August 6, 2001
Complications
Question from Dallas, Texas, USA:
I am 37 years old, have a prior history of gestational diabetes and was diagnosed with type 1 diabetes about a year and a half ago (blood sugar was 1858 mg/dl [103.2 mmol/L], and I had hyperosmolar coma) which remains uncontrollable. I recently visited the nephrologist, who said that during this past year, I have lost 40% of my kidney function so I am now on an ACE inhibitor (with increasing doses). Have you heard of this degree of kidney loss in such a short time span?
Answer:
There are several things about your history that are confusing to me. First, you refer to having type�1 diabetes but having experienced HHNS (hyperglycemic hyperosmolar non-ketotic syndrome). Hyperosmolar states are usually associated with type�2 diabetes.
Are you basing the diagnosis of type 1 on the fact you are receiving insulin? If so, you may have a form of type 2 diabetes which requires insulin to get the blood sugar down. If you do have type 2 diabetes, the history of gestational diabetes is more consistent.
Also, if you do have type 2 diabetes, there is also a problem with dating the duration of the disease since it is insidious in its onset. Many patients may have type 2 diabetes years before they come to diagnosis. Finally, if you have type 2 diabetes, it may be possible to have had undiagnosed disease, poor blood sugar control, and asymptomatic kidney disease.
I would caution you that one of the important things in your situation is to determine that you do not have another cause for your kidney problems, other than diabetes. This sometimes requires the performance of a kidney biopsy to rule out other causes. I would recommend speaking with your physician about this.
JTL
[Editor’s comment: If your blood sugar “remains uncontrollable” after a year and a half of diabetes, something’s wrong with your diabetes program. Go back to your diabetes team, and review your entire program (insulin, exercise, and meal planning, plus blood sugar monitoring technique, psychosocial adjustments, etc. If you are not under the care of a team, ask for a referral to a team.
WWQ]
