Q: I am 20 years old and have been suffering from diabetes for the last 16 years. I am also suffering from high blood pressure for the last four years. I have maintained my HbA1c in the range 6.0-7.0, but I have started smoking frequently since the last three years. My current reports are as follows: HbA1c - 6.43%; average blood glucose - 128.12 mg/dl; creatinine - 0.78 mg% (normal is 0.7-1.5); microalbumin urine - 20.30 mcg/ml (normal range given was less than 18 mcg/ml); creatinine urine - 158.42 mg/dl; albumin/creatinine ratio - 12.81 mcg/mg of creatinine; T3 - 208 ng/dl (normal is 60-200); T4 - 11 mcg/dl (normal is 4.5-12); TSH < 0.01 (normal is 0.3-5.5); total cholesterol - 140 mg%; triglycerides - 82 mg%; and HDL/LDL - 2.50. I am having Enam 5 mg twice a day and Asomex 2.5 mg once a day (20 days back I was taking Asomex 1.25 mg, but then my doctor advised me to change it to 2.5 mg). Is my microalbumin high? Am I running a risk of kidney damage? If so, what measures should I take to reverse the damage? Also, are my T3 and T4 reports normal? I am having a normal diabetic diet with less amount of salt and also less intake of fruits and salads. But recently I ate a lot of outside food.

A:Diabetes can damage the normal function of the kidneys. A urine test which measures the amount of albumin in the urine can indicate if diabetes is affecting the kidneys filtering action. Microscopic amounts of albumin in the urine (microalbuminuria) indicate diabetes-related kidney complications (also called nephropathy). The amount of albumin in the urine can also help the provider determine if nephropathy is worsening. It gives a hint of damage and as long as blood pressure control is done (less than 120/70 ), and medication may be recommended if albuminuria does not improve. A blood pressure medication an ACE inhibitor(in your case Enam) or angiotensin receptor blocker (ARB) is generally strongly recommended for patients with albuminuria that does not improve, even if blood pressure is normal. These medications slow down the amount of protein in the urine and can prevent or slow the progression of diabetes-related kidney disease. I would maximise the Enam (enalapril) to at least 20 mg to show maximum benefit or Telmasartan 40 mg to be doubled to 80 mg in four weeks. Your creatinine and potassium should also be monitored. You should not limit fruits and salads, as these are very important for your overall health. You should get your TSH and free T4 and T3 repeated again, as this is abnormal and needs to be discussed with an Endocrinologist.