Hey guys, a little protein in urine T1 for 16 years, first time

Diabetes Complications and other Conditions Kidneys
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Hey guys, I'm a T1 for 16 years and my sugars have always been in control for the most part (6's to mid 7's at most) and I had a bad few months (A1C of 8.6 yuck!) and I'm working on this NOW to bring it down at least two points to where I was.

But my doctor found a "little bit of protein" in my urine for the first time.

My aunt is also a T1 and has had diabetes for about 42 years. She has gone to a kidney doc for like 20+ years and has done fine in controlling the protein, even going long stretches without having to see that doc.

He put me on the lowest dose of lothartin or something...if i bring my sugars way down and take this, he says that might take away the protein.

Do I have early stage kidney disease? He was quite matter of fact about this.

Should I panic big time, or can I live with this in control for like 50+ years if I control it?

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You should take this seriously but there is no need to panic. It is just that an A1C of mid 7's or higher should be off limits from now on. Try to achieve an A1C of 6.3% or lower all the time. To achieve that you need to make huge investments - even changes in lifestyle - I am aware that it will not be easy. But at least it is the most effective way to reduce the stress on your kidneys. With this there is great potential that the low protein level can be stabilized or even that the kidney can heal itself.

Ask your medical team about medication for tighter blood pressure control. Small reductions in BP can have a positive effect on the kidneys too.

Since you are on shots my Glucosurfer project might be helpful for you too.

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Thanks. Yes he did prescribe me a low dose. He said maybe it will go away. Ive read that this typically happens to type 1s from 10-15 years into the disease, and good control doesnt necessarilly mean u wont get early stages. Is this true? Also, i read that if it doesnt progress to the next stage with more protein by 20-25 years with the disease then you have only a 1 percent chance of getting bad kidney disease from then on

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Another weird thing: i have zero neuropathy or retinopathy! Ive read that this is extremelly unlikely

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Was this a one-time test or a repeated result? Because it's very easy for urine samples to get contaminated with protein. Since your doctor put you on medication, I'm guessing this must have been repeated or at a level where there was confidence it wasn't a false positive.

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These days most of us get a microalbumin test which is very sensitive to protein in the urine. Unfortunately it also gives many false positives for a range of reasons. Some people just dump some protein, which can make the test basically useless as an early screening indicator. And there can be some things which give you transient levels of protein such as exercise. I have had this so and I had a test which showed "microalbuminia" which is the level at which the red flag goes up. But screening guidance says that you need to reconfirm a single microalbumin test with a second showing microalbuminia before making any diagnostic conclusion.

And even if you do have two positive microalbuminia most doctors would still not label you has having kidney disease until you have some level of reduced renal function as shown by you eGFR.

And your doctor probably put you Losartan (Cozaar) which is a blood pressure medication. Many of us are put on these medications as a way of preventing kidney problems. There is some thought that kidney problems occur because of high blood pressure (personally I think high blood sugars play a bigger role).

So if you have read this far you should know that I don't believe you should panic. Even if you turn out to have the first stages of kidney disease it doesn't mean you can't do something about it. People like Bernstein believe that with tight blood sugar control you can heal from moderate kidney disease. So don't panic, have it checked next time and take a look at your labs. If your eGFR is 90+ you have normal kidney function.

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This was the first time hes brought it up. But also my blood pressure reading was 140/75 (this is the first time its been this high but he didnt even make mention of this

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Also, hes put me on meds before as a precaution, isnt that a possibility?

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Some doctors say: you will have complications either with your eyes or with your kidneys but not with both. So - tada - you are the kidney type. The problem is that complications and their severity are influenced by many factors but most importantly:

a) your glucose control

b) the capability of your body to compensate / repair the damage caused by glucose deviations from "normal". The absence of neuropathy in you might be a good example for these individual capabilities. So genetically you have been dealt a good hand of cards.

c) even more complicated a) and b) have dependencies. For example it might be advisable to improve the quality of your glucose control only "gradually". The better your glucose levels the better your body and immune system can work. Sounds good but might result in an over-shooting reaction of your body to micro-damage it might find. To this point the higher glucose numbers hindered or impaired the healing process. For example with improved healing the invisible micro bleedings in the retina can progress to massive bleedings needing laser treatment. Again, the effect depends on very individual factors. I would tend to suggest that from month to month the improvement of the A1C should be in 0.5% steps. Perhaps there are even health guidelines for that I am not aware of.

Statistically good control will reduce your risks greatly - but sadly not to 0. But in the face of this bitter truth we all should try our best and hope for the best. I am sure it will pay out for you.

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Christopher - Do you exercise? If you do, then you might want to refrain from it a couple of days and redo your urine test.

I lift weights and run. If you do, a little bit of protein will show up in your urine - diabetes or not.

I am probably more the panicky one when it comes to kidneys and type one because non-diabetics on my mother's side have had kidney disease.

Your doctor probably put you on Losartan (angiotenisin II antgonist) - which is a blood pressure pill that will protect your kidneys. Other types of BP meds are ace-inhibitors like Lisinopril, etc.

With that being said, the best way to protect against any kidney disease is to get your A1C level down to at least 7% or lower.

Whenever I retest after not exercising - I show no protein in my urine, I am on losartan and was on Lisinopril for years util I got the cough.

An important number is GFR. If this is normal, then no worries. Just be proactive and stay on top of your blood pressure and diabetes control.
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About kidneys, protein in urine and blood pressure: If a person has low to reasonable blood pressure, wouldn’t the medication, ACE inhibitor, lead to low blood pressure, which may make a person feel light headed or dizzy?

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So here we are in nearly 2020, and back in 2015 that single test had come back positive…not only was there not a second positive test, but my doc has asked me several times whether I even wanted to take losartan anymore. He made note a few times that i have not had protein since that one time…and that “i don’t have kidney damage from diabetes”

What i’d like to know is, did I really even start to show kidney problems or was it a false positive??? Am I a person who reverted back to normoalbuminuria or did I never have it in the first place?

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What was/is your eGFR? What were your other kidney markers, then and since? For that matter what’s the latest urinalysis showing regarding protein? It’s so easy to do a test for that. Check kidney foundation health drives in your area if you can’t do it on your own or your doc won’t do it for you. They can do urine tests on the spot.

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My endo never had me get this tested. I’ve never been to a specialist, and he never said that number to me. Perhaps because I only had one positive test or he was not concerned?

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How weird, and how strange. I cannot imagine why the person in charge of managing your diabetes (or helping you to do so) would not want to know your kidney function. Kidneys, feet, eyes, heart too at times - these are the standard monitoring sites. Sigh. Maybe I’m missing something. Are you by chance extremely young?

Regardless, even people with diabetes who are only 30 years old get all the standard tests, including eGFR, which stands for estimated Glomerular Filtration Rate and is the best study to determine kidney function, obtained from calculations of the patient’s age, gender, race, and serum creatinine level. (There are some medical professionals (and non professionals) who disagree with having a separate category for African Americans, by the way.) Another blood test besides creatinine is “BUN,” blood urea nitrogen, and like creatinine is a nitrogenous waste product, sent to the kidneys for excretion. BUN can be re-absorbed, but creatinine cannot which is why it is a lower number when measured. BUN is the concentration of urea in the blood and is directly related to metabolic function of the liver and excretory function of the kidneys.

Then there are the urine tests, which is what you originally posted about (protein in the urine). If you are struggling to get a doctor to do another urinalysis or kidney function tests (blood), I recommend ordering urinalysis test strips and doing the test on your own - just make sure the strips are not expired. Unlike a lot of medications, urine test strips really do degrade rapidly after they’re expired. And again, you can try to find a kidney foundation screening in your area for a free ACR – albumin to creatinine ratio, which is a urine test that estimates the amount of protein (albumin) in urine in a day. Creatinine is a waste product of protein breakdown, primarily body muscle mass. Albumin is a protein that is present in high concentrations in the blood. Virtually no albumin is present in the urine when the kidneys are functioning properly. However, albumin may be detected in the urine even in the early stages of kidney disease. Most of the time, both albumin and creatinine are measured in a random urine sample and an albumin/creatinine ratio (ACR) is calculated. This may be done to more accurately determine how much albumin is escaping from the kidneys into the urine.

This is more information than you wanted, probably, but I must say it’s curious that a doctor has not insisted on having kidney function tests. Everyone, not just those with diabetes, should have one! Is it possible, he/she has done it, but you don’t know or never saw the results?

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That is probably correct. He did not share the results in great detail.

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You could ask for a copy of your blood test. There would be liver and kidney function testing and sites that will explain it.

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He says there has been nothing in my urine since that one time, and it has been nearly 5 years. I just want to know if I should consider myself a person who has reverted or has never had clinical microalbuminuria.

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A single positive test isn’t a diagnosis. Even a mild UTI with throw protein.

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My primary care asked to bring down my losartan because my blood pressure was so low. I told him my endo put me on them after i spilled a bit in one test, but not in the next test.

I asked him why my endo has me on them at all if there was no albumin after one (maybe false?) positive. I said as a preventative? He said it wouldn’t be preventative if it was positive…SMH!!!

So my endo says “you do not have kidney damage from diabetes”

Has asked me twice if I want to be on the blood pressure meds at all

And here I am wondering if i’m a kidney disease prone diabetic or not. I know the numbers are highly in my favor, as the vast majority of diabetics with kidney disease also have retinopathy, which I never had…also my numbers have always been in the 6’s to mid 7’s, which is typically low risk for kidney…ahhhh the stress!