Hoping for insight into lab results

Healthy Living Physical Activity
1

Hi,

I'm 45 yo, have had T1 diabetes for almost 25 years, and I've been working out consistently for the last 9 months. I do 4-5 days a week of moderate to heavy weightlifting and and moderate cardio. I was an intercollegiate track sprinter and have always been active despite the fact that my diabetes control had gone to crap for several years until last Sept when I discovered that I had mild retinopathy in my left eye, motivating me to get my a1c back down under the 8-9 range (after many years in the 4-7 range) .

4 months ago, my new endo discovered that I was spilling microalbumin with an ACR of 113 (Al 4.5 mg/dl, Cr 39.8 mg/dl). My serum Cr was 1.1 mg/dl and my estimated Cr clearance was 73. My endo told me not to be concerned because I was working out consistently, had a high muscle mass, and an a1c of 6.2. He told me to be sure to take a break from the gym for a few days before the next test. I followed his instructions but the lab results last month came back with an ACR of 294 (Al 17.66 mg/dl, Cr 60 mg/dl). My Serum Cr decreased to 1.0 mg/dl and my a1c actually dropped to 6.0. My estimated Cr clearance was still in the stage 2 CKD range though. My endo put me on Lisinopril and tried to reassure me.

After a few sleepless nights, I called my endo to see if he'd run a 24 hour urine to clarify some of the results. He's out of town til the end of the month so I made an appointment with my urologist instead. My urologist ran the 24 hour urine but since he's not well versed in diabetic issues, he only ran total protein and not albumin. The results came back with 96 mg/24 hours of total protein, urine creatinine 1968 mg/24hours (2.4l of urine), serum Cr 1.0 mg/dl, serum albumin 4.4 mg/dl, and a Cr clearance of 123. I had been on Lisinopril for 12 days when the 24 hour urine was done.

My urologist gave my kidneys a clean bill of health but I'm still concerned about spilling abnormal amounts of albumin.

My other comp met panel numbers are all normal, Ca is on the low side at 8.9 mg/dl. My lipid panel is good, 131 total chol, 53 HDL 68 LDL, 31 trigyl.

I'm completely confused and more than a bit anxious at this point.

Any insight or experience at all with lab results for T1s who work out consistently would be greatly appreciated.

Thanks,

Fred

2

can you email or have yoru docs service contact him?

3

Now I don’t know exactly what your workout routine is, but you have to realize that exercise and weightlifting in particular can cause you to dump protein in your urine. I am a T2, but I dump protein if I don’t lay off the workouts before urine tests. I give it 48 hours. I am 50 years old and typically do back squats with 1.5xBW and deadlift 2xBW. It is easy to understand how the exertion of weight lifting can cause spiking of internal pressures and even blood pressures leading to things like protein in your urine. I’ve never been able to find any information that suggests that weightlifting is bad or that benign transient proteinuria is a concern.

In the future, try laying off “ALL” workouts for 48 hours before tests and see if that totally eliminates the protein in your urine.

Hope that helps.

4

His service said I can see him as soon as gets back. I have some new labs to assess the effects of the Lisinopril to go over with him.

5

Yeah, I’ve been all over the internet and forums gathering info. My endo explained the effects of exercise on all my labs as well, which was why he wasn’t worried after the first set of labs came back. What I haven’t been able to find out is the magnitude of proteinuria a pre-lab workout can have. Everything just says, “you’ll spill more after exercisiing.” Albuminuria is reported in so many different units depending on the type of test that I have no idea if an ACR of 113 or 294 in a spot urine test can be caused by exercise. The amount of albumin I spilled went from 4.5 mg/dl to 17.66 mg/dl after 3 months, which has me and my endo concerned. I was clearing a low amount of creatinine for those tests as well, which had me concerned about my GFR. My 24 hour urine test, though incomplete, were encouraging, but again, I have nothing to compare the numbers to.

I was just hoping some athletic types out there had more insight on what numbers to expect based on any tests they might have had themselves.