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Medical Forum / Diseases and Disorders / Diabetes / June 2006

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My labs.  :(

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Julie Bove - 18 Jun 2006 08:54 GMT
Got my labs back today.  I've had bad swelling in my feet and legs for the
past several day and Endo. was concerned about protein in my urine.  And
indeed he found it.  :(  Not entirely sure what it means, although I've
looked it up and it doesn't look good.

Microalbumin 23.0, should be <18.0
Urine Creatinine 64.7 (lab doesn't say what normal is)
Microalb/creat ratio 36, should be <30

Interpretation:
30 - 300 mg/g Increased risk for diabetic nephropathy.
Two of three Microalbumin/Creatinine Ratios in this range indicate
microalbuminuria and diabetic nephropathy.

He also made a notation about my Lisinopril with an arrow pointing up and
some words neither I nor the pharmacist could read for sure.  I took this to
mean that he is increasing the dose.  And he did include a new prescription,
but for the same amount I'm already taking.  *sigh*  I have to wait till
Monday so the pharmacist can call him and straighten this out.

All my other labs came back normal except for the BG.  Random BG was 226 and
A1c was 6.9.  Drat it all!  Was 6.3 three months ago and I was just sure it
would have gone down.  Most of my numbers have been much better than they
were for the three months previously.  It's always something.

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Uncle Enrico - 18 Jun 2006 09:40 GMT
Good thoughts and prayers going out to you Julie.

> Got my labs back today.  I've had bad swelling in my feet and legs for the
> past several day and Endo. was concerned about protein in my urine.  And
[quoted text clipped - 24 lines]
> would have gone down.  Most of my numbers have been much better than they
> were for the three months previously.  It's always something.
Julie Bove - 18 Jun 2006 10:04 GMT
> Good thoughts and prayers going out to you Julie.

Thank you!
W.M.McKee - 18 Jun 2006 11:57 GMT
>He also made a notation about my Lisinopril with an arrow pointing up and
>some words neither I nor the pharmacist could read for sure.  I took this to
[quoted text clipped - 6 lines]
>would have gone down.  Most of my numbers have been much better than they
>were for the three months previously.  It's always something.

Sorry to hear about the frustrating news, Julie... I sincerely hope
you can turn things around this summer.

Will, T2
sonatabv@sbcglobal.net - 18 Jun 2006 13:29 GMT
(((((julie)))))

Love and prayers,

Vickie B.
Julie Bove - 18 Jun 2006 20:48 GMT
> (((((julie)))))
>
> Love and prayers,

Thanks!
Julie Bove - 18 Jun 2006 20:47 GMT
> Sorry to hear about the frustrating news, Julie... I sincerely hope
> you can turn things around this summer.

Thanks!
ray - 18 Jun 2006 15:08 GMT
> Got my labs back today.  I've had bad swelling in my feet and legs for the
> past several day and Endo. was concerned about protein in my urine.  And
[quoted text clipped - 20 lines]
> would have gone down.  Most of my numbers have been much better than they
> were for the three months previously.  It's always something.

I've been on a low carb diet, and had been seeing my A1C decline over the
last year - but the last one was up a bit. I've reminded myself that what
seems to make a significant difference is: zero calories between meals.
The one exception being the possible inclusion of a very dry alcoholic
drink of moderate proportions before bedtime.
Julie Bove - 18 Jun 2006 20:49 GMT
> I've been on a low carb diet, and had been seeing my A1C decline over the
> last year - but the last one was up a bit. I've reminded myself that what
> seems to make a significant difference is: zero calories between meals.
> The one exception being the possible inclusion of a very dry alcoholic
> drink of moderate proportions before bedtime.

I generally don't eat between meals.  And low carb simply does not work for
me.  It really won't work for me now.  I already have fatty liver, so I
can't eat too much fat.  And given this last set of problems, can't eat much
protein.  I also can't drink any alcohol whatever.

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ray - 18 Jun 2006 21:30 GMT
>> I've been on a low carb diet, and had been seeing my A1C decline over the
>> last year - but the last one was up a bit. I've reminded myself that what
[quoted text clipped - 6 lines]
> can't eat too much fat.  And given this last set of problems, can't eat much
> protein.  I also can't drink any alcohol whatever.

Sorry to hear that. I'm fortunate that I don't have dietary problems. My
cholesterol has dropped from 165 to 150 with the low carb diet, and
everything else is good - just battling the BG.
RB - 18 Jun 2006 17:36 GMT
>Got my labs back today.  I've had bad swelling in my feet and legs for the
>past several day and Endo. was concerned about protein in my urine.  And
[quoted text clipped - 20 lines]
>would have gone down.  Most of my numbers have been much better than they
>were for the three months previously.  It's always something.

Julie, as I recall your not using insulin as of now.  Perhaps I am
wrong on that point.

You might give strong consideration of starting a dialog with your
Doctor and discuss the applicability of Byetta in your case.  

I do not use it (don't qualify)and know it is still fairly new but
responders on this group as you have seen give it high marks.

A big step to take, and I know there are other considerations
involved, yet it may be time to talk about it with your MD.

Good luck on getting the numners down.

RB
Julie Bove - 18 Jun 2006 20:53 GMT
> Julie, as I recall your not using insulin as of now.  Perhaps I am
> wrong on that point.

Correct.  I produce waaaay too much insulin.

> You might give strong consideration of starting a dialog with your
> Doctor and discuss the applicability of Byetta in your case.
>
> I do not use it (don't qualify)and know it is still fairly new but
> responders on this group as you have seen give it high marks.

He has mentioned Byetta but does not put his patients on it unless their A1c
is >7.0.  However the more I read about it, the less likely it seems it
would work for me.  It would also not address my most recent concern.  The
protein in the urine.  At least I don't think so.

> A big step to take, and I know there are other considerations
> involved, yet it may be time to talk about it with your MD.
>
> Good luck on getting the numners down.

I am not concerned at this point about getting the BG down.  I AM concerned
with the protein in the urine.  That's a bad thing!   My A1c is still
considered in acceptable range.  I was just annoyed that it wasn't lower
this time around because my numbers had been much better for the most part.

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Leigh Melton - 18 Jun 2006 19:25 GMT
I hope things get straightened out for you pronto, Julie.  Please post
how it goes for you.

Leigh

--
Consequences, shmonsequences, as long as I'm rich.  - D. Duck
Julie Bove - 18 Jun 2006 20:53 GMT
> I hope things get straightened out for you pronto, Julie.  Please post
> how it goes for you.

Thanks!  I'll keep everyone updated.
Michelle - 18 Jun 2006 23:19 GMT
Hi Julie,

So sorry to hear about the abnormal urine tests.  Were these tests done
on 24 hour collection?  Is your doctor going to refer to a kidney
specialist?

I remember you saying that you make lots of insulin, however, I was
thinking about Jenny.  She also makes adequate amounts of insulin and
yet taking insulin has helped her control BG.  Apparently there is
something wrong with the insulin her body makes.  Maybe this is the
case with you as well?

Sending positive thoughts your way.

Michelle T2
diet & exercise

> Got my labs back today.  I've had bad swelling in my feet and legs for the
> past several day and Endo. was concerned about protein in my urine.  And
[quoted text clipped - 24 lines]
> See my webpage:
> http://mysite.verizon.net/juliebove/index.htm
Julie Bove - 19 Jun 2006 00:52 GMT
> Hi Julie,
>
> So sorry to hear about the abnormal urine tests.  Were these tests done
> on 24 hour collection?  Is your doctor going to refer to a kidney
> specialist?

No.  Random test.  He did do a 24 hour urine collection prior but to check
for cortisol.  Not sure if that would have been used to check for protein or
not.  I have heard nothing back from him aside from the scribbled note on
the copy of my labs.  I looked this up and it reaches beyond the kidneys.
This affects the eyes and heart as well.

> I remember you saying that you make lots of insulin, however, I was
> thinking about Jenny.  She also makes adequate amounts of insulin and
> yet taking insulin has helped her control BG.  Apparently there is
> something wrong with the insulin her body makes.  Maybe this is the
> case with you as well?

BG control isn't the issue here.  The A1c was higher than I want, but still
fine.  The Dr. does not feel that insulin would help at this point in time
because hyperinsulima creates a problem in and of itself.  As I said, most
of my numbers were fine.  Yes, I had wacky highs for the past few days,
although yesterday was fine...by me anyway.  Highest number was 136.  I have
had problems at times with bad hypos.  My BG can drop very rapidly and the
cause has not been found.  That "time of the month" occurred today.  So it
may well be the loss of control was hormonal.

> Sending positive thoughts your way.

Thanks!

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Saxology - 20 Jun 2006 18:30 GMT
<snip>
> So sorry to hear about the abnormal urine tests.  Were these tests done
> on 24 hour collection?  Is your doctor going to refer to a kidney
<snip>

<snip>

>> Microalbumin 23.0, should be <18.0
>> Urine Creatinine 64.7 (lab doesn't say what normal is)
>> Microalb/creat ratio 36, should be <30

<snip>

As far as I know, creatinine clearance is done with a 24 hour wee wee test
or serum.  You indicate that yours was done with the urine test.  This test
is hard to interpret because the test results need to be compared to a
corrected range or to a standard range if the results are corrected.  I have
had the same results reported ah "high" and "low" by the same lab, both were
incorrect.  The standard range is 97-137 ml/min.  Your data needs to be
corrected by using your height, weight, and age.  The standard range is
based upon a body surface area of 1.73 square meters.

There are more than one formula used to correct this, all produce similar
results (that I have investigated).  I have made a spreadsheet to aid in the
correction process.  Is your data (64.7) a corrected number?  If not, I
could correct the nukber for you and provide the answer to the best of my
abilities.

My results (on the same sheet of paper from the lab):
   141 High against 97-137 range
   87 Low against the 97-147 range
Actual result is 87 normal against a 81-121 range

On the first result the lab compared uncorrected data (height/weight)
against the standard to report a "high" incorrect result.

On the second result the lab reported a correct value (height/weight)
against the standard range to report an incorrect "low" result.

Subsequently, I corrected for age to determine the range that would go with
the corrected data to report the "normal" result.  I email this to my doctor
and he congratulated me on my efforts.  I have to say that the labs provide
less than stellar performance.

The serum creatinine range is .5 - 1.5 mg/dL on my lab reports.  Remember
that labs do have different ranges based upon the way they conduct tests and
choose to report results.  YMMV.

I haven't had to investigate the protein thing yet.... my next wee wee test
is this week!  2 days of wee wee collection.... personally, I find it hard
to #2 and collect 100% of #1..... maybe I should answer those adds for the
"super pecker pills" and get one that is 2-3 feet long, would make it
easier!
-Sax
Julie Bove - 20 Jun 2006 19:29 GMT
> <snip>
> > So sorry to hear about the abnormal urine tests.  Were these tests done
[quoted text clipped - 49 lines]
> "super pecker pills" and get one that is 2-3 feet long, would make it
> easier!

According to what I read, there is more than one way to do this test.  I am
still waiting for a call from the Dr.  At least this time I got through to
someone who actually spoke to the Dr. and was told he would call me back
shortly.  *crosses fingers*

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Michelle - 20 Jun 2006 19:34 GMT
> <snip>
> > So sorry to hear about the abnormal urine tests.  Were these tests done
[quoted text clipped - 11 lines]
> As far as I know, creatinine clearance is done with a 24 hour wee wee test
> or serum.

Hi Sax,

In an earlier post Julie indicated the tests were done on a random
sample, so the calculations for a 24 hour sample wouldn't be valid.  Oh
and the 24 hour creatinine clearance test requires both urine and
serum.  Some of the doctors I worked with believed a random was
essentially useless--but obviously others feel differently.

Michelle T2
diet & exercise.
Saxology - 21 Jun 2006 00:55 GMT
>> <snip>
>> > So sorry to hear about the abnormal urine tests.  Were these tests done
[quoted text clipped - 23 lines]
> Michelle T2
> diet & exercise.

Well, there is a number, no range, for Creatinine, Urine in the metabolic
panel.  This test requires no urine as far as I am aware.  It might be a
calculated number and that is why there is little weight given to it.  From
what I have experienced, there is a direct blood measurement (serum) and the
24 hour clearence (to test the efficiency of  you kidneys).  I don't know
what the other number means but I get that number from a blood test alone so
I don't think it is a direct measure.

I would call the lab (they won't like it as they only demand money from you
and don't want to talk to you) and get an explanation of the test.  If
requested, they must supply it.  They will give it to the doctor, not you.
So, I tell them to get the money from the doctor, not me as well.  It get
their shorts in a bundle!
-Sax
Michelle - 21 Jun 2006 02:15 GMT
> >> <snip>
> >> > So sorry to hear about the abnormal urine tests.  Were these tests done
[quoted text clipped - 38 lines]
> their shorts in a bundle!
> -Sax

Hi Sax,

I used to be a lab tech (in a hospital lab), and believe me it as
frustrating for the lab techs not to be able to give results to a
patient as it is to the patient.  I felt the same way that you do about
it.  However, we would have been reprimanded or fired for giving those
results--especially if they were abnormal.  The doctors didn't feel we
were qualified to explain the significance of the result we had
produced.  However, I can see that if the result is particularly
ominous.  The doctor really does need to be the one to break it to the
patient if the result indicates leukemia or something along that line.

Michelle T2
diet & exercise
Dennis R. - 21 Jun 2006 20:44 GMT
>>> <snip>
>>>
[quoted text clipped - 32 lines]
> their shorts in a bundle!
> -Sax

Sax: There are actually several different tests with similar sounding
names. Creatinine as expressed in what Julie quoted would normally be
the actual amount of creatinine (waste product produced by the muscles)
in the blood or urine sample. If it was serum (blood) her actual number
is close to or in the low normal range. The creatinine and albumin or
microalbumin ratio is used as a guideline only for an indication of the
efficiency of the kidneys. Another test result commonly looked at is BUN
(blood urea nitrogen), a measurement of the urea (waste normally
excreted by the kidneys) left in the blood.

Creatinine clearance is a much more accurate measurement of kidney
function. It is the one expressed as ml/min to indicate rate of
clearance of creatinine, as opposed to mg/dl (or the equivalent in
metric) to indicate the actual amount of creatinine per unit of blood or
urine. The gold standard for creatinine clearance is a 24 hour urine
sample, making the analysis straight forward. A shorter collection of a
few hours can be used, and then a formula is used to extrapolate the
clearance rate. A different formula is used to extrapolate from a single
urine sample. The latter two are not considered that accurate due
variations in timing in the release of protein ofter meals.

Julie, it is interesting that your microalbumin is elevated, but your
creatinine may not be. Let us know when you get a clarification.

Dennis (Type 2, Kidney Transplant 1995)
Julie Bove - 22 Jun 2006 01:28 GMT
<snip>

> Julie, it is interesting that your microalbumin is elevated, but your
> creatinine may not be. Let us know when you get a clarification.

The only thing the Dr. said was that I had a little protein in my urine and
he upped my ACE a bit.  I did have a really odd high BG reading about three
hours after the test and had swollen feet and legs for about three days
prior .  That's all I know at this point.

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Loretta Eisenberg - 18 Jun 2006 23:44 GMT
I hope this all gets figured out and that by your next test, your
numbers will change for the better.

Everyday is new day of struggle with diabetes and we have to fight.

Loretta

--
In tribute to the United States of America and the State
of Israel, two bastions of strength in a world filled with strife and
terrorism.
Julie Bove - 19 Jun 2006 00:47 GMT
> I hope this all gets figured out and that by your next test, your
> numbers will change for the better.

I hope so too.

> Everyday is new day of struggle with diabetes and we have to fight.

Very true.

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Susan - 19 Jun 2006 01:25 GMT
> Got my labs back today.  I've had bad swelling in my feet and legs for the
> past several day and Endo. was concerned about protein in my urine.  And
[quoted text clipped - 20 lines]
> would have gone down.  Most of my numbers have been much better than they
> were for the three months previously.  It's always something.

Julie, I'm really sorry to hear about your loss of kidney function.

Susan
Julie Bove - 19 Jun 2006 02:04 GMT
> Julie, I'm really sorry to hear about your loss of kidney function.

Thanks!
Mezza Luna - 19 Jun 2006 12:25 GMT
Sorry to hear about your recent lab results Julie. They support your
symptoms of swelling in your legs and feet. Are you avoiding salt and salty
foods? Hope things get better for you , my prayers are with you....Mezzaluna

> Got my labs back today.  I've had bad swelling in my feet and legs for the
> past several day and Endo. was concerned about protein in my urine.  And
[quoted text clipped - 24 lines]
> would have gone down.  Most of my numbers have been much better than they
> were for the three months previously.  It's always something.
Julie Bove - 19 Jun 2006 16:35 GMT
> Sorry to hear about your recent lab results Julie. They support your
> symptoms of swelling in your legs and feet. Are you avoiding salt and salty
> foods? Hope things get better for you , my prayers are with you....Mezzaluna

I don't eat a lot of salty foods.  But I am not by any means avoiding salt.
I don't think that would help in this case.

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Andrew B. Chung, MD/PhD - 19 Jun 2006 12:58 GMT
> Got my labs back today.  I've had bad swelling in my feet and legs for the
> past several day and Endo. was concerned about protein in my urine.  And
[quoted text clipped - 9 lines]
> Two of three Microalbumin/Creatinine Ratios in this range indicate
> microalbuminuria and diabetic nephropathy.

This would not explain the swelling in your feet and legs (anasarca).
Microalbuminuria does point to increased cardiovascular risk however.

> He also made a notation about my Lisinopril with an arrow pointing up and
> some words neither I nor the pharmacist could read for sure.  I took this to
[quoted text clipped - 6 lines]
> would have gone down.  Most of my numbers have been much better than they
> were for the three months previously.  It's always something.

Would suggest you seek a referral to consult with a cardiologist
because it is possible that you have suffered a silent RV infarct
(heart attack) which would explain your recent anasarca.

Prayerfully in Christ's amazing love,

Andrew
http://tinyurl.com/m3gnu
Mr Libido Incognito - 19 Jun 2006 20:17 GMT
Julie Bove wrote on 18 Jun 2006 in alt.support.diabetes

> Got my labs back today.  I've had bad swelling in my feet and legs for
> the past several day and Endo. was concerned about protein in my
[quoted text clipped - 4 lines]
> Urine Creatinine 64.7 (lab doesn't say what normal is)
> Microalb/creat ratio 36, should be <30

> My Microalbumin was up in my last several lab tests as well. So now I'm
on a hypertension pill for it (Altace) 2.5 mg a day...I have to monitor
my BP and watch for hayfever like symptoms among others due to the pills.
Hopefully I can get off the Altace in a 3-6 months or so after the
vessels in my kidneys shrink.

Seems a side effect of the Altace is shrinking the vessels in the
kidneys...reducing the likelyhood of protiens in the urine.

I tried reducing protien in my diet before taking the pill for a 3 month
period...that had some effect in the reduction of proteins, but made me
gain weight which raised my BG as I had added more higher carb veggies  
to my diet. And that made me eat vast quantities of food. So I had to
reluctantly go on the Altace.

Raised BP in a diabetic isn't a good thing and should be watched
carefully.

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Julie Bove - 19 Jun 2006 23:14 GMT
> > My Microalbumin was up in my last several lab tests as well. So now I'm
> on a hypertension pill for it (Altace) 2.5 mg a day...I have to monitor
[quoted text clipped - 13 lines]
> Raised BP in a diabetic isn't a good thing and should be watched
> carefully.

I've had high BP since my 20's.  Been on Lisinopril for years.  BP is
currently fine.  I'm still waiting to hear back from the Dr. as to what he
is doing with my meds.  My fear is that if he increases the dose of the BP
med, my BP will drop too low.  This happened to me before when I was seeing
a different Endo.  He put me on a Beta Blocker as well because I'd developed
a rapid heartbeat from being hyperthyroid.  At times I'd feel faint so I had
to stop that med.

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