Re: I just got back from the dr, questions and info needed

[Guest guest]

, don't give up the good fight...you've been an inspiration to many

here and you've come such a long way. We're all bound to have setbacks now

and then but that doesn't mean you should give up and indulge permanently. A

binge now and then...a short one...okay. If you can stop after a one-day

binge I'd say go for it...except for some, it's hard to get back on the

wagon.

There are no guarantees. We all try to keep our BGs down in the hopes that

this will keep the bad stuff at bay. We can only keep trying. Remember,

there is no data on well-controlled diabetics, we're in the avant garde here.

We want to prove that it can be done.

Oh, and BTW, I also take Prinivil. I think it's recommended for all diabetics

since we're at increased risk for heart disease and the " i-l " drugs are well

known to help decrease that risk. So it's well worth the expense. Take

care. Vicki

[Guest guest]

, I think alot of us take an ace inhibitor as a matter of course to

protect our kidneys. I take Prinivil and have never had a problem with it.

Other than the $$ I don't see any problem with it at all. You could look it

up at www.rxlist.com and see what they say.

Fbg's of a 140 would worry me, but the rest of your numbers sound ok. You're

aware that you would benefit greatly with more weight loss, and that should

help with your kidneys as well. It could be the extra weight, along with

the diabetes, that's causing the problem. It sounds like you've just had a

lot of stuff thrown at you all at once. If you can take the ace inhibitor,

do it - even if it's for a while, it'll help. I do agree with your doc on

this, and she's right that the endo would put you on it immediately anyway.

I do know the archives have a lot of good discussion on ace inhibitors.

Take some deep breaths and try to relax. The ace inhibitor is not a big

deal. Sorry we can't help with your doctor situation. Maybe the endo is

the way to go...

Barb

> my protein creatine ratio has been fine, but now in oct, and a repeat last

> week is elevated 56 in oct, 44 now. dr wants it under 30 i believe it was

10

> in Nov 2000.

>

> They want to put me on enapapril (sp) an ace inhibitor....

[Guest guest]

, I think alot of us take an ace inhibitor as a matter of course to

protect our kidneys. I take Prinivil and have never had a problem with it.

Other than the $$ I don't see any problem with it at all. You could look it

up at www.rxlist.com and see what they say.

Fbg's of a 140 would worry me, but the rest of your numbers sound ok. You're

aware that you would benefit greatly with more weight loss, and that should

help with your kidneys as well. It could be the extra weight, along with

the diabetes, that's causing the problem. It sounds like you've just had a

lot of stuff thrown at you all at once. If you can take the ace inhibitor,

do it - even if it's for a while, it'll help. I do agree with your doc on

this, and she's right that the endo would put you on it immediately anyway.

I do know the archives have a lot of good discussion on ace inhibitors.

Take some deep breaths and try to relax. The ace inhibitor is not a big

deal. Sorry we can't help with your doctor situation. Maybe the endo is

the way to go...

Barb

> my protein creatine ratio has been fine, but now in oct, and a repeat last

> week is elevated 56 in oct, 44 now. dr wants it under 30 i believe it was

10

> in Nov 2000.

>

> They want to put me on enapapril (sp) an ace inhibitor....

[Guest guest]

> my protein creatine ratio has been

> fine, but now in oct, and a repeat last

> week is elevated 56 in oct, 44 now.

> dr wants it under 30 i believe it was 10

> in Nov 2000. They want to put me on enapapril

> (sp) an ace inhibitor....

If that is microalbuminuria then 20mg/l is the limit for a negative

result, I believe. Getting it under 30 sounds like a good idea. I was

put on Atacand Plus which is 16mg candesartancilexetil plus 12.5mg

hydrochlorothiazid when mine went up to 46mg/l so that sounds about

right. Don't forget that microalbuminuria is still reversible with

medication while it is below 300mg/l so you have quite some way to go

yet, cheer up!

> My b/p runs 106/60

So the ACE inhibitor is for the kidneys, not the blood pressure.

> So i don't agree with the scale. I'm upset ...

Yeah, , I know THAT feeling!

> ... she's telling me that the elevated

> protein-creatine ratio in my urine, is

> due to my kidneys being damaged by the

> diabetes....

Yes, that's what happens. Microalbuminuria is the earliest possible

indication of a diabetic nephropathy. I understand that the state of

the kidneys is an indicator of long-term average blood glucose, just

like the retina (like the HbA1c but over years instead of months).

Have you had an eye examination recently? Twice a year is usually

recommended here.

> I thought if i was doing good with my

> bs readings, and HBA1C's, that i'd not

> get problems with my kidneys, and or

> other complications...

My opthalmologist tells me that it takes at least 5 years of elevated

blood glucose for the first eye damage to appear. The kidneys are

much the same so your recent BG readings are probably not so relevant

as your BG level a few years ago.

> I can't stop crying, .... all i want

> to do is eat foods that are not ok,

Try thinking positive, . Just consider how many people there

are around who are in a much worse state than you and don't even know

it. Many diabetics don't even get diagnosed until they are being

considered for dialysis.

> i can't afford to purchase the

> medication on a regular basis,

It is a good investment.

> ... she gave me a hard time when

> i said i wanted them to do a 24 hr

> urine to test for the same thing,

> and also to do a repeat urine test,

> even though i have a urinary tract

> infection, which can cause elevation

> in this.

I have had that problem, too, , but it seems that 24-hr urine

tests have gone out of fashion, except maybe in hospitals. When my

physician got high microprotein readings at the first try last year I

had climbed six floors by the stairs to get to his office before I

gave the sample and that (or any other exertion) can give a false

positive result, I found out later.

I, too, wanted him to do a 24-hour test but he said that they are not

done these days (they don't trust outpatients to make a 100%

collection). But he did make a microalbuminuria re-test later when I

came up in the elevator and he got a much better result. The best

results are obtained with the first morning urine so you should take

the sample at home after you wake up and not some time later during

the day.

By the way, you can buy urine test strips for microalbuminuria and

test yourself semi-quantitively if you want to.

I found that my results matched his when the sample was taken without

previous exertion. You should also eat very little protein in the

week before the test. If you had been eating high protein, high fat,

low carbohydrate meals before the test then that might have

contributed to a false positive result. Menstruation can also be a

factor and so can a high intake of fluids.

These precautions are described in the package insert that comes with

the test strips. Even then you should make three tests on different

days over a period of a few weeks and take the best two out of the

three.

> She's a good dr, and said that if

> i went to the endo at Albany Med,

> i'd automatically be put on an ACE

> inhibitor, and that i should just

> go ahead and take this.

It appears to be usual in Germany to put diabetics on an ACE

inhibitor to protect their kidneys. It seems to be a standard

precaution.

> ... info on why i'm having complications

> if i'm in good control.... and if i'm

> having complications anyway why should i

> bother to eat right?

In my opinion, as I said above, any complications you might be seeing

now could be the result of your BG levels a few years ago. You will

get the benefit of your present good control in a few year's time.

Anyway the aim is to postpone the onset and limit the effect of

complications, isn't it? I believe that the only way not to have any

complications at all is to die young.

I have seen reports over here of diabetics over 90 years old, 40

years on insulin, who have had every diabetes complication known to

medical science and who are still looking forward to next Christmas!

> And yeah i know i need to not get

> upset and stressed out about all of

> this....

Let it all come out, . If you choke it back it might show up

somewhere else, like an inflammation of the bowels (that's what

happens to me)! The positive approach is to make a list of all the

things that you should or could be doing and see where you could take

some action.

Cheer up!

[Guest guest]

> my protein creatine ratio has been

> fine, but now in oct, and a repeat last

> week is elevated 56 in oct, 44 now.

> dr wants it under 30 i believe it was 10

> in Nov 2000. They want to put me on enapapril

> (sp) an ace inhibitor....

If that is microalbuminuria then 20mg/l is the limit for a negative

result, I believe. Getting it under 30 sounds like a good idea. I was

put on Atacand Plus which is 16mg candesartancilexetil plus 12.5mg

hydrochlorothiazid when mine went up to 46mg/l so that sounds about

right. Don't forget that microalbuminuria is still reversible with

medication while it is below 300mg/l so you have quite some way to go

yet, cheer up!

> My b/p runs 106/60

So the ACE inhibitor is for the kidneys, not the blood pressure.

> So i don't agree with the scale. I'm upset ...

Yeah, , I know THAT feeling!

> ... she's telling me that the elevated

> protein-creatine ratio in my urine, is

> due to my kidneys being damaged by the

> diabetes....

Yes, that's what happens. Microalbuminuria is the earliest possible

indication of a diabetic nephropathy. I understand that the state of

the kidneys is an indicator of long-term average blood glucose, just

like the retina (like the HbA1c but over years instead of months).

Have you had an eye examination recently? Twice a year is usually

recommended here.

> I thought if i was doing good with my

> bs readings, and HBA1C's, that i'd not

> get problems with my kidneys, and or

> other complications...

My opthalmologist tells me that it takes at least 5 years of elevated

blood glucose for the first eye damage to appear. The kidneys are

much the same so your recent BG readings are probably not so relevant

as your BG level a few years ago.

> I can't stop crying, .... all i want

> to do is eat foods that are not ok,

Try thinking positive, . Just consider how many people there

are around who are in a much worse state than you and don't even know

it. Many diabetics don't even get diagnosed until they are being

considered for dialysis.

> i can't afford to purchase the

> medication on a regular basis,

It is a good investment.

> ... she gave me a hard time when

> i said i wanted them to do a 24 hr

> urine to test for the same thing,

> and also to do a repeat urine test,

> even though i have a urinary tract

> infection, which can cause elevation

> in this.

I have had that problem, too, , but it seems that 24-hr urine

tests have gone out of fashion, except maybe in hospitals. When my

physician got high microprotein readings at the first try last year I

had climbed six floors by the stairs to get to his office before I

gave the sample and that (or any other exertion) can give a false

positive result, I found out later.

I, too, wanted him to do a 24-hour test but he said that they are not

done these days (they don't trust outpatients to make a 100%

collection). But he did make a microalbuminuria re-test later when I

came up in the elevator and he got a much better result. The best

results are obtained with the first morning urine so you should take

the sample at home after you wake up and not some time later during

the day.

By the way, you can buy urine test strips for microalbuminuria and

test yourself semi-quantitively if you want to.

I found that my results matched his when the sample was taken without

previous exertion. You should also eat very little protein in the

week before the test. If you had been eating high protein, high fat,

low carbohydrate meals before the test then that might have

contributed to a false positive result. Menstruation can also be a

factor and so can a high intake of fluids.

These precautions are described in the package insert that comes with

the test strips. Even then you should make three tests on different

days over a period of a few weeks and take the best two out of the

three.

> She's a good dr, and said that if

> i went to the endo at Albany Med,

> i'd automatically be put on an ACE

> inhibitor, and that i should just

> go ahead and take this.

It appears to be usual in Germany to put diabetics on an ACE

inhibitor to protect their kidneys. It seems to be a standard

precaution.

> ... info on why i'm having complications

> if i'm in good control.... and if i'm

> having complications anyway why should i

> bother to eat right?

In my opinion, as I said above, any complications you might be seeing

now could be the result of your BG levels a few years ago. You will

get the benefit of your present good control in a few year's time.

Anyway the aim is to postpone the onset and limit the effect of

complications, isn't it? I believe that the only way not to have any

complications at all is to die young.

I have seen reports over here of diabetics over 90 years old, 40

years on insulin, who have had every diabetes complication known to

medical science and who are still looking forward to next Christmas!

> And yeah i know i need to not get

> upset and stressed out about all of

> this....

Let it all come out, . If you choke it back it might show up

somewhere else, like an inflammation of the bowels (that's what

happens to me)! The positive approach is to make a list of all the

things that you should or could be doing and see where you could take

some action.

Cheer up!

[Guest guest]

Hi ,

First, take a deep breath and look at the total picture. You have been

taking great care of yourself. You said you had a UTI....take care of that.

Retesting may not help until that is gone. Most Drs do recommend ACE

Inhibitors or similar drugs for kidney protection. Since my BP runs normal,

except before physicals, I take a small dose (5 mg) of lotensin. The drug

price is similar for all strengths so my Dr prescibes 17 - 10 mg pills/month,

which is all my insurance will cover at once. I cut them in half with my

trusty pill-guillotine and cut my cost in half.

Layered on top of this is the stress of your medical center closing. There

isn't much you can do about this, except start researching options and

finding out about various other Drs. I'm sure you will be given some choices

and having info about other Drs in advance can make the transition easier.

OK.....now that you took a nutritional vacation for a day, ask yourself how

you feel? Probably not any better, so why not start fresh today with

something healthy that you really like. Take a walk, unless ice is all over

the place. Do something nice for yourself...visit a friend, etc, get a great

library book.

Carol T...trying to make today a good day also.

> I can't stop crying, (and although i cry easily over sappy movies etc, i

> don't get upset like this normally over medical problems) all i want to do

> is

> eat foods that are not ok, i can't afford to purchase the medication on a

> regular basis, she gave me a hard time when i said i wanted them to do a 24

>

> hr urine to test for the same thing, and also to do a repeat urine test,

> even

> though i have a urinary tract infection, which can cause elevation in this.

>

>

> She's a good dr, and said that if i went to the endo at Albany Med, i'd

> automatically be put on an ACE inhibitor, and that i should just go ahead

> and

> take this.

>

> To top it all off, we just found out today, that Albany Medical Center is

> closing the family practise offices, the residents have no residency

> program

> now, etc. We have no idea where we as patients will be going, come june.

>

>

> And yeah i know i need to not get upset and stressed out about all fo

> this....

>

[Guest guest]

Hi ,

First, take a deep breath and look at the total picture. You have been

taking great care of yourself. You said you had a UTI....take care of that.

Retesting may not help until that is gone. Most Drs do recommend ACE

Inhibitors or similar drugs for kidney protection. Since my BP runs normal,

except before physicals, I take a small dose (5 mg) of lotensin. The drug

price is similar for all strengths so my Dr prescibes 17 - 10 mg pills/month,

which is all my insurance will cover at once. I cut them in half with my

trusty pill-guillotine and cut my cost in half.

Layered on top of this is the stress of your medical center closing. There

isn't much you can do about this, except start researching options and

finding out about various other Drs. I'm sure you will be given some choices

and having info about other Drs in advance can make the transition easier.

OK.....now that you took a nutritional vacation for a day, ask yourself how

you feel? Probably not any better, so why not start fresh today with

something healthy that you really like. Take a walk, unless ice is all over

the place. Do something nice for yourself...visit a friend, etc, get a great

library book.

Carol T...trying to make today a good day also.

> I can't stop crying, (and although i cry easily over sappy movies etc, i

> don't get upset like this normally over medical problems) all i want to do

> is

> eat foods that are not ok, i can't afford to purchase the medication on a

> regular basis, she gave me a hard time when i said i wanted them to do a 24

>

> hr urine to test for the same thing, and also to do a repeat urine test,

> even

> though i have a urinary tract infection, which can cause elevation in this.

>

>

> She's a good dr, and said that if i went to the endo at Albany Med, i'd

> automatically be put on an ACE inhibitor, and that i should just go ahead

> and

> take this.

>

> To top it all off, we just found out today, that Albany Medical Center is

> closing the family practise offices, the residents have no residency

> program

> now, etc. We have no idea where we as patients will be going, come june.

>

>

> And yeah i know i need to not get upset and stressed out about all fo

> this....

>

[Guest guest]

Hi ,

First, take a deep breath and look at the total picture. You have been

taking great care of yourself. You said you had a UTI....take care of that.

Retesting may not help until that is gone. Most Drs do recommend ACE

Inhibitors or similar drugs for kidney protection. Since my BP runs normal,

except before physicals, I take a small dose (5 mg) of lotensin. The drug

price is similar for all strengths so my Dr prescibes 17 - 10 mg pills/month,

which is all my insurance will cover at once. I cut them in half with my

trusty pill-guillotine and cut my cost in half.

Layered on top of this is the stress of your medical center closing. There

isn't much you can do about this, except start researching options and

finding out about various other Drs. I'm sure you will be given some choices

and having info about other Drs in advance can make the transition easier.

OK.....now that you took a nutritional vacation for a day, ask yourself how

you feel? Probably not any better, so why not start fresh today with

something healthy that you really like. Take a walk, unless ice is all over

the place. Do something nice for yourself...visit a friend, etc, get a great

library book.

Carol T...trying to make today a good day also.

> I can't stop crying, (and although i cry easily over sappy movies etc, i

> don't get upset like this normally over medical problems) all i want to do

> is

> eat foods that are not ok, i can't afford to purchase the medication on a

> regular basis, she gave me a hard time when i said i wanted them to do a 24

>

> hr urine to test for the same thing, and also to do a repeat urine test,

> even

> though i have a urinary tract infection, which can cause elevation in this.

>

>

> She's a good dr, and said that if i went to the endo at Albany Med, i'd

> automatically be put on an ACE inhibitor, and that i should just go ahead

> and

> take this.

>

> To top it all off, we just found out today, that Albany Medical Center is

> closing the family practise offices, the residents have no residency

> program

> now, etc. We have no idea where we as patients will be going, come june.

>

>

> And yeah i know i need to not get upset and stressed out about all fo

> this....

>

[Guest guest]

> I'm going to check more into this urine test, and try doing it in the am,

> after my urinary track infection is cleared up.

**, couldn't any test having to do with urine be screwed up if you

have a urinary tract infection? Personally, I think the 24 hour one after

your infection clears up, is definitely the way to go.

Barb