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Dr. Andrew Rynne

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Diabetic. What should be done to minimize the microalbumin level? Suggest diet plan

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Dr. Madhuri Patil

Diabetologist

Practicing since :1999

Answered : 362 Questions

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Posted on Wed, 26 Dec 2012 in Diabetes
Question: I am 31 years old male.
I am diabetic for last 2 years.Now in my urine mild protine is leaking.
e.i my random microalbuminuria is 37 mg/l and the normal level is <20mg/l.
fasting suger is 90 mg/dl and After food 132 mg/dl.
BP is 130/80 which is normal.
HbA1c is 6.8%.
Cholesterol is normal.
Bun is 11 mg/dl.
creatinine is 0.7 mg/dl.
These medical result is done before two month.
I have take insulin and Glycomet 3/850 medicine for suger.
I have take Rozavel for cholesterol and Cardace 2.5 mg for Microalbuminuria.

Pls guide me how can i minimise the microalbumin level to normal range.
And how many time it will take?

how many year to take microalbumin in urine to overt nepropathy and End stage renal dease?

In my foot I feel burning sensetion for one time only for 5 min in last 2 years.
is there any problem ?
One day in my hip also pain for some time. and never feel like that. what is the problem ?

I want to know the diet pattern and how much water is advisiable for me.
doctor
Answered by Dr. Madhuri Patil 4 hours later
Hi There,

The urine microalbumin of 37 and mild leaking of protein in urine with absolutely normal BUN and Sr Creatinine might not be part of diabetic nephropathy. Reasons like- Some local symptoms, general fever, temporary high sugars, strenous physical exercise can also cause this kind of proteinuria.
Let me ask you few things before we conclude that it is diabetic nephropathy:
- What was you blood sugar when you were first diagnosed to have diabetes?
- Does your family member have diabetes, and if yes, does he/ she has diabetic nephorpathy/ proteinuria or high blood pressure or diabetic retinopathy?
- Have you gotten your eye checkup done to rule out diabetic retinopathy? If yes, what did your Ophthalmologist say?
- you please answer these questions and get a test called ''24 hour urinary protein and creatinine'' done.
The sugars, blood pressure are great and you do not need to panic about your kidneys at this stage.
If at all other reasons are ruled out and it is confirmed that your proteinuria is because of diabetic changes in your kidneys then the steps taken are like this:

- Eat only plant proteins (like dal, milk, whole wheat etc) and no non-veg proteins
- Minimise salt in your diet as much as possible (over time you get used to less salt diet, so try it)
- Minimise fat intake as fat increases load on kidney tissues and blood vessels of the kidneys making it less functional
- Exercise has to be regular just the way any person without diabetic nephropathy does- minimum 45 minutes/day/all 7 days of the week
- Blood pressure has to be targeted below 125/ 75 mmHg. For this if you need to increase the dose of Cardace (Ramipril) or even if you need to add another anti-hypertensive medicine, still it's ok. This will take load from kidneys and they leak minimum proteins then
- Water intake has to be just normal at this stage as you do not have any overt kidney disease at all
- Smoking has to be stopped fully, if you smoke. Smoking has direct link to both diabetic nephropathy and diabetic macrovascular diseases.
- To take Tab Cardace regularly.
- Last but not least perfect blood sugar control is must.

Now your question how long it takes the kidneys to deteriorate to end stage kidney disease from this kind of mild proteinuria: If patient has family history of diabetic kidney disease, if patient does not follow the above mentioned guidelines then it takes less than 5 years, but a perfect implementation of the above mentioned guidelines makes it reversible and the patient might not even develop diabetic nephropathy at all!

After you take all the precautions it will take less than one month for you to get normal proteinuria readings.

I have already explained the dietary restictions and said about water intake. Please anyway follow them for best results.

The foot might have some neuronal irritation due to Diabetic neuropathy. You need to tell precisely what time you get the burning sensation and which part of the foot. I shall guide you on that. Hip pain is unlikely due to diabetes. If it is mild and not frequent, just ignore for the moment and exercise regularly. It might go off. If not, then let me know.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Madhuri Patil 14 hours later
when first i was test for diabeties the test result was 280 mg/dl (fasting).
I have done c-peptide test and doctor say i have Type 2 diabeties.
At that time my HbA1c was 7%.
And now HbA1c is 6.8%
My family history have no diabetic nepropathy and retinopathy.
My father have diabetics but he have no evidence of nepropathy and retinopathy.
I have done my eye check up.Doctor say there is absolutely good.there is no problem in my retina.
Doctor checked my foot also he say there is no problem in my foot also.

So pls tell me what u conclude in this matter?
doctor
Answered by Dr. Madhuri Patil 1 hour later
Hi again.

Thanks for this info.

Looking at all these points and ruling out diabetic retinopathy, it is unlikely that you have proteinuria due to diabetic nephropathy.
You wait for 1 more month, and at the end of it do 24 hour urinary protein and creatinine test. This will give us answer. Also get ultrasound abdomen done and if the kidneys are swollen (sign of initial changes in diabetic nephropathy) then only we should worry. I feel everything will come normal. But just to make yourself sure, do these tests and get back. Till that follow general health guidelines.
Do Not worry. The proteinuria is absolutely in a range where you can reverse it and will never see it again when you follow the other guidelines. Take care.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Madhuri Patil 2 hours later
Before 2 month I have checked for creatinine,BUN,Cholesterol,microalbumin,Suger and HbA1c.
Every things was in normal range.Only the micro albumin is 37 mg/l.The range is <20 mg/l.
So doctor tells that there is nothing the problem This is due to Diabetic change.
HbA1c was 6.8%.There was no problem in the kidney.GFR is also normal.
Creatinine level was .7 mg/dl.and BUN was 11 mg/dl.
You tell how can i minimise the microalbumin level?
How to stop increasing the microalbumin level?
Is this possible ?
I read an article that " 50% patients, although had albuminuria but had no renal failure ever in their life time while 50% patients had no albuminuria still had renal failure."
Is this true?
doctor
Answered by Dr. Madhuri Patil 55 minutes later
Hey hi again.

I know about your blood/ urine tests which you have mentioned in your first query itself. I am sure about your normal eGFR.
We do not label anybody's single reading of slightly higher urine microalbumin to be due to diabetic nephropathy- one has to confirm it by 24 hour urinary tests and by ruling out other possible reasons. Just because the person has diabetes, he/she cannot be always labelled to have diabetic nephropathy on such a mild reading of urinary microalbuminuria.
I have already mentioned, in my first answer itself, the steps to minimise and REVERSE this kind of microalbumin secretion through urine. And as I mention it before also- IT IS POSSIBLE.
The article you have mentioned here is right but diabetic nephropathy is always with history of months and years of secretion of more and more protein in the urine and presence of concomitant diabetic retinopathy.
I would say- just relax. Confirm the reason for such microalbumin in the urine. Take the steps mentioned above if it is confirmed to be due to diabetes and you can certainly REVERSE it as this stage.
I hope you got the answer. Take care and get back for any further query.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Madhuri Patil 24 hours later
hi doctor,
I want to know that how much amount of microalbuminuria is alarmic for me and how much Bp and suger is XXXXXXX for me.
doctor
Answered by Dr. Madhuri Patil 2 hours later
Anything above 20 mg/l is considered pathological. In your case also, 37 is alarming. But not something that you should directly think about end stage renal disease as upto 200 mg/l has been shown to be reversible if taken care of all the parameters mentioned above. Most importantly, this kind of microalbuminuria can be due to some temporary reason like UTI etc. and not necessarily only that of diabetes origin.
Being less than 40 years, your sugars must be targetted as:

- Fasting and any pre-meal sugar: between 80 to 120
- Post all major meals: 120 to 180
- HbA1c: less than 7%

Have already mentioned about BP:
- If you are having this microalbumin in the urine due to diabetes then it has to be targetted not more than 125/75 mmHg
- If this microalbumin is not due to diabetes then below 130/85 mmHg has to be the maximum BP in your case.

Anything beyond that CAN be XXXXXXX if maintained for a very long period, but not all the people develop complications of diabetes even though they might not have been maintaining these sugar and BP levels. It's all in their genes!!

All the best.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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