Nine Health Checks you Need for Diabetes by Johanna Hicks, Family & Community Health Agent

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Nine Health Checks you Need for Diabetes

               Numbers are a fact of life for people with diabetes – blood glucose levels, grams of carbs, units of insulin.  Those are important, but so are the target numbers for screenings.  Whether type 1 or type 2 diabetes, there is in increased risk of developing a slew of other serious health conditions, including heart, kidney, and eye disease. 

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               The American Diabetes Association provides a list of necessary medical screenings and how to make sure you’re in the target zone based on the ADA Standards of Medical Care in Diabetes:

1. A1C:  this is the test that measures your average blood glucose level over the past tow to three months.  An A1C of less than 5.7% is considered normal; 5.7 to 6.4 is considered prediabetes; and 6.5 or higher on two tests indicates diabetes.  A high A1C is a sign of frequent high blood glucose and puts you at risk for complications (nerve damage, kidney disease, vision impairment).  A more relaxed goal may be necessary for kids or adults who experience frequent low blood glucose (hypoglycemia).  Frequency of testing depends on your treatment goals – every six months if you last A1C was in goal range, every three months if medication changes or your last A1C is not in target range.
2. Albumin-to-Creatinine Ratio (ACR): this is a urine test that check how much albumin (a type of protein) is in your urine.  Too much is a sign of kidney damage.  More than 35% of people with diabetes ages 20 and older have chronic kidney disease.  Early treatment can prevent of slow the disease’s progression.  The target number is 30 mg/g of urine creatinine.  The test should be done annually.
3. Ankle-brachial Index: this is a blood pressure reading at your ankle compared to reading from your arm to screen for peripheral artery disease (PAD).  This disease can cause leg pain, weakness, and numbness when walking and can make it more difficult for foot sores to heal.  The target is 0.9 to 1.3.  This test is only needed if you have symptoms of PAD.
4. Bone Mineral Density:  measures density of bones.  People with diabetes are at a higher risk for hip fractures and osteoporosis.  A T-score of -1.o or above is desired.  A T-score between -1.0 and -2.5 indicates low bone density.  If below -2.5, medication for osteoporosis is needed.
5. Blood Pressure: measures force of blood flow in your blood vessels.  Diabetes raises the risk for high blood pressure which increases the risk for heart disease, stroke, vision loss, and kidney disease.  The target is 130/80mmHg if you have heart disease or high risk for it.   Get this checked with every doctor visit.
6. Body Mass Index: measure body fat based on your height and weight.  Added weight increases chances of complications from diabetes.  The target is 18.5 to 24.9.  If you know your height and weight, you can determine your BMI with the calculator found at http://www.cdc.gov.bmi.
7. Dilated Eye Exam: The eye doctor examines your eyes for signs of diabetic eye disease or diabetic retinopathy and other problems, such as glaucoma or cataracts.  Getting this done annually is a good practice.
8. Estimate Glomerular Filtration Rate: Estimates how well your kidneys function.  The target for the eGFR is higher than 60 ml/min/173m²  (normal is 100 to 120 ml/min/173m².  This test is recommended annually for type 2 diabetes or type 1 for at least five years, and twice per year if previous tests showed signs of kidney disease.
9. Cholesterol & Triglycerides: this test measures the waxy substance in your blood and the blood fats in your bloodstream.  High LDL (“lousy” cholesterol) and triglycerides raise chances of developing cardiovascular disease.  Target for cholesterol is less than 100 mg/dl (or under 70 mg/dl if you have heart disease).  HDL (“happy” cholesterol) should be higher that 4o mg/dl for men and 50mg/dl for women.  Triglycerides should be under 150 mg/dl.  Age 40 and under with diabetes should be checked at diagnosis and at least every five years.  If abnormal results, more frequent screenings may be needed.  If taking statin medications, you’ll need testing 4 to 12 weeks after beginning medication.  If numbers look good, repeat annually.

Hopefully this information from the American Diabetes Association helps clear up confusion about different testing. 

Closing Thought

The art of being wise is knowing what to overlook – William James

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