Living with diabetes means constantly managing blood sugar, medication, diet, and lifestyle. What often surprises many is that damage from diabetes doesn’t always announce itself with dramatic symptoms.
The slow and silent deterioration of kidney function, a condition broadly known as diabetic nephropathy or diabetic kidney disease, often creeps up under the guise of everyday fatigue or occasional nausea. By the time more obvious signs manifest, the damage may already be substantial.
Dr. Navin Kumar Jha, Consultant Nephrologist, Kailash Hospital & Neuro Institute, shares the overlooked signs of kidney decline in diabetics.
Recent data from India show the concern is real: a meta‑analysis of studies across the country found that about 44% of people with type 2 diabetes show signs of diabetic kidney disease (DKD) such as reduced filtration or protein in the urine.
Meanwhile, population‑level surveys indicate that among all adults, including those with and without diabetes, roughly 3.2% already have impaired kidney function (as per eGFR measurements), with diabetes significantly increasing that risk.
It’s these early, subtle signals, such as fatigue, nausea, and mild swelling, that merit attention, particularly when experienced by someone living with diabetes.
When ‘Just Tired’ Might Be More Than Fatigue
Feeling unusually tired all the time, even after a good night’s sleep, is often brushed off as stress, long work hours or ageing. For people with diabetes, however, persistent fatigue can signal kidney distress. As kidney function declines, the organs lose their ability to efficiently filter waste. This leads to the buildup of toxins and retention of fluids, disturbing the body’s delicate balance.
Moreover, reduced kidney function commonly leads to anaemia, a drop in red blood cell count, because diseased kidneys produce less of the hormone that stimulates red blood cell formation. This further saps energy, making daily tasks more taxing.
In a busy urban setting where fatigue can be chalked up to a demanding schedule or long commutes, this kind of warning sign may quietly go unnoticed. However, repeated tiredness, especially when accompanied by other subtle changes, should prompt a checkup.
Nausea, Loss of Appetite — Not Just Digestive Issues
For someone without kidney problems, occasional nausea or low appetite might be dismissed as reactions to diet, stress, or stomach issues. However, in a person with diabetes, these symptoms can hint at a deeper concern: declining kidney health. As filtration falters, waste products accumulate in the bloodstream, which can trigger persistent nausea, vomiting or reduced appetite.
Sometimes this manifests as early morning queasiness, a reluctance to eat, or an unexplained dip in body weight. These are rarely linked to kidney trouble by patients, or even by physicians, unless kidney health is explicitly considered. By then, though, the early stages may have moved on to more advanced kidney impairment.
Why These ‘Small Signals’ Matter, Especially in India
The high prevalence of diabetic kidney disease among people with type 2 diabetes in India is not just a statistic; it’s a wake‑up call. With nearly half in some cohorts showing signs of DKD, the risk is widespread. Many may not realise that kidney decline can start silently, without dramatic symptoms like swelling or foamy urine.
Further, diabetes in India often coexists with hypertension and other risk factors, which further stress the kidneys, because early kidney damage may not affect routine glucose levels or obvious general health; ignorance or delayed diagnosis becomes a serious problem. Patients may continue living “normally,” unaware that their kidneys are slowly deteriorating.
What to Do: Look, Listen, and Act
Recognising fatigue or mild nausea as potential signs of kidney trouble is the first step. For people managing diabetes, it’s not enough to monitor only blood sugar. Regular kidney screening should be treated as a standard part of diabetes care.
Key recommended tests:
1. Urine test for protein (albuminuria/microalbuminuria): The Presence of protein in urine is one of the earliest signs of kidney damage.
2. Blood test for kidney function (such as eGFR, serum creatinine, BUN) to gauge how well the kidneys are filtering waste.
Alongside screening, maintaining stable blood sugar, controlling blood pressure, avoiding nephrotoxic medications (like frequent pain‑killer use without advice), staying well‑hydrated, and seeking regular check‑ups, all contribute significantly to preventing or slowing down kidney damage. Experts emphasise that timely intervention can make a real difference.
(This article is based on information available in the public domain and on input provided by experts consulted.)
