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Re: [IP] ACE Inhibitors

        My daughter is almost 20, & has been on ACE inhibitors for 5 1/2 yrs. 
Her blood pressure was 90/60 before the meds, & has remained in that range, 
despite taking 10 mgs of Vasotec daily. She has had no side effects, not even 
the infamous "tickle in the throat cough".The ACE inhibitor was begun because 
Melissa was "shedding" MASSIVE amounts of protein within a few years of 
diagnosis. A cardiologist friend & a nephrologist acquaintance both felt ALL 
diabetics should be on ACE inhibitors, but her ped endo was extremely 
conservative. The same Children's Hospital that did nothing when her 24 hr 
urine showed 300 mgs & then 500 mgs of protein back in 1995, now routinely 
puts adolescents on ACE inhibitors as soon as they pass 30 mgs ( 30-300 mgs = 
    Because her case was so aberrant, she also underwent a kidney biopsy in 
November 1997, which fortunately showed nothing amiss in the kidney. The 
"explanation" offered to me by a renowned researcher from Australia, Dr. Marc 
Cooper,  was an unscientific retort that Melissa has "leaky kidneys". Bottom 
line: the diabetes was exacerbating a benign condition ( orthostatic 
proteinuria) that can appear in adolescents & then resolve. The Vasotec 
reduced the amount of protein ( which went as high as 2600 mgs at its 
worst!!) by 95%. Her pediatric nephrologist was delighted, but not surprised. 
My friends across the USA whose children see very proactive ped endos tell me 
that their children are screened annually. I know Michael has posted that 24 
hr urine tests are antiquated, but in Melissa's case, a first morning 
collection was inexplicably NORMAL, whereas the full 24 hr collection was 
horribly ABNORMAL(and she did 6 of them that summer).....so much so that I 
spent 8 hours straight on-line researching kidney problems & had my then 14 
yr old mentally "prepped & on the O.R. table" in my distraught state of mind!
    Dr. Cooper told me that in Australia, where they are more aggressive 
about prescribing ACE inhibitors, they have already seen a dramatic decline 
in diabetic nephropathy diagnoses, & that he predicts that these medications 
will change the course of diabetic complications in the future.
   Since that time, I have seen many published reports attesting to 
comparably positive results, not only in the kidney but also in other 
vascular areas, like the heart & quite likely, the eyes. I also asked a 
Boston retinopathy specialist how she felt about its impact on the eyes & she 
explained that although there were no studies yet to confirm it, common sense 
dictated that it should have an equally protective impact there too. 
   That said, here's the conundrum: if only 40% of diabetics will face kidney 
problems, is it ethical to prescribe a medication to EVERYONE, knowing that 
60% don't NEED it??? Melissa's doctor's view is that EVERYONE should be 
screened annually, so that at the first indication of a rise in protein, 
intervention can be started in those who would benefit.
     Nonetheless, since this is relatively NEW, especially for younger 
diabetics who were thought to be "protected" from any damage all throughout 
their teens, many doctors aren't "up to speed"- analagous to all the IPers 
who have had to fight to get their endos to prescribe pump therapy. Melissa 
STILL has to explain to every specialist she sees - from her gynecologist to 
a gastroenterologist - why she's on Vasotec if she doesn't have high blood 
    But then again, the gynecologist also asked Melissa when she was dx'd 
(age 9) & how long she's had to take insulin. Melissa almost blurted out "DUH 
- aren't they one & the same???", but didn't!
     So I guess my advice would be to find out WHY your endo is so opposed to 
you taking an ACE inhibitor. Have you been screened recently for proteinuria 
or microalbuminuria?? Unless someone invents a genetic decoder ring that 
"lights up" in those people genetically predisposed to get or not get 
complications from diabetes in the future, I believe it behooves all of us to 
be as educated, as proactive & as empowered as possible to optimize the 
health of those living with diabetes today.
Renee (Melissa's pump mom/advocate)
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