My 12 year old son was diagnosed with type�1 diabetes about six months ago. He was doing really well with an A1c of 7.6%, but now he seems to be out-of-control (his new A1c was 12.9%), and he showed small quantity of albumin in urine. What is the link?

The main reason for your son’s elevated hemoglobin A1c is an insulin deficiency resulting in higher blood sugars. I would recommend that you and your son review blood sugars with your diabetes team on a weekly basis [or more often] until his blood sugar control is dramatically improved.

You may also wish to look into an insulin pump which can help to manage diabetes and assist in lowering his hemoglobin A1c. I would also make certain that your son is getting his insulin as prescribed. Having a trace amount of microalbumin in his urine is not likely to represent diabetic kidney disease because he has had diabetes for less than a year. However, it may be prudent to document the exact amount of albumin in his urine with some more detailed urine testing at your physician’s discretion.

MSB

[Editor’s comment: A few additional thoughts:

It is not unusual for active teenage boys to have small amounts of microalbumin in the urine. This is usually exercise-induced and can be ruled out by checking a first-void early morning specimen after 24 hours of no heavy physical activity.
At this stage, it is likely that your son may be coming out of the honeymoon period and is now requiring a significant increase in his insulin dose.
Your son’s age make me wonder if he is beginning puberty. Hormonal changes that occur during this life stage cause a great deal of insulin resistance, again necessitating a need for a massive increase in insulin.
Boys this age often begin to eat a great deal, and your son may be doing so, but be afraid to tell anyone. This is normal! He should visit with his dietitian to make sure his current meal plan is adequate to satisfy his needs.
I agree with Dr Brown that you and your son need to closely monitor his blood sugars and record results. (But be certain not to place value judgements on the numbers!) These records then need to be assessed by your son, you, and his diabetes team to develop a treatment plan that will optimize control and improve your son’s lifestyle.
SS]