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November 13, 2005

Complications

Question from Mineola, New York, USA:

I've had type 1 diabetes since I was nine. I am 34 years old now, with A1cs that have been below 6.0 since I was 25 years old, so, I am in great control. I've been through one pregnancy and didn't develop proteinuria during that time. It has been four and a half months since giving birth and I recently did my microalbumin and protein in a 24 hour urine. My protein was 115mg/24 hours. I know under 150 is acceptable. My microalbumin was 13mg/24 hours. I know acceptable is 30. During these years, my microalbumin was usually 5 to 9mg. I just wanted to know if 13 is okay or does it show it is going up? Also, is 115mg okay for protein? Usually, my protein is around 80 to 94 g.

Answer:

Albumin excretion is more specific for diabetes-related changes in kidney function. Your albumin excretion is normal. There is very little difference from this number to previous values. There is also a fair amount of intraindividual variability. I would not be surprised to have another collection tested and right back where it was before. The good news is that after more than 15 years of type 1 diabetes without microalbuminuria, you have fallen out of the high risk of patients at risk for developing nephropathy, as most of these patients develop microalbuminuria after 10 to 15 years of type 1 diabetes. Great job!

JTL
Additional comments from Dr. Bill Jones:

For pregnancy and the diagnosis of preeclampsia, I am more concerned about total protein in the urine. The diagnosis of preeclampsia requires greater than 300 mg of protein on a 24 hour collection. Thus, you are well within that parameter. In addition, you must have hypertension and edema as well. It is important to continue to follow your kidney function during the pregnancy since mothers with type 1 diabetes are at risk of developing preeclampsia.

OWJ