Kidney Damage - Early Stages

[ursamere]

When I received latest blood test results from my doctor, I was a little overwhelmed.  A1C was 5.6 (which he indicated was excellent - the best yet), but also indicated early diabetic kidney disease for the first time.  I've been diabetic for 40 years, it just surprised me that with the diabetes under the best control ever, I'm showing the signs of kidney disease now.
Has anyone had a similar experience.  I'm pretty disappointed, such good control is very difficult, I thought better health would be the result.

[JDRF-Team-wak]

I am not a physician, but a mom of a type one diabetic child. and daughter to a type 2.  I realize how hard it is for you to get that GREAT A1C,    and to stay within the “ideal ranges.” all the time.    
The thing with complications from diabetes is that they do not happen over night. They usually show up over time.   My mom is a type 2 diabetic and after several years of not taking care of herself properly she is now having the complications.  They show up down the road so to speak.  That is why it is so very important to always try to stay in control.  Which believe me I know it is hard.  I have a 9 yr old, who loves candy and junk food.   I know she sees what is happening to her grandma and she does not want it to happen to herself so she tries to be good.

If you keep that good control now it will help lessen the complications and their severity in the long run.   Do not be discouraged.  Keep up the good blood sugars and things will get better.

Good Luck and keep up the good work.

[JDRF-Team-LRS]

Hello Ursamere.
As you probably know, we're not physicians here, but are happy to share our experiences with you so you can explore the ideas further with your diabetes team.  I'm also a long-time DMer - about 35 years.

5.6 is an excellent a1c and as one who's not (yet) achieved an a1c under 6, I admire the work & discipline it takes to achieve that.  Kidney damage, I've been told, is not the same as kidney disease and the "meaning" of kidney damage was once explained to me with this analogy... A person falls down & skins his knee.  It may bleed and scab over and even look nasty for a whlie.  That person has knee damage, but the knee itself works quite well otherwise, allowing the individual to walk normally, ride a bike, etc.  By analogy, it's possible that our kidneys have .. over the decades ... experienced some damage due to the wear & tear of our disease, while they still function quite normally.

Did you urine test show micro-albumin? Were there some anomalies in your blood work?  My endo (and my opthalmoologist, for that matter) has used a rule of thumb with me saying that when a diabetic gets past 20-25 years without kidney disease, it's very unlikely we'll develop it later.

Having said all that, how is your blood pressure?  Are you taking any meds to keep it low?  Increasingly, docs are encouraging us to keep BP around 120/80 in addition to keeping vigilant watch over our BG.  Has your doc suggested repeating the test that showed kidney damage? or has s/he suggested any changes to your already-superb diabetes management?

It is a real blow to work so hard and achieve such excellent control only to hear that there's something awry.  Try to keep your spirits up as you work thru whatever you must.

[ursamere]

Thank you for your responses.  I discussed the test results with my doctor last evening, as he reviewed the results more closely, he found huge discrepencies in the results and it appears the lab made calculation errors in the urine testing (the blood tests were usual - no change from previous testing).  I will have the tests redone and hopefully, the results will be correct.  Diabetic kidney disease is a family condition (my father and grandfather both died from it).  I have been very closely monitored and have taken Vasotec (Enalapril) for about 13 years to keep my blood pressure lower than normal.  Since there is no change in my blood pressure and the A1c results were very good, it does appear lab error (and not extreme kidney problems) are the problem.  I appreciate the support this site provides.

[JDRF Team SGG]

Just a comment here... if the test that was done was simply a random microalbumin test and not a 24-hour creatinine clearance test, the number can be affected by being dehydrated or other factors besides actual kidney damage. Some web sites that discuss the random microalbumin test state that several elevated numbers in a row need to be present in order to diagnosis actual kidney health or damage because of this. The actual 24-hour test is more accurate but is not done as often now because the microalbumin test has been developed and uses some lab adjustments to show reasonable accuraccy. Do have the second test done and compare numbers over a period of time.

Also, LRS has a good point about the current thoughts of helping maintain kidney health with blood pressure meds. Many doctors put all diabetic patients on these drugs even if blood pressure is very normal or even slightly low, for they have been proven to help protect the kidneys from long-term damage.