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February 16, 2005

Complications, Other

Question from Houston, Texas, USA:

My 10 year old daughter has had diabetes for eight and a half years. Her blood sugars vary from 100 mg/dl [5.6 mmol/L] to 250 mg/dl [13.9 mmol/L]. They vary frequently, even if she follows a strict diet. A month ago, she got shingles and her blood sugars were unmanageable for three weeks. Today, we got her A1c and it was 9.0%. They also did a urine test and the doctor found a trace of protein in her urine. The next step is to the 24 hour test. Her first test result was 19 and the doctor said it should be lower than 16. I am very worried. If this test is correct, what does it mean? Is 19 very high? Would the shingles and high blood sugars have anything to do with this?

Answer:

The urine protein test was probably a microfilming test. If positive, this could just be post-virus from the shingles virus. Repeating the test or doing a more formal 24 hour urine would be fine. If only done with a screening dipstick for microalbumin, the more formal tests would use more sophisticated measurements technology as well. Usually, such timed overnight or 24 hour urine tests for microalbumin are done at least several times (we do them three times) before deciding if medication, such as lisinopril, is needed. The higher the glucose levels and the higher the A1c, as well as the longer the duration of the high glycemia, the more likely there is to be early kidney damage. Blood pressure is sometimes also elevated. Family history of kidney or blood pressure problems would also be important to know about as well as excluding thyroid or adrenal gland problems. You should go back to your diabetes team and ask them what steps they might consider to improve glucose control, more shots, more testing, different analysis, different insulin programs, insulin pumps, etc.

SB