Our 17 year old daughter, who has had diabetes since age seven, was recently diagnosed with kidney disease after repeated, elevated urine microalbumin determinations. Her hemoglobin A1cs have averaged about 8.5% for the last 10 years, and while we know that this is high, she tries so hard to control her diabetes (tests five to eight times a day, counts carbs, and works hard, etc.). She accepts her illness and actually can see how coping with diabetes she has become a stronger person. She is currently taking an ACE inhibitor. She is faxing her educator and is working on lowering her numbers. She is in cross-country and is captain of her team! So exercise makes life even more challenging!

I have several questions:

As my daughter is so young and this is going on so soon (not exactly 10 years after puberty) is there any hope of reversing this?.
Will she be able to have children?
How can I give her the best support? I am very discouraged. Kidney disease is overwhelming and very raw for all of us. Actually, my daughter is more accepting of all of this then I am.
She is a senior in high school and she is dreaming of colleges. How often should she be seen by her specialist while in college? Our insurance does not cover out of area except emergencies.

A lot of your questions would better be answered by your daughter’s physicians since they know her specifics, lab results, etc. In general, the amount of kidney damage is reflected by overall glucose control over many years, family history of similar problems (blood pressure, vascular disease, lipids, etc.), since this involves genetic risk assessment.

The key question would be why she is only able to get her hemoglobin A1c levels to the 8% range and not any better since better glucose control improves kidney function and may even allow decreased protein losses. ACE inhibitors are an excellent way to treat such protein leakage as well as any hypertension. She should not be smoking since smoking adds to these risks. If there are lipid abnormalities, these should also be treated aggressively. She may want to start taking a small dose 81 mg/day of aspirin and perhaps some of the anti-oxidant vitamins and minerals such as would be available in a multivitamin/multimineral preparation like Theragram, Centrum or similar generic formulations. Cutting back on animal-source protein is also helpful under such circumstances since the kidneys do not have to work so hard. Go back to her diabetes team and ask these same questions so that you can have a better understanding.

SB

[Editor’s comment: Also, see How to Protect your Kidneys at the Diabetes Monitor.

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