I have had type�1� diabetes for nine years. I have had a couple of high blood pressure readings in the last six months, but so far I have not been prescribed any medication, nor have I been taken off the contraceptive pill. When I saw a specialist, my blood pressure was 160/90. However, I think this may have been “white coat” hypertension, as when I saw my local doctor a week later, he was pleased with my blood pressure.

My question though relates to microalbumin. What are reference ranges? My test revealed a level of 30 mg, and the endocrinologist was a little concerned about this. He didn’t prescribe me any medication, but said that if it is still that high in a year, he will prescribe ACE inhibitors. I am concerned that if I wait that long kidney damage will have escalated. Should I be re-tested before then? I would like to try to become pregnant in 18 months and am wondering about the effect of ACE inhibitors on the fetus. What studies have been done? Also, can you suggest any dietary guidelines to lower microalbumin/blood pressure naturally?

The questions raised are very good ones. One of the issues we will have to deal with in answering your questions are regional differences in practice patterns. Clearly, a blood pressure of 160/90 is too high. If it remains that high, even some of the time, that should be treated. In the United States, the American Diabetes Association has recommenced that blood pressure be maintained at a level less than 130/85. The more readings on your blood pressure, the more sure you will be about what it usually is. Overnight or 24-hour blood pressure monitoring can also be performed, although its availability is variable. The other thing you need to know about microalbumin would be indications to initiate ACE inhibitor therapy. It is true that you would have to stop ACE inhibitor therapy when you attempt to become pregnant. There is also an increased risk of worsening of kidney and eye changes from diabetes with pregnancy. Therefore, I would recommend you speak with your obstetrician regarding your specific situation prior to planning your pregnancy.

With regard to natural ways of decreasing protein excretion, studies have been performed which have shown that protein restriction with impaired renal function helps to preserve kidney function. I do not think that the benefit of dietary protein restriction has been established with normal albumin excretion or mild levels of albumin excretion which fall into the microalbumin excretion range.

JTL