PERIODIC TESTS AND INVESTIGATIONS OF DIABETES

  • Why are regular tests important for people with diabetes?
  • Why is it important to check weight or BMI levels on a regular basis?
  • How is waist-hip ratio related to my health?
  • What is HbA1c, how frequently it should be done and what is its target range?
  • What is blood pressure? How is it related to health? How frequently a person with diabetes should get it checked?
  • How are high cholesterol levels related to my health? How often should cholesterol levels can be checked and what are the recommended target goals to prevent any heart-related complications?
  • How can high BP and cholesterol be managed?
  • How can we know that our kidneys are working well and not affected due to diabetes?
  • What tests can be done to check the eyes of people having with diabetes? How frequently it can be done?
  • Is numbness of feet related to diabetes? What should one do? If one feels numbness in feet, can it be related to diabetes? With whom can I discuss foot related issues and how frequently do I need to get foot exam done?
  • How are gums problems related to diabetes? How to keep a check on them?
  • Why is it important to get a vaccination for people with diabetes?
  • What are the important points that can be discussed with the healthcare provider at every visit?
Why are regular tests important for people with diabetes?

Diabetes over a time, may increase the risk for many health problems. It can harm blood vessels and nerves of the body, including those in eyes, kidneys, brain, feet, gums, skin, heart and more. The damage can start even before someone notices the symptoms.

For people with diabetes, apart from self-monitoring of the blood glucose (SMBG), periodic tests for diabetes are important to catch problems early before they become serious health issues. These routine tests are also an important tool in managing your treatment plan and preventing long-term complications of diabetes. One should talk to their healthcare provider about what specific tests needs to be done and their recommended target goals.

Why is it important to check weight or BMI levels on a regular basis?

The measurements of body weight and height commonly help to calculate any ‘deviation’ from the ideal weight. It helps to classify underweight, overweight and obesity in adults and also an important tool to assess risk for chronic diseases (diabetes, cardiovascular problems, BP, and metabolic disorders). On the basis of this assessment a healthcare provider will make modifications in current diet, exercise, lifestyle and medication schedule to bring a person to normal levels in order to prevent/delay complications.

How is waist-hip ratio related to my health?

Body shape and abdominal fat have been found to be important when predicting a person’s risk of cardiovascular disease and metabolic conditions like diabetes. The waist-to-hip ratio (WHR) can be used to classify people as either pear- or apple-shaped. People with a pear-shaped body (more fat deposition in the hip area) have a low WHR and are at a lower risk of cardiovascular complications, compared to people with an apple-shaped body (more fat deposition in the abdominal area).

Health risk can be evaluated by using the following table:

Variable                                           Male                      Female                    Health Risk

Abdominal Obesity                       ≥90 cm                  ≥80 cm                   More Risk
Waist Circumference (cm)

Waist-to-Hip Ratio                          0.95 or below        0.80 or below        Low

0.96-1.0                  0.81-0.85               Moderate
1.0+                         0.85+                      High

What is HbA1c, how frequently it should be done and what is its target range?

HbA1c is a blood test which shows the average blood sugar level for the past three months as a percentage. It helps the doctor in managing the treatment plan. This test is done 2-4 times a year depending on the last value and glycemic control. For the majority of adult people with diabetes the target goal is to keep it less than 7%. For your specific target you need to consult your healthcare provider.

What is blood pressure? How is it related to health? How frequently a person with diabetes should get it checked?

Blood Pressure (BP) is the pressure against walls of your blood vessels. The first number (systolic pressure) of the BP is the pressure when your heart beats. The second number (diastolic pressure) is the pressure between heartbeats. High BP causes your heart to work harder. It also can increase your risk of damage to your eyes, brain, kidneys, heart, and blood vessels.

Your doctor should check your blood pressure at every visit and if you have the problem of high BP then you should check it more frequently even at home and discuss measures to control with your healthcare provider. It’s is advised to maintain BP below 130/80 mmHg to prevent or delay complication/s.

How are high cholesterol levels related to my health? How often should cholesterol levels can be checked and what are the recommended target goals to prevent any heart-related complications?

Cholesterol (lipids) is a blood test which measures the amount of fat build-up in the wall of our arteries (which carry filtered blood from the heart to other parts of the body). Diabetes itself can cause high LDL cholesterol (bad cholesterol) and high triglycerides (a type of fat in your blood). Higher cholesterol levels can cause your blood vessels to become narrow or clogged. If not treated may lead to heart attack or stroke. You should check your cholesterol levels at least once a year but more frequently if levels are high.

Recommended Targets (ADA)
Total Cholesterol aim for below 200
LDL (bad) cholesterol aim for below 100
HDL (good) cholesterol aim for above 40 (men) and 50 (women)
Triglycerides (TG) under 150 mg/dl

How can high BP and cholesterol be managed?

In order to prevent or delay complications you need to keep your BP and cholesterol in range. Important areas you need to focus on are:

  • Lose and maintain weight
  • Be more physically active and exercise regularly
  • Eat healthy and balanced diet, reduce salt and fat (saturated and trans fats) in your diet
  • Quit smoking and avoid alcohol

Discuss if you need medications to lower your BP or lipid levels.

How can we know that our kidneys are working well and not affected due to diabetes?

Diabetes is the leading cause of kidney disease. Damaged kidneys do not do a good job of filtering waste and extra fluids. Without treatment, this can lead to kidney failure. There are two main tests to figure out the functioning of kidneys.

  • Microalbumin: A urine test will show if your kidneys are leaking protein, an early sign of kidney disease.
  • Creatinine: a blood test to show your kidneys are working well.

These tests should be done at least once in a year, more frequently if results are deranged. Target goal of microalbumin is less than 30 and for creatinine it’s usually less than 1.2 mg/dl but reference range for creatinine is different for different labs and for male and females.

What tests can be done to check the eyes of people having with diabetes? How frequently it can be done?

Diabetes is a major cause of blindness. It also increases your risk of other eye problems, such as glaucoma, cataract and damage to the retina (diabetic retinopathy). Regular eye exams help to catch problems early. A special exam by an eye specialist (optometrist or ophthalmologist) to look at the retina of the eye after dilation (opens up pupil to check retina and signs of damage clearly) is done at least once a year.

Is numbness of feet related to diabetes? What should one do? If one feels numbness in feet, can it be related to diabetes? With whom can I discuss foot related issues and how frequently do I need to get foot exam done?

Nerve damage from diabetes can cause numbness in feet.  There may be a cut or a blister which we cannot feel. Regular foot-inspection can help prevent minor wounds from becoming serious health issues.

We should discuss the problems with the doctor and diabetes educator. A special exam by a foot doctor (podiatrist) can be done to carefully inspect feet for any minor cut, infection or abnormality.

Any change in shape or colour of feet must not be ignored. The decrease in circulation can be evaluated by a through a physical exam and other tests like a pinprick, vibration, and monofilament pressure to check altered sensation. Foot inspection should be done at every clinic visit and a complete foot exam should be conducted at least once a year.

How are gums problems related to diabetes? How to keep a check on them?

Diabetes can increase your risk of infection and other problems in your mouth. High blood sugar levels help harmful germs grow. This can lead to cavities and gum disease. An examination by a dentist for proper oral check-up and cleaning should be done for at least twice a year, more often if have gum or tooth problems.

Why is it important to get a vaccination for people with diabetes?

Although people of all ages are prone to infectious diseases like pneumonia and influenza, extremes of age and certain underlying medical conditions such as diabetes, asthma, chronic bronchitis and heart disease aggravate the risk. The increased susceptibility of diabetes patients to flu and pneumonia is mainly due to high blood sugars, poor long-term diabetes control, longer duration of diabetes, decreased immunity & impaired lung functions in elderly. That’s why safe and effective vaccination is recommended for all people with diabetes which can greatly reduce the risk of serious complications related to different infections.

Recommended vaccines for Diabetes patients

  • Pneumococcal (Polysaccharide) single dose
  • Influenza (flu shot) one dose annually
  • Hepatitis B Three Doses

What are the important points that can be discussed with the healthcare provider at every visit?

We should be very conscious about our health and discuss on the following points:

  • Diet and physical activity
  • Sugar pattern and management
  • Medications/Insulin-related queries
  • Smoke or alcohol
  • Sex or other personal problems
  • Stress/anxiety

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