Six Tests Help People Manage Their Diabetes and Prevent Complications

Diabetes affects an estimated 21 million children and adults in the United States — 7 percent of the population.  An estimated 14.6 million Americans have been diagnosed, leaving 6.2 million Americans unaware that they have the disease.  In addition, 54 million Americans are thought to have pre-diabetes, or elevated blood glucose levels that put them at risk for developing type 2 diabetes. If untreated or poorly treated, diabetes can lead to blindness, kidney disease, stroke, nerve damage and circulation problems that can result in limb amputations.

Fortunately people with diabetes can take steps to help prevent these serious complications. By keeping blood glucose in good control, going for regular checkups with health professionals, and taking control of one’s diabetes, much can be done to hold complications at bay.

Experts at Joslin Diabetes Center say getting involved with your own care, and knowing how well your treatment plan is working, is crucial to diabetes management. Regularly monitoring your blood glucose, cholesterol and blood pressure — and keeping them at or below target levels — along with periodic eye and foot exams and kidney function tests help to prevent or slow diabetes complications.

Joslin experts recommend that all people with diabetes be aware of their results on these tests to help manage diabetes: 

• A1C Test:This important blood test reflects the average blood glucose level for a two to three month period before the test. This test, done by a health professional, gives a comprehensive snapshot of your diabetes management and should be done every three to six months. Joslin recommends an A1C value of less than 7.0 percent as a general rule. The AlC should be as low as possible without increasing the risk of other complications, such as hypoglycemia (low blood glucose). If your A1C is elevated, increasing physical activity, losing weight and talking to your physician about altering medications may help.

• Blood Pressure: Checking blood pressure and treating elevated levels is important to reduce the risk of blood vessel damage. Because high blood pressure is a silent killer, it is important to have it checked by your healthcare team at each appointment, and at least twice yearly. Your blood pressure should be less than 130/80, and if kidney complications from diabetes have already developed, the target should be at or below 125/75. Physical activity, losing weight, quitting smoking and medications can help lower blood pressure. Your healthcare team will determine which of these is most appropriate for you. 

• Urinary Microalbumin: To detect the earliest evidence of kidney disease, your doctor should check your urine microalbumin levels at least annually. The normal albumin level in the urine is less than 30 mg. Keeping your A1C and blood pressure at target levels is the best way to prevent and treat albuminuria. Your physician can prescribe specific medications to treat high levels of microalbumin.

• Lipids: Monitoring your blood fat levels annually is important because diabetes and high fat levels pose significant risk factors for heart attack and stroke. There are two types of cholesterol: HDL (the good cholesterol that protects against heart disease) and LDL (the bad kind that can damage your heart). Your LDL levels should be below 100, and even under 70 for those at very high risk. This can be achieved by physical activity, losing weight, eating a diet lower in saturated fats and, if prescribed by a physician, taking cholesterol-lowering medications. Joslin recommends HDL levels of greater than 40 for men, and greater than 50 for women. Triglycerides, another blood fat, should be below 150 mg/dl.

• Eye Exam: Diabetes puts people at risk for cataracts, glaucoma and diabetic retinopathy, a leading cause of blindness. An annual dilated eye exam can identify eye complications early on.  If your doctor finds early signs of eye disease, laser eye surgery, contact lenses, glasses and medications may be recommended. Keeping your A1C level on target, controlling blood pressure and quitting smoking also can help prevent vision loss. 

• Foot Exam: Because diabetes can affect the circulation and impair sensation (neuropathy), have your feet checked at least once a year for altered sensation, decreased circulation and/or infection.

Joslin Diabetes Center recommends that patients with diabetes include the following tests and exams to help them live well with diabetes and avoid complications:
 

A1C Test: Check 2-4 times annually

Blood Pressure Test:  Check at least 2 times annually

Lipids Test: Check at least annually

Urinary Microalbumin:  Check at least annually

Eye Exam: Check at least annually

Foot Exam:  Check at least annually