July 10, 2002
Complications
Question from Los Angeles, California, USA:
I have type 2 diabetes treated with Glucophage [metformin], and about five months ago, my hemoglobin A1c was 11%, and it’s now 6.6%. However, in reviewing my blood tests, I noticed that my BUN level went from 10 five months ago, to 15 two months ago, and now it’s 20. This led my doctor to begin talking about ACE inhibitors, but I have not had a test for microalbuminuria, just an office urine dipstick which indicated no protein present.
Is it appropriate to consider an ACE inhibitor at this stage or should a microalbuminuria test be done? Did the rising BUN level suggest anything that make the use of an ACE inhibitor seem a good thing to do?
Answer:
Without a doubt, a test for microalbumin test should be performed. It is important to note that changes in microalbuminuria precede changes in the BUN and creatinine in diabetes-associated kidney dysfunction.
If you have an elevated blood pressure or evidence of microalbuminuria through your physician’s testing, you should consider using an ACE inhibitor The BUN can be changed as a result of your volume status (whether you have lost fluids on a hot day or have had fluid loss with a diarrheal illness), use of diuretics, or several other reversible factors.
JTL