Protien in urine, lisinopril for life?

[LauraRP]

I have had type 1 Diabetes for 21 years. For the last five years I've had excellent control. I've had two healthy babies and an A1C of 5.0-6.5. Unfortunately I've had more years out of control than in control. Today my lab results showed protien in my urine. I am not taking this well, even though I knew it was inevitible because of my history. My Doctor has perscribed Lisinopril after I have my third child. My questions are: Are there many type 1 who have to be on this type of pill for life? Is there a way to stop the protien from spilling over even with good A1C? I feel like this is the beginning of a long road of battles.  Like it's all downhill complications from here. Is this accurate? So far I've been very healthy, am I a walking time bomb?
Any words of comfort yet real truths would be appreciated. Thanks

[Anniecure]

How long after taking  ace inhibitor did it take for Microalbumin to go away?

[AmrcnGirly]

My 18 year old daughter (she was diagnosed Diabetic Type 1 at the age of 7) was just prescribed this medication and I came across this discussion in looking up info for the drug. The first reference referred to being primarily used to prevent hypertension and heart attacks.  So I narrowed the search further which brought me to this discussion.  Reading your question and all the comments is very helpful to me.  I will share it with her.  

She has been out of control for the past 2 years, and more recently has an elevated A1C (13.5/14) and sugars averaging in the 400s.  At one point (from last year through February, she advised she wasn't doing readings at all and was just taking insulin.  

She was prescribed this medication after 2 visits with a new adult endocrinologist (she had been with a pediatric doctor all these years.  Her A1Cs have gone from a 7 when diagnosed to 11, then back down, to this present 13.5/14.  After visiting with this new adult diabetes doctor, 2 micro-albumin tests (I do not believe she took the first one properly and doubtful the second), some diabetes education classes, a second insulin schedule, and now this medication, I am hoping she begins to see the light before it is too late.  

Thanks very much for the information.  I would like to watch the discussion here and follow up with questions if I can with any of you and I wish you all the best with your health.

[JDRF-VOL-SG]

Laura, I agree with what Larry has written. A one-time show of  protein may not indicate kidney damage. Sometimes even being dehydrated before the morning of the test can make some protein show up and then things are really OK. Your a1c levels are great, and I would wait until the next test to see how things are. Many doctors now are putting ALL of their diabetic patients on blood pressure meds because recent tests show that these meds protect the kidneys -- so this is becoming a normal prevention routine. Even diabetics like myself with very normal blood pressure are put on these meds just to protect our kidneys. Better to be safe than sorry. Another med that many doctors are putting all diabetic patients on is aspirin. This is to protect the heart. So both meds are becoming very normal as preventive therapy for diabetic patients. Read up, and you will be encouraged. You are not on a downhill slide, but your doctors are just following normal procedures to protect you and ensure a long and healthy life.

[LauraRP]

Hey Larry,

Thanks for writing. It sounds like I need to do more homework on all this as well as get more answers from my doctor. I think I would feel better if a 24 hour urine test was done. I do have more hope now than a I did a few days ago, and I agree that I need a more helpful doctor. I appreciate the info you've given me.

I'm glad to hear you are doing well now. You give us hope!
Thanks again,
Laura  

[Larry68]

Hi Laura,

First, I am not a doctor, so don't take this as medical advice, just information based on my personal knowlege and experience. If your doctor did not suggest a follow up with a 24 hour collection, get another doctor. This test is standard follow-up procedure if a single collection test shows some elevation.

Second, up to 30 mg/L is considered in the "normal range" though diabetics need to be evaluated further if there is any microalbumin present. 9.4 mg/L indicates some elevation, but it can vary during the day. A 24 hour collection can give a much more accurate measure of any kidney damage.

Third, kidney damage is usually due to blood vessel impairmant, which is caused by high BG, high BP and high cholesterol/atherosclerosis in any combination. You need tight control on all three of these, but especially BP and cholesterol for the kidneys.

I have been advised by my heart specilist that even with normal BP (which I now have), a small dose of an ACE inhibitor apparently provides some protection to the vessels in the kidney. The dose I take does not drop my BP, and it is a cheap generic (Enalipril). I do not find it affects me in any detectable way, and I am very sensitive to most meds side effects.

Make sure you get what you need from your doctor by being as educated as he/she is on the subject. This, unfortuantely, isnot hard to do. If the doctor does not want to answer your questions, again, search for a new doctor who will.

Good Luck,
Larry

[JDRF-VOL-RL]

Hello, Laura.  Congrats on your recent control, but sorry to hear about your recent diagnosis.  Are you pregnant right now?  If so, is there a chance that the protein is just a result of that?

I am not a medical professional, just the parent of a kid with diabetes, so some of your questions I'm just not fully qualified to answer.  Even though the drug has been on the market for 15 years, I can't find info on whether or not people can stop needing to take it.  Sorry that I can't answer that for you.  From what I can find about Lisinopril, it looks like it can do a good job of controlling the protein and protect your kidneys.  If you can do that, your load road might be easier to take.  The best thing you can do to protect your kidneys is to control your blood pressure, take ACE inhibitor medicines like Lisinopril, and continue to test regularly.  You've got work to do to stay healthy, but it can be done.  It sounds like you are taking the right steps.  Good luck.

[LauraRP]

Larry,
Thanks for writing. So let me get this straight. There was protien in your urine from a 24 hour test. You got your blood sugar more in control as well as blood pressure and cholesterol by exercising, etc.? You now take an ACE inhibitor and there are no traces of protien in your urine? If that's the case it gives me hope. My blood pressure is fine as well as my cholesterol. My Doctor has not ordered a 24 hour urine. I don't know what kind of scale the first urine test is on, but my result was 9.4, and they like it to be a 0. I just moved and this was my first time at a new doctor, and they weren't very helpful in answering my questions. They just said, after I have my next baby I'll be on a pill for life. If I can help it, I'd like NOT to take the pill and to strengthen my kidneys with other methods. But you think taking the pill is helping you not develop long term complications?
Thanks again for writing.
Laura

[Larry68]

Hi Laura,

First, don't panic. If you had a microalbumin spot check with a small urine sample, I would expect you will follow this up with a 24 hour check. This will determine if you have a significatn problem, or are in the early stages. Your A1C indicates that you have good control, but how is your blood pressure?

In my case (a 43 year type 1), I showed elevated protein levels in a 24 hour test. I took better control of my BG at that point as it needed improvement, but I also worked on my cholesterol and B.P. with meds and exercise. I now have them under control. I take an ACE inhibitor at a very small dose just for added protection of my kidneys.

Subsequent tests have not shown any protein in my urine, and that has been the case for over 6 years.

I hope you find your problem is minimal and reversible, as mine was.

Larry