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.
Foot Exam
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.
Eye Exam
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.
Kidney Test
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.
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