidney failure is bad of course. And you mentioned the connection there, yeah between blood sugar and kidneys. Maybe you can explain that, like what is that connection? Why is high blood sugar so bad for the kidneys?

Megan Henderson, NP: Right. So high blood sugar damages the blood vessels that, you know, feed the blood to the kidney. So overall it reduces the blood flow leading to the damage and that can cause increased blood pressure. High sugars, damage the cells, and then cause inflammation in the body. Also elevated blood sugars actually affect the structure of the kidneys and break down the actual structure of the kidneys. So the higher your blood sugars, uncontrolled blood sugars, the more kidney damage that you're going to have.

Host: Yeah, and I think it might be important, Megan, to kind of talk about some of the early signs and symptoms, right? So that someone with diabetes, might be experiencing, how are these things connected? Even some subtle signs that their diabetes is affecting their kidneys.

Megan Henderson, NP: Sometimes people they'll come in and they'll say, Hey, I just haven't been urinating as much. I've been having difficulty urinating. They could come in with some swelling in their legs, feet or other, you know, it could go anywhere in your body really. When you're having kidney issues, it can cause confusion, shortness of breath, loss of appetite, nausea, vomiting, itching, tiredness, and weakness. So all those little things can be from the diabetes or high blood pressure, whichever one.

Host: Yeah. So what are some of the steps? I don't know that most of us, Megan think about our kidney health per se, right? But what are some steps that a diabetic patient could take to protect their kidneys?

Megan Henderson, NP: Well, definitely taking your medications as prescribed. You know, a lot of times, people are like, oh, I'm not very consistent with taking my medication. Well, that's not, you know, going to help your body because it's going up and down like you're controlling it, then you're not controlling it. Trying to adhere to a diabetic diet, watching what they're eating.

Definitely controlling their blood pressure and then keeping regular follow ups with your healthcare provider or their specialists is definitely some key points to keeping your kidneys healthy. Also drinking plenty of water. You know, we like to drink lots of other things, but water's definitely the best thing for us and our kidneys. So drinking enough water, keeping those kidneys flowing the way that they should.

Host: Sure, yeah. Let's drill down and talk more about high blood pressure. You know, those of us with high blood pressure and I'm one of those people, one of those patients, you know, I think about controlling my high blood pressure, but I don't always think about the connection between my high blood pressure and other things like my kidneys.So what's that connection?

Megan Henderson, NP: Right, right. So when your blood pressure's high, obviously your heart is pumping harder than it needs to. So when your blood pressure's high, it increases that pressure in your vessels. And you know, it constricts them. So as the vessels narrow and weaken, the blood flow starts to slow and cause damage.

So once the kidneys are damaged, they begin to have difficulty filtering waste out of the body. So their our main filtration system. They filter toxins and things out of the body that build up. So when it's not working correctly, you know, those toxins and things build up in the body. So when the kidneys are damaged from blood pressure, they also dump protein out of the body into the urine.

So that's one way we can kind of see, are you having some kidney damage? We can check your urine and make sure there's no protein in the urine. And then that's kind of one way we can screen the degree of kidney damage we do urine micro albumin, things like that. And then the more damage the kidneys become, the harder it's serve the body to control blood pressure.

So it's sort of a vicious cycle. I actually used to work in dialysis, so a lot of those patients were on, that's stage five kidney disease when you actually have to be on dialysis. So, those patients a lot of times had very uncontrolled blood pressures, most of the time, very high blood pressures.

Most of the time those patients are on, you know, five different blood pressure medicines. Every once in a while you'd have somebody with low blood pressure, but typically with kidney disease, it's very uncontrolled, high blood pressure. So when the kidneys aren't filtering urine correctly, the patient might have fluid retention in their body and then you know, typically that's seen in lower legs and feet, but that can also occur with heart failure and cardiovascular disease as well.

Host: Yeah, I see what you mean. The cycle there that the blood pressure, high blood pressure affects the kidneys. The kidneys raise your blood pressure and it just becomes this vicious cycle. Yeah, so it makes me wonder then, how can we manage our blood pressure? Obviously we need to see our providers, we need to be diagnosed. We may need to be on medications, but what else can we do?

Megan Henderson, NP: Tips for managing your blood pressure could include your diet, obviously. Drinking water, like I said earlier, maintaining a healthy weight, exercise. If you're a smoker or you vape, quitting smoking, definitely limit alcohol intake. A little is okay, but managing that and then, you know, even managing like stress because a lot of people come in and they have a stressful day and their blood pressure's higher because they're stressed. And so you definitely see that take a toll on blood pressures. So definitely managing stress, you know, anxiety, emotional things like that is also important in managing your blood pressure. Taking your medications as prescribed, I'm going to keep saying that.

Host: Yeah. Right.

Megan Henderson, NP: And then monitoring your blood pressure at home. I think that's really important. A lot of people with high blood pressure or diabetes don't even have a blood pressure cuff or a blood sugar meter, and they really don't feel like they need that. And I think it's important for them to take accountability for their disease and monitor that at home because you know, in the office, a lot of people will come in with their high blood pressure and then at home, their blood pressure is totally fine. You know it, when they come in the office, it makes them nervous because somebody's checking it, there's white coat syndrome, that kind of thing.

So I'm always asking people, do you check your blood pressure at home? Do you have a way to get a blood pressure cuff? They're very cheap. $20, you can get a decent blood pressure cuff, you know, at any drug store. You can go on Amazon or whatever. But, them taking control of their own health is very important, I feel like.

And their willingness to understand and educate themselves about their disease, will help them manage it so that my patients that really know what they're taking, why they're taking it, and I always try to educate them on what they're taking, why they're taking, why they need to know what they're taking, and what it can do to their body. So I think those are some pretty good tips as far as, you know, managing your blood pressure and that all is going benefit your kidney health.

Host: Yeah, I've heard that a lot, Megan, from Franciscan Health Experts, over the last few months about the importance of checking our blood pressure at home. Because most of us, we go to the doctor once a year for our, you know, wellness exam. Our physical, they take your blood pressure. Right. But then we don't take it any other time. As say, the cuffs are relatively cheap or they have the little things, the chairs at stores, you can sit down quick and, you know, check that. And, it's such a good advice, especially for folks with high blood pressure, because we don't want that and we don't want it to affect our kidneys and get that cycle going and all of that.

Yeah. So let's talk about like lifestyle modifications. You talked some of the greatest hits earlier. Quit smoking, don't drink too much, all of that, right? But how do we prevent or slow the progression of kidney damage you know, if we have diabetes and or high blood pressure?

Megan Henderson, NP: Right. So I did talk about quitting smoking. A healthy diet. So you want like a rich diet in, you know, whole grains, vegetables, fruit, lean meats, for kidneys, your cardiovascular health, whatever it is, avoid excess in salt, processed foods, those type of things. Regular exercise, all those things, drinking water, like I said, you know, those are all going to be, things that are going to help you know, slow the progression of kidney disease and if you do have a degree of kidney disease, it's important. I feel like, I usually have patients see a specialist once they've reached like stage three kidney disease and that's really when you really start seeing your labs changing a little bit and that sort of thing.

So, to slow progression like a specialist to see the patient because they go to the specialist and the specialist may say, well, that blood pressure medicine is okay, but let's maybe try this one that's better for your kidneys.

There's certain cholesterol medicines that are a little bit less harsh on your kidneys. So it's always good to get like a specialist point of view, when you're, you know, starting kidney disease and a lot of people don't realize that they even have kidney disease. And when I tell them that they have kidney disease, they're like, what?

When did I get kidney disease? Like, what's going on? And so I always try to make them aware, where their kidneys are. And you know, if they do have the start of kidney disease, I let them know and educate them on that because a lot of people are very like, oh my gosh, my kidneys. Because they don't realize, they think how much blood pressure and those things are affecting their kidney health.

So, a lot of people are like, wait, I saw on my on, on MyChart, it said I have kidney disease, like what's that about? And it really gets people upset sometimes and

Host: Yeah. Gets their attention for sure.

Megan Henderson, NP: Told me. Yeah. Like no one told me. So, I try to always like let them know if there is a degree of kidney disease and if we're at that point where we need to see someone.

Host: Right. And I'm sure it's just important, Megan, just regular follow ups, right. With our primary, with specialists like nephrologists, things like that. Experts like that, I'm sure. It's just important that we stay on top of things. Right?

Megan Henderson, NP: Yes, exactly. Typically I see people every three to six months for blood pressure, diabetes. Specialists sometimes see patients twice a year or once a year. They don't always see them as much. We typically see them more, but when I feel like they, you know. It's important for them to see their specialist. And that could be a kidney doctor, that could be a cardiologist, that could be endocrinology. If we're having issues, getting the patient, under control, their blood sugar's, under control in the office. In our office, we do a lot more managing of those things just because specialists are out of town and things.

So we try to do as much as we can here at our office. But typically, you know, we're checking, your A1C, which is a three month average of your blood sugar every three to six months. We're checking every six months, at least your kidney function. So that helps us just to stay on top of your diabetes and see how controlled you are and those types of things.

Host: Yeah, good stuff today. Really helpful for folks to understand, you know, if they are a diabetic, the connection between diabetes, high blood pressure, kidneys, kinda as we prefaced here, covering all things, but really understanding the impact that high blood sugar, can have on the kidneys, the effect that, you know, kidney failure can have on those other things.

And so, said, it really is a cycle. We need to be diagnosed, we need to be treated, we need to follow up, all of that. If, if you a single sort of message that you would want to share with listeners, the takeaway today regarding the connection between these things, what would it be?

Megan Henderson, NP: I really think education. I really think educating yourself on your disease is so, so important. And if you don't know, ask questions. If you don't have resources, ask your healthcare provider for resources. There's lots out there that you can look at, but I think educating yourself and being in control of your body and your disease is really important and you know, just keeping in contact with those specialists or your healthcare provider and then if you have any issues arise, definitely not waiting and getting in and making an appointment and addressing those things.

Host: Yeah, absolutely. As you said, you know, some of the signs of kidney issues, kidney damage could be subtle, right? But don't dismiss them, right? If you have diabetes, if you have high blood pressure and you're experiencing some of those quote unquote subtle issues, speak with your provider, right?

Megan Henderson, NP: Right. And I would like to add like some early signs and symptoms of diabetes, you know, could be increased thirst, increased hunger. You could be going to the restroom, urinating more frequently. Those are signs and symptoms that you might be experiencing some diabetes. Low blood sugars and things can make you feel very dizzy or, almost like your brain kind of slows down.

So those are important if someone isn't diagnosed yet. So that's definitely something to look at as far as signs and symptoms of just diabetes itself.

Host: Yeah, exactly. Like when in doubt, speak with your provider. Send a message through MyChart, whatever it is, just don't dismiss these things, because all connected. They can all be bad if left undiagnosed and untreated. So, thank you so much for your time today. I really appreciate it.

Megan Henderson, NP: Thank you so much.

Host: And to learn more, visit franciscanhealth.org and search diabetes. And if you found this podcast helpful, please share it on your social channels, and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.