Important Tests Needed By People With Diabetes - P4

There are always more tests if you have diabetes. One test that you will receive or should be given every time you visit the doctor is the blood pressure (BP) test. This non-laboratory test is an indicator of your heart activity, health, and potential artery problems.

Blood pressure (also termed hypertension) is measured as systolic (upper) and diastolic (lower) pressures. BP numbers are usually written as 120/80 mmHg (120 systolic over 80 diastolic millimeters of mercury). Systolic means the pressure when the heart beats while pumping blood and diastolic means the pressure when the heart is a rest between heartbeats.

The table below shows normal blood pressure numbers for adults. It also shows which numbers put you at greater risk for health problems.

Categories for Blood Pressure Levels in Adults (measured in millimeters of mercury, or mmHg)

Category	Systolic (top number)		Diastolic (bottom number)
Normal	Less than 120	And	Less than 80
Prehypertension	120–139	Or	80–89
High blood pressure
Stage 1	140–159	Or	90–99
Stage 2	160 or higher	Or	100 or higher

The ranges in the table apply to most adults (aged 18 and older) who do not have short-term serious illnesses.

High blood pressure, is a persistent elevation in blood pressure that taxes the heart and can, over time, cause damage to organs such as the kidneys, brain, eyes, and heart. BP is the amount of force blood exerts on the walls of the arteries and veins. BP depends on the force and rate of the contraction of the heart as it pumps oxygenated blood from the left ventricle (compartment) of the heart into the arteries and the resistance to that flow. The amount of resistance depends on the elasticity and diameter of the blood vessels and how much blood is flowing through them.

Blood pressure is dynamic; it rises and falls depending on a person’s level of activity, time of day, and physical and emotional stresses. In healthy people, it is largely controlled by the autonomic nervous system but is also regulated by hormones, including:

• Angiotensin II — produced by the kidneys, it causes increased resistance in blood vessels.
• Aldosterone — produced by the adrenal glands in response to angiotensin II, it affects the amount of sodium, potassium, and fluids excreted by the kidneys.
• Catecholamines — such as epinephrine, also called adrenaline, produced by the adrenal glands in response to stress and increases heart rate and resistance in blood vessels.

When one or more of the regulating factors is not able to respond appropriately to the demands of the body, then the pressure of the blood may become persistently increased.

With diabetes you should schedule yourself or an annual eye exam. Retinopathy is what the eye doctor should be monitoring. Normally your doctor will advise you to have this done. The purpose is to establish a baseline early to help determine if retinopathy is happening or progressing. Retinopathy is caused by the rupture of small blood vessels in the eye and over time causes dimming of sight and eventually blindness. This is a major reason for managing diabetes and maintaining excellent blood glucose levels. BP levels can also have an effect.

Another exam that needs to happen is a hearing test. This will also develop a baseline for future tests to determine if there is hearing loss happening. Small blood vessels in your inner ear can be damaged by high blood glucose levels and over time will rupture and cause hearing loss. It is important to maintain excellent blood glucose levels and BP readings.

Many people and even doctors forget about establishing a baseline for the thyroid gland by giving a TSH test. People with all types of diabetes may develop thyroid problems. The test is also known as Thyrotropin with the formal name of Thyroid-simulating Hormone. Related tests include T4, T3, Thyroid Panel, Thyroid Antibodies. The reason to have the test is to screen for and help diagnose thyroid disorders - to monitor treatment of hypothyroidism and hyperthyroidism. This test may be given anytime you have blood drawn and some medications can affect the results so it is important that you tell your doctor about all medications and supplements you are taking. For more information see this web site.

A person may develop hyperthyroidism when TSH levels are increased. Symptoms include rapid heart rate, weight loss, nervousness, hand tremors, irritated eyes and difficulty sleeping. If TSH levels decrease, hypothyroidism may develop. Symptoms include weight gain, dry skin, constipation, cold intolerance, and fatigue. Thyroid diseases may alter thyroid hormone levels regardless of the amount of TSH present in the blood.

If you are taking metformin, know that the B12 test is important because metformin does deplete the level of vitamin B12. If you obtain a lot of B12 from the food you are eating, B12 supplements may not be necessary. All persons that have been on metformin for any length of time should ask for the B12 test. Generally once a year is sufficient unless there are problems and then it may be done more often by your doctor.

A high coronary artery calcium (CAC) score is known to be a strong indicator of coronary heart disease. This test is becoming more important in the analysis of heart disease in everyone, but since people with diabetes are even more at risk for heart disease, this could be especially important for people with diabetes. Persons with diabetes are twice as likely to develop heart and vascular disease. About 60 percent of diabetes patients are likely to die from a vascular event. Read this article about CAC.

One last item is to obtain copies of all tests to allow you to track the results. You may see something that your doctor misses and by charting the results, this will give you a good insight into your own health and show favorable and unfavorable trends.

Part 4 of 4. This concludes the lists of tests for people with diabetes discussion. There are always others tests for other conditions.

Important Tests Needed By People With Diabetes - P3

The discussion of this blog will be about tests doctors should use to track your diabetes and related possible complications. The first test helps analyze the status of your kidneys, liver, blood proteins, electrolytes, and acid/base balance. This is a Comprehensive Metabolic Panel (CMP) and is typically a group of 14 specific tests that have been approved, named, and assigned a CPT code (a Current Procedural Terminology number) as a panel by Medicare. Read about the different tests here.

The CMP includes these tests: glucose and calcium; albumin and total protein (proteins); electrolytes – sodium, potassium, CO2 (carbon dioxide, bicarbonate), and chloride; liver tests - ALP (alkaline phosphatase), ALT (alanine amino transferase, also called SGPT), AST (aspartate amino transferase, also called SGOT), and Bilirubin; kidney tests - BUN (blood urea nitrogen) and creatinine.

Next is the Basic Metabolic Panel (BMP), a group of 8 specific tests that have been approved, named, and assigned a CPT code. Many doctors use this test instead of the CMP. Read about the different tests here and compare to the CMP. Both tests are done from a blood draw. Neither the BMP or CMP are diagnostic in nature, but can help the doctor decide if more specific tests need to be completed for diagnosis of a problem.

The BMP includes these tests: glucose and calcium; electrolytes – sodium, potassium, CO2 (carbon dioxide, bicarbonate), and chloride; kidney tests - BUN (blood urea nitrogen) and creatinine.

More of us are probably familiar with the cholesterol tests (lipid panel). This is a group of tests that should be performed on a quarterly basis, but may not be if you have had no problems in the past. This is a very important groups of tests and give the doctor good information about cardiovascular health. The lipid profile is a group of tests done to determine the risk of coronary heart disease and are good indicators if someone is likely to have a heart attack or stroke caused by blockage of blood vessels or atherosclerois (hardening of the arteries. Read about the different tests that make up the lipid panel here.

The lipid profile normally includes - total cholesterol, high-density lipoprotein cholesterol (HDL-C) — often called good cholesterol, low-density lipoprotein cholesterol (LDL-C) —often called bad cholesterol, and triglycerides. An extended profile may also include very low-density lipoprotein cholesterol (VLDL-C) and non-HDL-C. Some labs also include ratios in the test results.

The last test in this group is the microalbumin test for kidney damage. This test is preferred annually if you have diabetes or hypertension and is extremely important for those not managing their diabetes or hypertension. For those with higher A1c's that are not managing their diabetes, the tests may be done more frequently. It screens for metabolic and kidney disorders plus urinary tract infections.

You will be asked to collect either a random sample of urine while you are at the doctor's office or laboratory, a timed urine sample (such as 4 hours or overnight), or you may be requested to collect a complete 24-hour urine sample. Your doctor or the laboratory will give you a container and instructions for properly collecting a timed or 24-hour urine sample.

The National Kidney Foundation recommends that everyone with diabetes between 12 and 70 years of age have a urine test for microalbuminuria at least once a year. According to the American Diabetes Association, everyone with type 1 diabetes should be tested annually, starting 5 years after onset, and all those with type 2 diabetes should start at the time of diagnosis.

If microalbuminuria is detected, it should be confirmed by retesting and, if positive on 2 of 3 determinations over a 3-6 month period, it is considered to be present and appropriate treatment should be given. Patients with hypertension may be tested at regular intervals, with the frequency determined by their doctor.

Part 3 of 4