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February 12, 2000


Question from Indiana, USA:

My son has had type 1 diabetes for 10 years. He also had minimal lesion nephrotic syndrome. He has been in remission for the minimal lesion for 8 years. He is 12 years old now. He is starting to leak more protein than he normally would (he's always leaked protein since remission, about 1+. I hadn't noticed an increase in his dipsticking, it is still 1+ but his 24 hour came in at 1270 mg protein in 1550 ml urine. The highest he had ever been was 4 years ago at 960 mg/ml). His doctor thinks he is in the beginning stage of diabetic nephropathy. He started him on an ACE inhibitor. Could Amylin Polypeptide help assist in control and hence in stopping the progression of this? I'm scared and want so badly to stop this. Help. (He's already pumping.)


Diabetes doctors tend to assume that any protein or increase in protein in the urine is due to the diabetes and this may not necessarily be so. You should perhaps discuss with his kidney doctor, whether in the circumstances it might be justifiable to do a renal biopsy. This might help to determine whether the protein leak is due to some form of chronic glomerulonephritis or could be due to the diabetes. Certainly it is justifiable for the time being to use ACE inhibitors even though the blood pressure may not be increased and his diabetes doctor might also think to add an antioxidant like Vitamin E.

I do not think that Amylin would help with his blood sugar control; but if his A1c remains obstinately high you might also discuss the possible use of metformin [a pill usually prescribed for Type 2 diabetes] to diminish the production of glucose from the liver.