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March 25, 2004


Question from Pittsburgh, Pennsylvania, USA:

I have been a type 1 diabetic for about nine years. My A1c has mostly been under 7%. My blood pressure is 150/75 at the doctor's office and 125/70 at home. I do not smoke. I currently use an insulin pump for treatment. I've only been on it two months. Before, I was doing multiple injections, four or five per day. I've always had sporadic numbers, but my A1c was always normal. My concern is about microalbumin. My new doctor runs this test yearly. My first test was normal, my second test was okay, and now with my third test, they are saying results are pending. I am very scared of getting kidney disease. What are the odds for someone with my scenario having kidney disease?


Your risk for kidney complications is higher if you have: poor diabetes control, A1c greater than 7-7.5; high blood pressure; and microalbumin in the urine. It appears that you are not in the high risk area. However, I would discuss the possibility of using an ACE inhibitor in addition to your treatment. This could decrease the risk of renal complications. The use of a pump is an excellent modality for preventing poor glucose control, lowering the risk of complications.