Q: I am a 45 years old male, suffering from diabetes for the last 15 years. I am taking insulin - mixtard 30 (40 units in morning and 34 unites in the evening). During the last two and a half years, my microalbumin (second urine of morning) has gradually increased from 28 to 1140 (28, 108, 86, 140, 444, 240, 1140). The normal range is up to 30 only. My glycosylated haemoglobin HbA1c is 7.8 per cent and blood pressure is 144/86 mmHg. Are my kidneys at a risk of getting damaged?

A:I presume that you have Type 2 DM. Due to long duration of disease and uncontrolled glucose levels you are having diabetic nephropathy. To prevent progression of disease the targets are fasting blood glucose (FBG) 90-130, PP <180, HbA1C <7, BP <130/80 mmHg. Controlling blood glucose is of utmost importance. I suggest you to take Metformin 500 mg twice daily for 15 days and then 1 gm twice daily, go for strict diet control and exercise. Also get USG for kidneys and fundus examination from eye specialist. ACE inhibitors or ARBs are essential for your blood pressure control. It will be nice if you can pass on the list of all the medications to me for further advice. You need to reduce your weight as well.