From Charleston, South Carolina, USA:
My daughter 12, type 1 since July 2003, A1c of 7.4, pumping since November 2003 and loving it, has had no negative effects of diabetes, so far. If we can keep her blood sugars in a decent normal range, would you say she could have a normal life expectancy with little complications? I have heard that some endocrinologists, especially those up north, are giving their young pediatric patients ACE inhibitors to help prolong better kidney function and they are seeing great results. Should I ask my endocrinologist for this? Is it safe long term? I asked our nurse and she wasn't familiar with this. Another mom of a diabetic said she never heard of it either. Please shed some light on this. Maybe down here in the south we just haven't caught up yet.
I am a transplanted northerner, now also in the south, just up the highway from you. I can tell you that while the south may be slower paced than other regions of these United States, the scientific community is not slower.
Has your daughter been followed by the pediatric endocrinologists at the local medical university? She should since they will have the latest news, devices, and up-to-date science. Unfortunately, there has been a recent turnover of personnel there.
To address your question: you are referring to the use of an Angiotensin Converting Enzyme (ACE) inhibitor to help "protect" the kidney from further diabetes-related issues. Other than by performing a biopsy to look for subtle changes, the next "screen" we have for diabetes related kidney problems is to measure for very minute amounts of protein (called albumin) in the urine of someone with diabetes. This is called "microalbuminuria." But microalbuminuria is not specific for diabetes. Several non-worrisome, transient processes can cause a bit protein to spill into the urine. If "true" microalbuminuria is present in someone with diabetes, an ACE inhibitor is generally prescribed and widely known worldwide to ease the burden on the kidney. ACE inhibitors are anti-high blood pressure medications and they may help the early affected "diabetic kidney" by limiting the "pounding" of blood pressure onto the kidney. The best thing for diabetes-related kidney issues is to keep glucose control in great shape. But these medications are for those with already documented microalbuminuria. I am not aware of standard-of-care procedures to prescribe ACE-inhibitors as any type of prophylaxis before there is microalbuminuria.
Finally, there are certain tests that are typically suggested to be obtained annually for the person with diabetes, especially type 1 diabetes. Commonly, it is suggested not only a special urine screen for protein, but also blood tests for autoimmune thyroid disease, lipid profile, and possibly screens for celiac disease or even autoimmune adrenal disease. If your physician does not routinely do such annual screening, they should start. Again, you may wish referral to the pediatric endocrinologists at either of the two university based programs in your state.
Last Updated: Tuesday April 06, 2010 15:09:56
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