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[IP] ACE inhibitors-long

>I have been taking an ACE inhibitor (zestril 2.5 mg
 per day) for the last 18 months >This is obviously a YMWV thing - I know that
most folks with DM do not have low BP and an ACE inhibitor
>is a good thing ...


 The best care you can get is that where you combine knowledge (medical
professionals and your own) with being pro active in your own care. All of the
people on this list fit that category or they wouldn't be here. Knowledge is
always expanding, thank goodness, or we would still be starving children (thanks
for the story link BTW).

 The ADA standards of care include the use on an ACE-I or an ARB (B/P meds) as
first line treatment to prevent the progression of diabetic nephropathy. This
finding has been well documented in several studies. In general, low dose
ACE-I's do not cause a big change in the B/P of a person with normal B/P,
however the deciding factor is going to be what symptoms it causes in each
person...ie: you were dizzy etc. Even then, the risk of your falling down from
orthostatis, is weighed against the benefit of it protecting your kidneys,
keeping you off dialysis, and/or prolonging your life.
It is what all of us do every day...weigh risks vs benefits.

Current thinking on this topic can be gathered at the ADA website, 


 Hit the link...for health professionals...then, clinical practice
recommendations...then, position statements...then diabetic nephropathy.

Diabetes Care 2003 Volume 26, Supplement 1: 94-98
"Diabetic Nephropathy" 


 "In the treatment of both micro- and macroalbuminuria, either ACE inhibitors or
ARBs should be used. (A)
 In patients with type 1 diabetes, with or without hypertension, with any degree
of albuminuria, ACE inhibitors have been shown to delay the progression of
nephropathy. (A) b" In patients with type 2 diabetes, hypertension and
microalbuminuria, ACE inhibitors and ARBs have been shown to delay the
progression to macroalbuminuria. (A) b" In patients with type 2 diabetes,
hypertension, macroalbuminuria, and renal insufficiency (serum creatinine >1.5
mg/dl), ARBs have been shown to delay the progression of nephropathy. (A) b" If
one class is not tolerated, the other should be substituted. (E)"


>I'm glad I'm not seeing previous endo for my DM any
>longer. And, I'm glad that my new endo is on top of
 Please don't be so hard on the guy (or gal). Most likely, they were doing what
they felt was the best treatment.

>Then he looked at my meds list and said "why the H***
>are you taking an ACE inhibitor????

 I truly hoped that was a rhetorical question given the fact your B/P was low.
If he really didn't know why you may have been taking an ACE-I, you should look
for another doctor no matter where he works or what his degree.

 I hope you can all make use of the info that the ADA provides to get the best
possible care for yourselves.

Sorry this was long.

Joann, Mom to Cara
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