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October 20, 2010

Complications

Question from North Carolina, USA:

Diagnosed at the age of two, pumping at the age of five, my daughter is now 15 years old. Several years ago she went through a time where she wasn't taking very good care of herself. Her A1c reached the high 13s. It wasn't until her kidney functions came back not so good that she decided to take her care seriously. She went on lisinopril and worked very hard to get her A1c down to 8.1. In the beginning, the nephrologist said she would probably never come off the medicine. But, last year, the doctor said that if she continued to work hard, she might be able to wean herself off the medication. When she went for her endocrinology appointment last week, her levels were up again for her kidneys. Her microalbumin was 150 (I believe) and her creatinine was 99 (again, I think). I am so very confused. She has been working on her blood sugars and taking her medicine so why is she still having high numbers? Also, what would be the next step for us? We see the nephrologist in a few weeks.

Answer:

It is hard to know for sure. I would guess that the period of time with very high sugars did some damage to the kidney’s blood vessels. Sometimes this shows up as high blood pressure, sometimes some protein leakage with the earliest detectable leakage called microalbuminuria. Lisinopril is an excellent treatment but not perfect. The key is to allowing whatever healing is now possible, getting the A1c into the high 6% range safely and keeping it there. So, the discussion really has to center on what she needs to do, with both her kidney team and her diabetes team. With some consistency of timing, carbohydrate counting and frequent analysis of frequent monitoring, the pump should allow this to happen. There are no guarantees that this can be reversed but, given the chance, the body often can do some miraculous healing.

SB