I am 26 years old, have had diabetes for about 14 years, and for insurance reasons, I had to switch doctors this month. I’ve only seen my new doctor once, and I’m not confident he has enough training in type 1 diabetes. He recently ordered some lab work, and my microalbumin was 8.7. I have had this test done many times, but my previous doctor had never told me the results. Should I be concerned about 8.7? Why? What’s normal? Also my TSH was “high”. The office called to tell me my results but never recommended an appointment. Should I request one?

In the modern era of health-care insurance, there exists this relationship of the primary care physician as the gatekeeper. In most cases, it works well. In some situations, the overwhelming issue is to decrease costs at the expense of quality results. I try to tell people with diabetes that if they are not receiving the care they need, they have a right to ask for consultation from a physician who has expertise in the area of diabetes.

For instance, the American Diabetes Association has provided guidelines for the treatment of diabetes which are universally seen as a model for treatment. Your hemoglobin A1c should be less than 1% above the normal level. If not, you need to speak with your physician about how to make this better. With the above as an introduction, we can comment on your results.

I would suggest your current physician has done the correct thing in checking your microalbumin and letting you know the results. Although the units for reporting vary, most labs report a normal value as less than 30 mcg/mg creatinine. If yours is 8, you are doing well. Also, patients with type�1 diabetes develop autoimmune thyroid disease more commonly than the general population. It is not surprising that your TSH might be high. However, you need to know how high and if therapy is recommended.

JTL