My 12 year old daughter has had Type 1 diabetes or five and one half years. She has been in fair to good control (A1C’s between 8-9%) most of this time. I am a diabetes educator and her stepfather is a critical care RN, so we have tried to do all of our “homework”. She uses an intensive insulin regimen (four or more injections daily) and monitors four times per day. She has never had DKA nor been hospitalized because of diabetes.

She had her first microalbuminnephropathy this early in the disease process? Any ideas or suggestions? She is on Avapro ( she is not hypertensive), but no other treatment at this point. I really feel that there must be more that can be looked into.

First of all, it is standard good practise to evaluate microalbuminuria in a 12 year old girl who has had autoimmune diabetes for more that five years. However, it would be very unusual to find evidence of renal disease. Having said this, I think that you need to talk to the doctor to find out exactly what units the 1100 figure is expressed in. In our center, we routinely use a timed overnight sample, and, if the albumin level is <7.6 microgram/minute, we assume that to be normal, 7.6 to 20mcg/min is borderline and over 20mcg/min would justify trying for meticulous control -- possibly with a pump and the use of ACE inhibitor drugs which can reverse the process. Another unit that is used is mcg/mg of creatinine where any value over 30 would suggest treatment. Even if the degree of albuminuria turns out to be significant, it is important to remember that diabetes complications are not the only cause and that a previous urinary tract infection, a subclinical glomerulonephritis or even an improperly collected specimen can be responsible. DOB