My 18 year old son was diagnosed with type 1 diabetes in November 2005. His blood sugar was 645 mg/dl [35.8 mmol/L] and his A1c was 9.4. At our last checkup at our endocrinologist, his A1c was 8.1, his BUN was 13 and Creatinine 1.1. His endocrinologist was happy with these results and said my son is improving. He is currently on 70/30 insulin, 29 units in the morning and 29 units in the evening. I believe his BUN and Creatinine are elevated. Should we be concerned? What can we do to improve these numbers? Also, could you please explain BUN/Creatinine ratio?

The BUN and creatinine are indicators of kidney problems, but the values you reported are normal values. The ratio is much less important and sometimes useful in evaluations of dehydration or in people who take supplements in the gym. These are potentially dangerous in everyone and especially so if someone has diabetes sine they may cause the kidneys to “overwork.”

The A1c of 8.1% is still too high and likely reflects less than optimal insulin treatment. Many diabetes specialists do not use premixed insulins in this fashion just for this reason and recommend intensified diabetes treatment with carbohydrate counting, adjustable insulin algorithms and more targeted results to try to get the A1c below 7% safely.

SB