Over the years (and years) of having diabetes and being very active, I flirt with higher numbers, meaning, micro albumin and some other function numbers were out of range. Probably once a year, I get a reading that sparks concern and by the follow up appointment I'm well in the normal range. I also find that if my hydration isn't enough, I see abnormal numbers, which I could so easily see happening to kids and teens. What can parents do to help reduce these numbers beside tight blood sugar control?
It seems incredible to me that children are already showing kidney function issues just 5 years into it. I think back to when I was 5 years into it and we didn't have the ability for tight control, but the standard practice was to tell patients was keep the body moving and that was considered rocket science in those days.. it was right after they invented the wheel! 
I think a blogpost on hydration and urine tests would be very useful.
I once had a urine dipstick test that showed microalbuminuria (indicating 30 to 300 micrograms per milliliter). I hadn't had anything to drink the morning of the test. I asked for a quantitative test, because a reading of 31 would be one thing, and a reading of 299 would be another.
The quantitative test measured the albumin:creatine ratio, which is supposed to control for hydration. This time I made sure to drink a lot of water, and the results said the albumin level was so low, they couldn't detect it. I wanted more details, but the lab wouldn't talk to me because I'm not a doctor.
What do you think of running an annual cystatin-c test in people who have had type 1 diabetes for many years?
Hi Ellen: As I do not treat adults with diabetes, I had to look up the Cystatin-C test. As you know, the Cystatin-C test is an alternative to evaluation of serum Creatinine and Creatinine Clearance. My understanding is that with a history of kidney disease or other chronic illness, it detects abnormal glomerular filtration rates sooner than with conventional CrCl testing. Physicians are still evaluating its place in evaluation of kidney disease based on the information I have obtained. I, therefore, think that the Cystatin -C test is certainly another valuable tool to allow for evaluation impending kidney disease in an individual with longstanding diabetes or other disease as it may be more sensitive than conventional methods. I would use any tool available in order to reverse or possibly prevent nephropathy!
Just my thoughts,
DrC
recent mornning urine check===
Albumin--190.52mgdl
creantine---.64mgdl
Microalbuminuria---297mgdl
Plz suggest further test or advice me
your results:
recent mornning urine check===
Albumin--190.52mgdl
creantine---.64mgdl
Microalbuminuria---297mgdl
I usually see results reported as micrograms of albumin/mg creatinine. I am assuming this is what you meant. If so, it appears that there is indeed significant microalbuminuria. I would verify once again and if confirmed, discuss with your health care provider your options which include medication as described above in the blog.
Dr.Cogen
thanks for reply
there is little change in parameter of spot urine check--
urinary albumin--1.90.52 mg/l
creantine-----0.64 mg/l
microalbuminuria---297.6 (30 to 3000mg/g
sir please advie me --am i suffering from microalbuminuria
my doubt is that micro albuminuria parameter is wthin normal range as listed above.
Sir Please ignore my previous mail----
thanks for reply
there is little change in parameter of spot urine check--
urinary albumin--1.90.52 mg/l
creantine-----0.64 mg/l
microalbuminuria---297.6 (30 to 300 mg/g)
sir please advie me --am i suffering from microalbuminuria
my doubt is that micro albuminuria parameter is wthin normal range as listed above.
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What's your opinion of the recent study showing that a ketogenic diet reversed diabetic nephropathy?
Hi Gretchen: would you kindly provide the original reference so I can check out??
DrC
I was afraid you'd want the reference because I couldn't remember where I'd filed it. But thanks to the miracle of Google, I found it again.
The study was in rodents, and the authors have some caveats. But I think it's interesting.
Hi Gretchen!! You are tossing basic science tidbits into my clinical arena!!! But, I will try to give my opinion anyway despite basic science research background. According to the authors of the study,
We therefore hypothesize that the ketogenic diet reverses diabetic nephropathy by raising blood levels of 3-OHB which subsequently reduce glucose metabolism in at least some tissues including kidney. Since ketones and the ketogenic diet are neuroprotective in a wide range of conditions [31], a phenomenon we have corroborated in the present study (Figure 6), it seems highly likely that the ketogenic diet will be protective in diabetic neuropathy and possibly retinopathy as well.
My concerns:
1. The ketogenic diet in this study produced weight gain in people with diabetes: not good for T2DM
2. People cannot permanently stay on the ketogenic diet (the authors addressed this concern and suggested even intermittent ketogenic diet might work)
3. ketogenic diets reduce glucose metabolism: but what happens with type 1 diabetes patients where ketones (especially the ketone measured in this study) causes major metabolic decompensation?
4. Does the diet work differently in T2DM vs. T1DM???
Overall, very interesting. I think I would wait for the human studies though!
DRC
I agree about waiting for human studies before prescribing for patients.
I disagree that most people gain weight on ketogenic diets. Most people lose weight. I also disagree that they can't be maintained. I've been on a mild ketogenic diet for about 15 years. Not as strict as the ones they use for children with seizures, which are 20 g of carb a day or less; I have around 50 g carbs a day, mostly from low-carb vegetables and almonds, but I usually show "mild ketones" unless I eat a lot of fat, and then it moves to "moderate."
Gretchen: re the weight gain: the study noted weight gain in the diabetic rodents that were on the ketogenic diet. My experience with the ketogenic diet is weight loss as well!
FC