August 3, 2016
Five Important Tests if You Have Diabetes
Tests of several different types are important if you have diabetes because diabetes does not just affect a person's blood glucose levels. Diabetes can affect your heart, kidneys, eyes, and even your feet. It is therefore important to manage your diabetes and the following routine tests are important to tell your diabetes healthcare team how you are doing.
The A1C Test
The hemoglobin A1C test or A1C test is the test for measuring your overall blood glucose management over the prior three months. The A1C test can be done on a sample of blood collected from a finger stick, or from a small vial of blood drawn from the arm. Most doctors and diabetes clinics recommend that this test be done every three or six months. Your goal that you want to meet should be better than what most doctors want as most doctors and diabetes clinics just want you to be below 7 percent. The better doctors and clinics will prefer that your A1C be below 6.5%. The reason for this is the development of complications happens at a much slower rate than 7 percent. The reason for the 7 percent is these doctors are very afraid of hypoglycemia and want this kept to the very minimum. You doctor can suggest an A1C goal or target for you, but should never set your A1C goal.
People with diabetes are at a higher risk of developing foot problems due to decreased circulation and lack of feeling in the foot from high glucose levels. A common foot complication is diabetic neuropathy, which typically occurs when nerves in your feet become damaged, resulting in the inability to feel pain or discomfort from injuries or sores. Diabetes can also cause circulation problems that prevent you from healing as quickly as people without diabetes do.
Most good doctors and diabetes clinics recommend that you have your feet checked at least annually, and preferably at every medical visit, for altered sensation, decreased circulation or infection. During the exam, the doctor will perform a visual inspection and look for skin color changes, cuts, and other damage. The doctor will also take a pulse at key points of the foot to determine circulation levels. There will be a test of sensation, where the doctor uses a tuning fork, pinwheel, or tin gram fiber to evaluate awareness of touch, dull versus sharp pain, and movement of the tool across the skin. Always see a podiatrist if your doctor does not check your feet at least annually.
Diabetic eye disease is painless and often has no symptoms until advanced stages, meaning many people with diabetes can have the disease and not even know it. Diabetic retinopathy is the most common eye disease for people with diabetes and occurs when the small blood vessels in the eye are damaged by high levels of glucose in the blood. Diabetes also puts people at risk for cataracts, glaucoma, and other complications.
The earlier diabetic eye diseases are diagnosed, the more that can be done to halt vision loss. Serious eye damage can prevented if complications are found early, so it is important to get an eye exam annually or as often as the doctor orders, even at every six months or quarterly. The exam can take up to two and a half hours, and includes dilating the pupil to be able to see the back of the eye. The entire exam is painless, but you should be prepared to wear sunglasses after the appointment, as your pupils will become sensitive to light after they are dilated.
Blood Pressure Test
High blood pressure is more common in people with diabetes, and controlling your blood pressure is essential in preventing serious complications such as heart failure, stroke, or eye and kidney disease. Most doctors check your blood pressure at every medical visit. The suggested blood pressure goal is less than 140/90 mmHg for people under the age of 18 and less than 130/80 mmHg for individuals without cardiovascular disease or multiple risk factors. If you already have complications due to diabetes, such as kidney disease, your blood pressure goal may be different. Be sure to ask your healthcare provider what your goal should be.
There are two types of kidney exams that should be performed annually. The first is a special type of urine test that tracks excess protein in the urine, a condition known as microalbuminuria. The normal albumin level in the urine is less than 30 mg. Anything above that is abnormal and reflects an early sign of kidney disease. The second test is a blood test that measures the blood creatinine level. The creatinine is a substance that is always in the blood, but when there is kidney failure, the level of this substance will rise. By checking the glomerular filtration rate (GFR) of your kidneys, your doctor can tell how well your kidneys are filtering your blood. Remember to always ask your doctor what your GFR is.
Word of caution, always ask for these tests when they should be scheduled and if the doctor says not to worry, consider finding a different doctor as your health depends on knowing this information. I also urge all diabetes patients to receive a copy of the lab reports done by any doctor.