Justin Delgado is husband to Kacie Doyle-Delgado, diagnosed at age 11. After more than a decade together, he considers himself to be an expert carb counter and Dexcom inserter. He graduated with his Master of Science in Finance from the University of Utah in 2013 and has been working in commercial banking since then. He attended his first Friends for Life conference in 2015 and is looking forward to volunteering with the teens.
July 16, 2009
Question from Mineola, New York, USA:
Now 38, I've had type 1 diabetes since I was nine. My A1cs have been below 6 since I was 25 years old, so I am in good control. My 24 hour protein levels have varied from 80 to 130 mg/24 hour and mircoalbumin tests have varied between 6 to 9 in a 24 hour period. I went through one pregnancy doing 24 hour urines and everything was fine. Four and a half months after giving birth, my microalbumin went up to 13 (still in range) and protein was 93 and 115 on another day. In the four years since then, my microalbumin has stayed pretty much the same at 13, 12 and protein was around the same as previously mentioned. In August 2008, I was 8 weeks pregnant when my 24 hour protein was tested again. Protein was 93, microalbumin was 6, which I found strange because it had been 13 before. I don't know if the laboratory made a mistake. I then had a miscarriage. I got pregnant again in December 2008, had another 24 hour test done in March 2009 (6 to 7 months later), when I was 12 weeks pregnant to find that my protein had jumped to 180 mg/24 hour, with a microalbumin of 32. I was shocked. Also, please keep in mind I had switched laboratories for these results due to insurance reasons. I am now currently 28 weeks pregnant and have been doing repetitive 24 hour urine tests every month, ranging from 130 to 180 mg/protein every month. The doctor has not repeated the microalbumin. This new laboratory for protein reference range is only up to 100 mg being normal. My previous laboratory was up to 150. What happened to me? Why, all of a sudden at 12 weeks of pregnancy, did my microalbumin go up to 32? I just had it done 6 months prior to that when I had my miscarriage and it was 6. I know I am pregnant, but find it hard to believe that it was from only being pregnant for 12 weeks. Can microalbumin go up in pregnancy that early on? I am getting conflicting information. Also, please remember I've switched laboratories, both laboratories having good reputations. I am confused.
The are many things to consider when interpreting albmumin (and protein) excretion from urine samples. First, there is tremendous variability in the normal range for a single patient. Good laboratories can have values of 6 to 13 and be considered near identical for purposes of evaluating for any interval change. False positive albumin readings can occur with intense exercise (if done right before your collection), a high protein diet, or very high blood sugars on the day of sampling. Add pregnancy into the picture and it is even more complicated. First, pregnancy is associated with transient worsening of albumin excretion. In addition, retinopathy can also become transiently worse during pregnancy. Blood pressure control becomes important. However, you are much more restricted in the agents you can use during pregnancy. I know your glucose levels have been good. With your duration of diabetes, your current age, and your pregnant state, it is not surprising that the albumin excretion rates would be higher than normal. Hopefully, these will not change much more and go back to baseline levels after your pregnancy. A good reference laboratory is not that much different than another reference laboratory. The variability is just so high for a single person. Changes or therapeutic interventions are best made on the average of several readings.
Additional comments from Dr. Bill Jones:
During pregnancy, blood flow to the kidneys is increased dramatically and early in gestation. Thus, with more blood flowing through the kidneys, more protein is filtered and passed in the urine. Why the change for you is so much, I cannot answer. However, you have had long-standing diabetes and, even with good control, there is probably some amount of kidney damage. Being pregnant probably accentuates that. The good news is that your overall proteinuria is still within the normal range (less than 300 mg/24 hours). It will be important to follow this since you are at risk of developing preeclampsia both because of the diabetes and your age.