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December 29, 2006

Complications

Question from Northville, Michigan, USA:

My 18 year old son, who was diagnosed one year ago, is currently on Lantus, 30 units in the morning, and NovoLog injections to cover meals. His A1c in October was 8.0 when he was on was on 70/30. He started the Lantus/NovoLog after the October endocrinologist visit. His microalbumin, tested by a random urinalysis at the October endocrinologist visit, came back elevated at 16.5. His BUN and creatinine were within normal limits. My son is allergic to shellfish and, therefore, iodine. His endocrinologist did not want to start him on an ACE inhibitor until he consulted with a nephrologist because of the chance of an allergic reaction to the ACE inhibitor related to his iodine allergy. He scheduled us for a February visit and said not to worry until then. I am concerned with the elevated microalbumin level and that it may be a precursor for kidney problems. I am not comfortable waiting for treatment if these two months will only worsen his possible kidney problems. Should we consult someone else? Should he be on an ACE Inhibitor equivalent already?

Answer:

The microalbumin results are mildly abnormal. With diabetes of such short duration, it is unlikely that this represents significant diabetes related kidney problems, but may represent some other kidney abnormalities. If his blood pressure is also normal and the blood work you reported normal as well, there is no urgency medically, only emotionally. We and most others usually run two or three such timed overnight or 24 hour samples before deciding about treatment. ACE inhibitors are the usual, but not the only, medications available under such circumstances. Most importantly is getting the A1c below 7% safely and without excessive hypoglycemia. Knowing something about family history of hypertension, kidney and circulatory problems is important. Not smoking is key. Controlling not only glucose levels, but also lipids, if abnormal, is also important. So, waiting a few months for a kidney specialty consultation is not so unusual, but I would strongly suggest more than a single timed urine sample to see what type of variability exists.

SB