May 28, 2005
Complications
Question from Mobile, Alabama, USA:
I am 28 years old and I’ve have had type 1 diabetes for about five years. I’m on an insulin pump. A couple of weeks ago, I went to the doctor for my A1c and a urine test. My A1c was 5.9%, but my microalbumin level was.41mg. I exercised, jogging and weights, two days in a row before the test and the day of the test, about an hour before I took the test. My doctor ordered a 24 hour urine test. I was very concerned about the results. However, the results are back with a new microalbumin reading of 21.3g, normal being less than 30. and a creatinine clearance of 84, normal being 88 to 128. My doctor said this was a normal result.
My A1cs have stayed below 7.0% since diagnosis, usually below 6.5%. Also, I’ve never shown any sign of microalbumin. I have very good blood pressure with every reading staying around 110/70.
Do you think the first microalbumin reading was caused by the exercise?
Are the second results normal, in your opinion?
What can I do to prevent any kidney damage? I want to have a baby in the next couple of years
Answer:
Possibly. It is one of the reasons for a false-positive test. There are others that include high protein diet, transiently poor blood sugars at the time of the urine sampling, and marked upright posture. Therefore, most people feel the best way to sample is an early morning sample. We do random collections for albumin to creatinine ratio. Twenty-four hour urine samples are not necessarily required for people with normal random samples. We have also done research looking at the effect of different intensities of exercise and done urine sampling after the exercise. The albumin excretion is not markedly elevated after the first few hours. However, within the first two hours, there may have been some effect. Finally, there is a large variability for albumin excretion within the same patient so you are much better off with multiple sampling over time to be assured it remains less than 30 mcg/24 hours or less than 30 mcg/mg creatinine. It is a good sign your blood pressure is also normal. Keep up the good work and stay healthy!
JTL
