Regular checks for people living with diabetes

Adeyemi Maxwell

THE BEST and most ideal situation is not to be diabetic, but if you have been diagnosed as having the disease, there is a burden of responsibility on you towards the effective management of the condition. The multidisciplinary healthcare team has their role to play in assisting you, but you as a patient have the responsibility to take charge of the disease with the team to have things under control at all time.

Before you may notice the symptoms of diabetes, the high blood sugar can damage parts of the body. That is why certain diabetes tests to check blood sugar control and to detect problems early are so important.

Many diabetic patients are missing essential checks that should be done at certain intervals due to various reasons, which may include: lack of knowledge, poor appreciation of the situation, missing or not going to the clinic regularly (especially those who just go to the drugstore and buy their medicine for months or even years without visiting a doctor, or maybe their doctor doesn’t ask them to do it).

There are a lot of people with diabetes who are coming down with complications that could have been prevented. It is also very important for people who don't have diabetes to get into this preventive mode to prevent developing diabetes in the first instance and, if already diagnosed with diabetes, to work at preventing complications.

The following tests are recommended once you are diabetic. They should be done regularly to monitor the progress of the disease, to detect and diagnose complications early so that effective strategies to treating them can be instituted:

1. Glycosylated haemoglobin (HbA1c)

This blood test called glycosylated haemoglobin or HbA1c tells how well diabetes is managed over time. It measures your average blood sugar in the previous three months to see if it has stayed within a target range.

Red blood cells contain haemoglobin, which allows cells to transport oxygen to tissues. As a cell ages, the haemoglobin becomes increasingly glycated, that is, more glucose molecules stick to it. Higher glucose levels in the blood mean higher glycated haemoglobin, which translate into higher percentages of HbA1c.

Normal HbA1c is five per cent or less. An HbA1c value above seven per cent means diabetes is poorly controlled. Generally, the international standard targets an HbA1c of 6.5 per cent or less.

Many studies have revealed that the better controlled your blood sugar, the better your HbA1c. The risk of complication is significantly reduced with a good control of HbA1c, as this test is a good predictor of complications. With a well-controlled HbA1c, eye disease risk is reduced by 76 per cent, kidney disease by 50 per cent and nerve damage by 60 per cent. This test should be done at least twice a year.

2. Eye examination

With diabetes, high blood sugar damages tiny blood vessels in the retina, the light-sensitive tissue at the back of the eye. This can progress to bleeding, blurred vision, severely damaged retina, vision impairment, and even blindness.

If you have diabetes, your ophthalmologist (eye doctor) should perform a dilated eye examination, in which the pupils of the eye are widened with drops, to check for signs of diabetic retinopathy at least once a year.

Once detected early, diabetes eye complications can be treated to prevent vision loss. So, check yearly and don’t wait until your vision is getting bad before you go to the eye doctor.

3. Foot examination

Diabetes can cause nerve damage and numbness. It also leads to decreased circulation that makes it harder for your body to fight infections. Patients with reduced sensation/numbness due to nerve damage may not notice or feel if they injure a foot. A resulting infection may not heal well and skin with other tissues may die; this may progress into a complication that requires amputation.

Once or twice a year your doctor should do a very thorough foot examination (preferably by a podiatrist – foot doctor in the diabetes care team). But foot inspection and examination should be done at every visit.

4. Blood lipids

This test checks your low-density lipoprotein (bad cholesterol), triglycerides and the high-density lipoprotein (good cholesterol). The fasting lipid protein should be done at least once a year. Elevated bad cholesterol and low levels of good cholesterol can increase your cardiovascular risks and should therefore be managed.

5. Kidney (renal) function test

This test may include urine test for presence of protein (micro albumin), blood test to check for creatinine clearance at least once or twice a year. These tests indicate how well your kidneys are working. Increasing levels of protein in your urine and rising levels of creatinine are indicative of kidney disease.

6. Blood pressure

Your blood pressure must be checked at every medical appointment. The goal for the people with diabetes is a blood pressure of 130/80 or less if they have no complication. But if there is complication, the goal is lower – 125/75. It should also be noted that most people with diabetes will develop high blood pressure over time, so regular checks and monitoring are important.

7. Fasting blood sugar

This test is done usually first thing in the morning after not eating or drinking at least eight hours from the night before. A finger stick can be done (though less accurate, it gives a rough estimate of your blood sugar) or a blood sample can be taken and sent to the laboratory for a more accurate reading. This should be done at every clinic appointment.

8. Electrocardiogram (ECG)

This is the measurement of electrical impulses through the heart as it contracts and relaxes. Information can be obtained from the test about the performance and events taking place in the heart. It can also give an indication of impending danger so that actions can be taken. It is also important in diabetics as damage to nerves around the heart may mean patients don’t feel chest pains when having a heart attack. They can also have silent heart attacks that can be picked up on electrocardiogram. This test should be done at least once a year.

Other things that should be done when you visit the doctor include:

Biometric data such as weight, height and body mass index (BMI): waist circumference measurements so that these parameters can be monitored and used as goals of treatment.

Nutrition and dietary counselling with a nutritionist so that relevant education, evaluation and dietary guidelines for management can be integrated into the management plan.

Mental health counselling is vital to enhance the coping skills, and the mental health of the diabetic person can be improved.

Physical activity counselling is important as a lifestyle adjustment to increase energy expenditure and increase insulin sensitivity.

Regular review of your individualised management plan is also important to see if you are meeting treatment goals.

If you are diabetic and these tests are not being done, please ask your doctor about them.

Contact Dr Maxwell on 3631807 or 7575411