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Diabetes is the leading cause of end-stage renal disease (ESRD) and patients with diabetes are the fastest-growing segment of the ESRD population.  Diabetic kidney disease (nephropathy) accounts for 42 percases of end-stage renal disease and is the fastest growing cause of renal failure with over 100,000 cases per year.  Approximately 50% of juvenile onseent of all new ct diabetics will develop ESRD within 20 years of the onset of diabetes.  Diabetes is also the leading cause of new cases of blindness and lower extremity amputations. See the National Diabetes Fact Sheet from the CDC.

Diabetes can damage and eventually destroy the function of the small arterioles and capillaries in the kidney. The first signs of kidney damage from diabetes include protein in the urine, low serum albumin, high cholesterol, and edema. Later symptoms include an elevated blood urea nitrogen (BUN), high blood pressure, as well as damage to the small blood vessels in the eye and damage to the nerves. See the NIDDK publication Kidney Disease of Diabetes for an overview.

Diabetic patients with decreased renal function should have their insulin dosages regulated by blood glucose levels. Obviously, urine glucose levels are NOT appropriate for these patients. Also, the insulin dosages may need to be reduced due to the decreased ability of the kidney to metabolize insulin and the increased half-life of insulin.