Q: I am a 63 years old male suffering from diabetes for the past 20 years. I am taking these medicines - human mixtard insulin 30, 30 and 25, Zilos (25 mg) for blood pressure, Rivotrillo (0.5 mg) for heel pain, Glimulin (20 mg) and Recarb (25 mg). Yesterday I underwent urinary microalbuminuria test, which showed microalbumin >200 mg/L, 12 hours night collection - 1.12 to 7.08 and 24 hours collection - 2.6 to 16.6. I consulted a doctor who told me that this is beginning / early stage of microalbumin, which can be cured. He advised me to reduce dal in diet. I underwent proteinuria test at my doctor's lab about one year back and the test report was 46 mg as against the normal value of 30 mg. Simultaneously, I had tested my urine at another lab, in which the report showed as 36 mg as against 30 mg. My blood glucose level is within limits. I have no blood pressure and no cholesterol problem. Now the microalbumin has increased very abnormally and I am unable to find out the reason for the same. How can microalbumin in my urine be reduced?

A:Micoalbuminuria is early sign of kidney involvement and all patients with this condition do not go into kidney failure. Two other tests which will be useful are retina eye examination and USG for kidneys. Albuminuria may be present if urine sample is given after exercise or in presence of infection. Treatment of this condition includes tight control of blood glucose, BP <130/80, low protein diet and medications such as ARBs or ACE inhibitors. Zilos 25 is too small a dose. Increase it to 50 per day and if BP still not controlled then you can further increase it in consultation with physician / endocrinologist. Glimulin may not be useful at this stage and with already good dose of insulin.