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June 20, 2003

Complications

Question from Hartland, New Brunswick, Canada:

I am 37 years old, have had diabetes since the age of nine months, and I have always taken good care of it. My hemoglobin A1cs fluctuate in the 5% range, but I have had only one at 6.2% when I switched to the insulin pump about two years ago. Anyway, my microalbumin was elevated for the first time in my life. It has always been 0.7mg/d, but this time it was 5.5mg/d.My creatinine clearance was 2.87ml/s which is higher, but I did drink two large diet pops that day plus lots of water. I do go to a diabetologist whom I have appreciated over the last 10 years, but he is a textbook doctor, in that if I come in with a symptom, he automatically he associates it with my having had diabetes so long. So, he felt this was the very beginning stages of kidney disease. Just two weeks ago, I told him I want to be treated like someone off the street coming into his office. Please don't put me in the diabetic box first until something is proven to be diabetes related. Is there anything else this could be? I am very educated about microalbumin and urea, and I understand about kidney disease, but I guess I am asking for other suggestions. I have been quite worried about this result and would appreciate any insight you may have.

Answer:

The first thing I would recommend to you is to have the urine test repeated. It should be specific for microalbumin. False positive results can occur when testing for microalbuminuria. The most common reasons include exercise, a high-protein diet, a high blood sugar at the time of urine testing, and elevated blood pressure.

The most important things here are good blood sugar control and good blood pressure control. If the blood pressure is okay, I would repeat the test before considering therapy with a medication. Even if it is positive, it does not mean your are headed for end-stage renal disease. That can only be answered by looking at the rate of change over time. Medications, including ACE inhibitors and angiotensin II blockers have been shown to preserve renal function with diabetes.

JTL