By Charles M. Peterson, Lois Jovanovic (auth.), Eli A. Friedman M.D., Charles M. Peterson M.D. (eds.)

Diabetic nephropathy is a sad sickness. Its frequently insidious onset within the insulin­ based (type I) diabetic, normally a tender grownup, heralds the final act during a ailment that would more and more develop into the dominant preoccupation within the patient's shortened existence. for many style II diabetics, the start of medical renal insufficiency is yet a section in a continual deterioration that is affecting the integrity ofjob, marriage, and family members. The nephropathic diabetic is hypertensive, has worsening retinopathy, and quite often, can also be suffering from peripheral vascular insufficiency, middle affliction, gastrointestinal malfunction, and deepening melancholy. until eventually the 1980's, few kind I diabetics who turned uremic (because ofdiabetic nephropathy) lived for greater than years. rarely any attained real rehabilitation. This dismal analysis is altering considerably for the higher. study in diabetes has ended in impressive advances at either ends of the sort I diabetic's typical historical past. in a single intriguing scientific trial now underway in London, Ontario, halfofchildhood diabetics handled with cyclosporine inside six weeks of onset evince"permanent" disappearanceofhyperglycemia and the necessity for insulin. on the otherendofthe average historyofdiabetes for the nephropathic patientwith worsening eye illness (renal-retinal syndrome), who gets a kidney transplant, sufferer and graft survival, years after cadaveric kidney transplantation in kind I diabetics is now equivalent to that of the nondiabetic.

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Extra info for Diabetic Nephropathy: Strategy for Therapy

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Am J Med 70:331-338, 1981. 11. Knowles He. Magnitude of the renal failure problem in diabetic patients. Kidney Int. 6 (Suppl. 1):2-7, 1974. 12. Levin ME, Bonink I, Anderson B, Avioli LV. Prevention and treatment of diabetic complications. Arch Intern Med 140:691-696, 1980. 13. McVerry BA, Hopp A, Fisher C, Huehns ER. Production of pseudodiabetic renal glomerular changes in mice after repeated injections of glucosylated proteins. Lancet 1:738-740, 1980. 14. National Diabetes Data Group. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance.

Peterson CM, Jones RL. Minor hemoglobins, diabetic "control' and diseases of postsynthetic protein modification. Annals Int Med 87:489-491, 1977. 17. Peterson CM, Jones RL, Esterly JA, et al. Changes in basement membrane thickening and pulse volume concomitant with improved glucose control and exercise in patients with insulindependent diabetes mellitus. Diabetes Care 3:586--589, 1980. 18. Peterson CM,Jones RL, Koenig Rj, et al. Reversible hematologic sequelae of diabetes mellitus. Ann Intern Med 86:425-429, 1977.

EXERCISE Exercise has long been recognized and recommended as integral to the management of diabetes. Every uremic patient entering an exercise program should be pretested in order to determine their level of cardiovascular conditioning, flexibility, and strength training. Unless medically contraindicated, an optimum program would be a supervised exercise session three times a week, including a period of cardiovascular conditioning lasting for at least 20 minutes, during which the heart rate is kept at 70% of the maximum predicted rate.

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