Diabetes is a medical condition that impacts the entire body, not just your blood sugar! 

Diabetes affects every system in our body – and long-term uncontrolled diabetes will result in significant damage to many organs. In this article, we will discuss the relationship between diabetes, diabetic nephropathy (or kidney disease), and fluid retention. 

What is Diabetes?

For those who may not be as familiar, diabetes is a medical condition that impacts the body’s ability to create or respond to insulin. Our pancreas produces insulin (the hormone responsible for moving sugar from our bloodstream into storage in the body). When our body does not create enough or does not respond adequately to insulin, blood sugar levels remain high – which can be incredibly damaging to the rest of our organs in the body, which produces negative side effects on overall health.

The Impact of Diabetes on the Kidneys

As we discussed, diabetes impacts the entire body when not properly managed, including our kidneys. Prolonged exposure to elevated blood glucose levels can damage the filtration system in our kidneys, resulting in many health issues and eventual kidney dysfunction. Without proper kidney function, water retention will begin as the kidneys are unable to properly filter out the excess fluid. Swelling in the lower limbs (edema) is a symptom of water retention. 

Kidney damage caused by uncontrolled diabetes is called diabetic nephropathy (“nephro” meaning kidney, “pathy” meaning disorder). In this article, we will shine some light on diabetic nephropathy, and discuss its causes, symptoms, and connection to body composition.

What is Diabetic Nephropathy?

Diabetic nephropathy (or diabetic kidney disease) is the result of long-standing mismanaged diabetes. Kidney failure is a very serious medical emergency and can be fatal if not corrected. Chronically low kidney function results in fluid retention (edema) in the body, inability to filter out metabolites and waste from the blood, and increased risk of infections.

So, what causes diabetic kidney disease in the first place, and how can we manage and prevent diabetic edema?

The Relationship Between Diabetes, Your Kidneys, and Water Retention

To properly understand how diabetes impacts water retention, we must first understand the science behind diabetes.

Diabetes mellitus is an endocrine condition associated with insulin resistance or insufficient insulin creation. Insulin is a hormone created in the pancreas. When functioning correctly, insulin enters the bloodstream after a meal to move the extra glucose into cells. If the body does not produce enough insulin or has become resistant to insulin, the body is subjected to chronically high blood glucose levels. 

As mentioned above, having chronically high blood glucose levels results in damage to the nervous system, eyes, kidneys, and heart. Chronic high blood sugar acts like a sticky coating on the organs and blood vessels. Blockages in the blood vessels cause high blood pressure, impair nerve message transmission, and slows down the function of the kidneys. Long-term exposure to high blood sugar levels can result in significant damage and can even become fatal if not properly treated.

What Causes Diabetic Nephropathy?

Think of our kidneys as a water filter – passing all of our blood through their many vessels to filter out metabolites and waste. Through chronic exposure to high blood glucose levels, the nephrons (filtration systems within the kidneys) become damaged and less efficient at their job. Repetitive damage to the kidneys results in reduced function and an increase in fluid retention in the body.

Diabetic nephropathy is caused by poor glycemic control, as the excess glucose in the blood damages the microvessels in the kidneys. Additional causes for diabetic kidney disease include high cholesterol, smoking, environmental factors, and a person’s genetic makeup. 

What are the Early Signs of Diabetic Nephropathy?

Diabetic nephropathy comes in stages, as the kidney’s ability to function continues to decline due to chronic damage. Early signs of diabetic kidney disease include:

• elevated levels of creatinine in the urine

• elevated levels of albumin in the urine

• decreased glomerular filtration rate (GFR, the rate at which the kidneys clean our blood)

Body composition also plays a factor in the early stage of diabetic nephropathy. Factors such as total body fat, visceral fat (VF), and subcutaneous fat (SF) play a role in managing blood glucose. Adipose (fat) cells are more resistant to insulin than other tissues in the body. It is important for people with diabetes to monitor their total body fat composition, as elevated amounts of adipose tissue will make managing diabetes more difficult.

In patients with elevated total body fat levels, it is common to find lower amounts of skeletal muscle mass. Elevating the amount of skeletal muscle present through regular activity helps improve the management of diabetes.

Other important body composition markers to watch for include fasting blood glucose levels and A1C testing (percentage of hemoglobin covered in glucose). These values are connected directly to blood glucose levels and are important values to monitor for proper diabetes management. 

The less controlled all of the above-mentioned values are, the more likely diabetic nephropathy will occur (and will progress rapidly). Late-stage kidney disease results in fluid retention, or edema, difficulty breathing, impaired cognition, and eventual death. Thankfully, with proper management, these conditions can be avoided.

How Common is Diabetic Nephropathy?

Unfortunately, diabetic nephropathy is a relatively common condition. Globally, it is estimated that 20-40% of people with diabetes develop diabetic nephropathy. As the number of people diagnosed with diabetes each year increases, more people are experiencing the symptoms of chronically poorly controlled blood sugar levels.

A diagnosis of diabetes does not automatically mean a person will experience kidney-related issues. We all have different bodies and different body composition that makes us more or less likely to develop kidney issues. But, regardless of personal differences, it is important to understand what symptoms are connected to diabetic nephropathy, to help people identify early-onset diabetic nephropathy. 

Common Symptoms of Diabetic Nephropathy

Common symptoms of diabetic kidney disease include:

• Increased blood pressure – This is due to increased stress on the body, as the kidneys are no longer able to filter out all of the metabolites and excess fluid needed to keep the blood pressure at a stable level.

• Proteinuria (protein in the urine) – Chronic kidney damage results in the protein being excreted in our urine. This is not a normal finding!

• Fatigue – Poor kidney function impacts every other organ in the body, as they work harder to compensate, leading to fatigue and low levels of energy.

• Lower extremity edema – Fluid retention due to poor kidney function often occurs in the lower extremities. Puffy, swollen ankles and legs that appear shiny or waxy are common in people who suffer from severe diabetic nephropathy.

• Shortness of breath – As the fluid builds up in the body from poor kidney function, additional weight can be stored on and around the lungs. This can make breathing very difficult when lying down or during physical activity.

• Impaired cognition – Left unfiltered, metabolites in the blood can cause damage to the brain. Memory loss, mood changes, and loss of consciousness can occur due to poorly filtered blood.

What Happens if Diabetic Nephropathy is Left Untreated?

If left uncontrolled, diabetic kidney disease will continue to worsen and cause more severe symptoms. Diabetic nephropathy is the leading cause of kidney disease patients requiring extensive replacement therapies or kidney transplants.

It is important to note that uncontrolled diabetes does not just affect the kidneys. So, while all of the debilitating symptoms of diabetic nephropathy are occurring, a person may also be experiencing severe symptoms of heart disease, retinopathy, and neurological changes. 

All of these comorbidities can be avoided or significantly reduced through proper management. Better yet, understanding more about your unique body composition can lead to more effective diabetes management. Let’s explore the world of body composition and its many benefits for managing diabetes and diabetic nephropathy.

Managing Diabetes by Monitoring Your Body Composition

Understanding our body composition is a great starting point for managing diabetes. There are many biological markers within the body that can act as indicators for possible dysfunction.

Plasma volume, albumin, and glomerular filtration rate change due to chronic kidney damage – so monitoring fluid retention is a great way to gain insight into the internal health of your body. Bloodwork and urinalysis testing can also be done to collect the needed diagnostic information – annual testing can help identify health trends and manage fluid retention.

Regular monitoring of blood pressure is another fantastic way to check in with your health. Daily blood pressure monitoring can help map out trends, develop a baseline, and provide information into the possible need for medication management for hypertension.

Additional body composition monitoring such as evaluating BMI and total body fat, fasting blood glucose levels, and A1C testing can be very helpful for understanding the risk for diabetic nephropathy progression. Having excessive fat and high blood glucose levels indicates poorly managed diabetes, and are known to be markers for increased risk for diabetic nephropathy. 

Muscular wasting is also connected to uncontrolled diabetes. Sarcopenia, or the loss of muscle mass and strength, can make symptoms of diabetes more profound. Loss of muscle mass (leg lean mass, total muscle mass, etc.) contributes to an increase of adipose fat tissue growth. Increased fat tissue in the body increases diabetic insulin resistance, causing an increased risk for the progression of diabetic nephropathy. 

Regular monitoring of these body composition values can be preventative care for diabetics. Assessment of body composition helps guide treatment – the more information, the more specific the care. Now that we understand the importance, let’s discuss some additional preventative measures for diabetic nephropathy.

Prevention of Diabetic Nephropathy

People with diabetes can live healthy and happy lives – so long as they manage their disease. Treatment options for diabetics to reduce their risk of developing diabetic nephropathy include:

• Monitoring blood glucose levels – Daily assessment of blood glucose levels is an essential step in preventing diabetic nephropathy. Taking readings via the finger needle method or using implanted glucose monitors in the body are both available options to monitor blood sugar. Keeping blood glucose levels within the healthy range will prevent organ damage and additional fluid retention!

• Lifestyle and diet changes – When safe, increasing daily activity and changing dietary habits to include less refined sugar can be disease-altering treatments. For those with type II diabetes, lifestyle changes can be enough to eliminate insulin resistance altogether.

• Insulin therapy – For type I diabetics, insulin replacement therapy is essential for proper health. Using injectable insulin after meals or using basal insulin pumps are both available options to reduce massive spikes and drops in blood glucose.

• Smoking cessation – Smoking increases blood pressure and adds additional stress to the body. Diabetics who stop smoking notice positive changes in their symptoms.

• Monitoring blood pressure – As mentioned above, regular monitoring of blood pressure will provide insight into the internal health of the body and reduce the risk of developing diabetic kidney disease.

• Fluid management – If diabetic nephropathy symptoms have already begun, fluid retention treatment is necessary to reduce the severity. Taking diuretic medications to remove excess fluids and reducing daily fluid intake can help reduce the severity of diabetic edema.

• See a professional – When in doubt, get checked out! If you or someone you love has diabetes and is unsure about changes to their body – see a health professional. Reaching out for help and further education about diabetes management will reduce the risk of developing severe symptoms of poorly controlled diabetes.

Treatment for diabetes looks different for everyone. We all differ in body composition – individual genetic and health factors require specific treatment options that vary from person to person. Collecting the necessary information about our unique body compositions will make a great difference in the treatment of diabetic kidney disease.

Putting It All Together

Diabetes is an endocrine disease that affects every organ in the body if not properly managed. Diabetic kidney disease is a severe side-effect of mismanaged diabetes – and nephropathy leads to many poor health outcomes.

Kidney failure comes in stages and may not be detected in the early stages. Regular health assessments of your body composition can reduce the risk of this stage going undetected and lead to earlier and more successful treatment. 

Diabetic nephropathy causes fluid retention in the body, especially in the lower extremities. Severe kidney damage from chronically high blood glucose levels results in insufficient blood filtering. Long-term, this leads to fluid retention, hypertension, fatigue, and many more negative health outcomes.

Understanding the importance of education about body composition is an essential step to the successful treatment and prevention of diabetic nephropathy. Regular blood work, urinalysis, and blood pressure monitoring are crucial aspects of diabetes health monitoring.

Treatment options vary from patient to patient – but there are many ways to successfully manage diabetes. Regular blood sugar checks, using modern diabetes technology, making lifestyle changes, and getting educated about diabetes and body composition are great options for promoting lifelong diabetic health.

Overall, diabetes is a complex disease that can greatly limit a person’s health and lifestyle if not adequately managed. Becoming aware of your individual body composition and the plethora of health information it can provide will keep you on track to living life as the healthier version of you!

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Claire is a registered nurse based in Alberta, Canada. She is a certified operating room nurse and enjoys creating educational content for her patients.

A widely-known but often misunderstood disease is steadily overtaking an increasing portion of the U.S. population. In this country, more than one-third of adults are at a high risk for developing this condition and causes about 330,000 deaths each year. This disease is diabetes.

Diabetes, type 2 in particular, is a condition affecting an ever-expanding pool of Americans. In fact, the Centers for Disease Control and Prevention (CDC) reports that 30.3 million Americans had diabetes in 2015. That’s nearly 10 percent of the population! Furthermore, about 90 percent of those people had Type 2 Diabetes, and those numbers are only expected to rise.

The steady increase in diabetes diagnoses is due, in part, to the obesity epidemic. 87.5 percent of adults with diabetes are overweight or obese according to their Body Mass Index (BMI), a simple health indicator based on the ratio of weight to height. However, these findings make it seem like only those with high body weight are at risk for diabetes, and that is not the case. In fact, so-called “skinny fat” people, individuals with a normal or low BMI but a high percent body fat, are at an increased risk to develop diabetes or prediabetes. As you can see, the underlying theme here is that, rather than a high body weight, it is an imbalanced body composition that increases the risk of diabetes. This is why it is important for those looking to reduce diabetes risk or manage their diabetes to understand their body composition.

So what’s going on here? How does your body composition affect your diabetes risk, and can improve your body composition reduce that risk or help you overcome diabetes?

Let’s first take a look at body composition. What is it and why is it important?

What is Body Composition?

The term “body composition” means exactly what it sounds like: the components that your body is made up of. Generally speaking, these components can be simply categorized as fat and fat-free mass. As you might expect, your fat-free mass, also called Lean Body Mass (LBM) is everything in your body that isn’t fat. It includes your lean muscle, organs, blood, and minerals.

The body generally needs a balance of LBM and fat mass to function optimally and maintain positive health. However, this balance is disrupted in many overweight and obese individuals due to excess fat.

Most people think that the ultimate goal for overweight individuals should be to lose weight, but this overlooks the bigger picture. In order to improve your health, get physically fit, and fit into those skinny jeans, you’re going to have to change your body composition. In other words, the goal for overweight individuals should not be to simply lose weight; instead, it should focus on improving body composition by reducing fat mass while maintaining or increasing LBM.

Not only will a more balanced body composition make you look leaner, but it can also reduce your risk of diabetes and other obesity-related disorders. Furthermore, it can have a positive effect on your metabolism.

Diabetes and Metabolism

When most people think about metabolism, they imagine some magical system within the body that allows certain people to eat more food without gaining weight. In reality, metabolism simply refers to the process of breaking down foods in order to supply energy for the maintenance and repair of current body structures.

When you consume food, your body breaks it down into its elemental components and then directs each piece to where it needs to go. It looks something like this:

• You eat food.

• Your body breaks down carbohydrates into glucose, a simple sugar.

• The glucose enters your bloodstream.

• Your pancreas releases a hormone called insulin (Phase 1 insulin response).

• Insulin helps the glucose enter your body’s cells so it can be used for fuel, stored for later use, or stored as fat.

• Since your pancreas has released insulin, it needs more. So it starts to create more insulin. (Phase 2 insulin response)

• Now your body is ready to start the process all over again the next time you eat.

Seems like a relatively simple process, right? But for people with diabetes, the process doesn’t work the same way.

This is because diabetes is a metabolic disorder. It changes the way your body metabolizes food so that your cells are unable to use that glucose for energy. How? It all comes back to insulin.

Let’s look at that metabolism breakdown again. There are two places where insulin is key: the Phase 1 and Phase 2 insulin responses. Insulin is a hormone that helps your cells absorb glucose to use for energy. Your pancreas releases this hormone when it first detects the glucose from your food, and then it makes more insulin to use later.

In people with type 1 diabetes (T1D), the body does not produce insulin at all. In type 2 diabetes (T2D), the body produces insulin, but the cells can’t use it properly. This is called insulin resistance. Without access to insulin, glucose can’t get into your cells, so it ends up lingering in your bloodstream.

Of course, when the glucose can’t make its way out of the bloodstream, it will start to build up. All that excess blood sugar may then be converted to triglycerides and stored as fat. With this increase in fat mass, hormone imbalances or systemic inflammation may occur or persist, increasing risk for many other diseases or conditions. Diabetes is associated with increased risk for heart attacks, stroke, kidney disease, nerve damage, skin infections, and eye problems. Diabetes can even result in an impaired immune system, which, combined with poor circulation to the extremities, increases risk of wounds and infections, sometimes even leading to amputation of the toes, foot, or leg(s). In far too many cases, diabetes creates complications that eventually lead to death.

Effects of Type 2 Diabetes on Muscle

Many are already aware of the connection between high-fat mass and diabetes, however, more recently, researchers have begun to focus on another aspect of body composition as it relates to diabetes risk: Lean Body Mass. Many studies have shown strong links between Type 2 Diabetes  (T2D) and low lean body mass.

A large component of our LBM is our skeletal muscle mass, the muscles used for posture and movement. Unfortunately, diabetes is not only more common in those with less muscle, it can actually have negative effects on their muscle.

There are three main muscle characteristics that T2D affects: fatigability, strength, and mass.

Muscle fatigability refers to the rate at which your muscles become weaker after exercise or movement, and the amount of time it takes for them to recover or return to their full power. Researchers have known for years that muscle fatigability increases with T2D. When people with T2D perform an exercise, their muscles lose power faster than those of a healthy person.

T2D reduces overall muscle strength as well. Even after adjusting for age, sex, education, alcohol consumption, lifetime smoking, obesity, and aerobic physical activity, people with T2D had less handgrip strength than people without it.

Not only do T2D patients have both reduced muscle recovery and strength, they also start to lose muscle mass. In fact, the longer you have diabetes, the more muscle mass you tend to lose, especially in the legs.

As you can see, the raised blood glucose levels caused by diabetes and insulin resistance puts your muscles at a disadvantage for a number of reasons.

How Building Muscle Mass Reduces Risk of T2D

Here’s the good news. You can take control of your diabetes risk by improving your body composition. It all starts with Skeletal Muscle Mass.

Research has shown that increasing your muscle mass reduces your risk of T2D. For example, In a 2017 study, researchers in Korea and Japan followed over 200,000 otherwise healthy people who had no diabetes or prediabetes at the start of the experiment. After 2.9 years, the participants with more muscle mass were significantly less likely to have T2D: Yet another reason to include muscle building resistance exercises into your workout routine.

In fact, exercise is good for reducing diabetes risk as well as improving diabetic state all on its own. This is because exercise increases the delivery of glucose to our muscle cells. When you exercise, your muscles are exerting more than their normal energy demand, thus creating a higher need for energy/glucose to fuel them. In fact, resistance training has been shown to be particularly beneficial for T2D. Larger muscles require more energy, therefore the leg muscles, being the largest muscles in the body, are especially important for glucose uptake and regulation. Therefore, targeting the legs with resistance exercise may improve diabetes risk factors as well as promote physical function. As mentioned previously, those who are diagnosed with T2D often lose the most muscle mass in the legs, making leg day all the more important to maintain and build muscle mass to reduce the risk of diabetes.

Although type 2 diabetics are insulin-resistant, this increased demand for glucose from exercise helps to increase the efficiency of insulin to get glucose into the muscle cells, improving their diabetic state overall!

How to Improve Insulin Resistance with Diet and Exercise

So what does this mean for you? We’ve talked a lot about diabetes and its relationship to your body composition. Remember, people with T2D and pre-diabetes are resistant to insulin, meaning their cells can’t utilize the insulin they need in order to absorb glucose from the bloodstream. Eventually, this can lead to a number of health complications and other debilitating diseases. However, we’ve seen that it’s possible to significantly reduce diabetic risk and, in some cases, even reverse T2D. Here are some diet and exercise tips that will help you improve your body composition and get to a healthy level of insulin sensitivity.

If you are otherwise healthy but have low LBM and high PBF

If you don’t currently have diabetes or pre-diabetes, the most important thing you can do to lower your risk is exercise.

In one study, researchers looked at data from the National Health and Nutrition Examination Survey III. The survey covered 13,644 adults who were not pregnant and not underweight. They reviewed each person’s muscle mass and compared it to their diabetes status. What they found was astounding.

For each 10% increase in the ratio of skeletal muscle mass to total body weight participants showed an 11% decrease in insulin resistance and a 12% decrease in prediabetes. The results were significant, even after the scientists took into account other factors affecting risk for insulin resistance.

For people with T2D and Prediabetes

If you already have high blood sugar or diabetes, there are still ways that you can improve that. First, resistance training 2-3 times a week can relieve some diabetic symptoms.

One study found that participants who completed a strength training program had reduced their HbA1c levels from 8.7 to 7.6 percent. In fact, 72% of participants in the resistance exercise group were actually able to reduce their medication use after 16 weeks of a strength training program.

Regardless of the type of training you engage in, getting started is the first step. However, make sure you check with your health provider if you have diabetes or any other conditions before you start an exercise regimen.

Takeaways

The major takeaway here is that diabetes is not only a disease that has to do with weight – high body fat and low muscle mass both increase diabetic risk.

The main goal to reduce this risk or improve diabetic state is to improve body composition. This can be done by reducing body fat for those who are overfat, as well as building muscle for those who have low skeletal muscle mass. One study showed that people who increased their LBM while reducing their fat mass had a much lower risk of T2D than people who had high fat mass combined with high LBM, or low body fat combined with low LBM.

What’s next?

The best thing to do in order to have a better idea of your health risks and create attainable goals for yourself is to get your body composition tested. From there, you can make adjustments to your lifestyle to alter your body composition, if necessary, to reduce your risk for diabetes and other conditions. If you already have T2D or prediabetes, focus on losing fat while engaging the muscles with exercise.

Hopefully, you now have a better understanding of how your body composition affects your diabetes risk, and how you can harness the power of diet and exercise to control that risk. A low-sugar, high-protein diet combined with regular exercise, especially strength training, can improve your body composition and improve insulin sensitivity, among other benefits.

So what are you waiting for? See what you’re made of and get started on the path to a healthier life today!

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Nicole Roder is a freelance writer specializing in health, mental health, and parenting topics. Her work has appeared in Today’s Parent, Crixeo, Grok Nation, Chesapeake Family LIFE, and the Baltimore Sun, among others.