Diabetes Forecast

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The Healthy Living Magazine

9 Health Checks You Need

How to interpret your medical test results

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Numbers are a fact of life for people with diabetes. There are blood glucose levels. Grams of carb. Units of insulin. Those are all important, but so are the target numbers for screenings that can help you stay healthy for years to come. “Whether you have type 1 or type 2 diabetes, you’re at an increased risk of developing a slew of other serious health conditions, including heart, kidney, and eye disease,” says Robert Gabbay, MD, PhD, chief medical officer and senior vice president at the Joslin Diabetes Center in Boston, and a member of Diabetes Forecast’s editorial board.

Read on for a roundup of necessary medical screenings for people with diabetes and how to make sure you’re in the target zone based on the American Diabetes Association (ADA) Standards of Medical Care in Diabetes. 

1. A1C

What It Is: A blood test that measures your average blood glucose level over the past two to three months. An A1C of less than 5.7 percent is considered normal; 5.7 to 6.4 percent is considered prediabetes; and an A1C of 6.5 or higher on two tests indicates diabetes.

Why You Need It: A high A1C is a sign  of frequent high blood glucose, which puts you at risk for complications such as nerve damage, kidney disease, and vision impairment.

Target Number: Individualized; less than 7 percent for many adults

Learn More: Your doctor may give you a higher or lower A1C goal, depending on your health and glucose trends. For instance, women with diabetes should aim for an A1C as close to normal as possible before trying to get pregnant and during pregnancy. A more relaxed goal may be necessary for kids or adults who experience frequent low blood glucose (hypoglycemia) or who don’t experience symptoms of hypoglycemia. Older adults are more at risk for lows and may have other health complications, such as heart disease, that require extra caution. “If your blood glucose levels drop too low, your heart rate and blood pressure may both increase, which raises the risk of heart attack or stroke,” says Gabbay. In these cases, an A1C of less than 8 percent may be appropriate.

How Often: It depends on whether you’re meeting your treatment goals, but aim for:

  • Every six months if your last A1C was in goal range.
  • Every three months if your medications have changed or your last A1C was not in your target range. 

2. Albumin-to-Creatinine Ratio (ACR)

What it is: A urine test that checks how much albumin (a type of protein) is in your urine; too much is a sign of kidney damage.

Why You Need it: More than 35 percent of people with diabetes ages 20 and older have chronic kidney disease. Early treatment, along with well-managed blood glucose and blood pressure, can prevent or slow the disease’s progression.

Target Number: Less than 30 mg/g of urine creatinine

How Often: Once a year, if you have type 2 diabetes or have had type 1 diabetes for at least five years. More frequently, if your previous test showed excess albumin.

3. Ankle-Brachial Index

What It Is: A blood pressure reading measured at your ankle. Results are compared with a blood pressure reading from your arm to screen for peripheral artery disease (PAD), a condition in which clogged arteries reduce blood flow to your limbs.

Why You Need It: PAD can cause leg pain, weakness, and numbness, especially when walking or doing exercises involving the legs. It can also make it more difficult for foot sores to heal, raising your risk for amputation. If you have diabetes, you have a greater chance of developing PAD.

Target Numbers: 0.9 to 1.3

How Often: You need this test only if you have symptoms of PAD.

4. Bone Mineral Density

What It Is: A scan that helps estimate the density of your bones—usually measured at the hip and spine—and how likely they are to break.

Why You Need It: People with type 1 and type 2 diabetes are at a significantly higher risk for hip fractures and osteoporosis. If you have additional risk factors—such as having previous fractures or having gone through menopause—talk to your doctor about whether you need a bone density scan.

Target Number: A T-score of −1.0 or above. (A T-score indicates how much higher or lower your bone density is than that of a healthy 30-year-old adult.)

Learn More: A T-score between −1.0 and −2.5 indicates low bone density. If your T-score is below −2.5, you have osteoporosis and will need medication. 

How Often: Most providers suggest a baseline scan for women when they begin menopause and for men at around age 50, says Gabbay.

5. Blood Pressure

What It Is: A measurement of the force of blood flow inside your blood vessels.

Why You Need It: Diabetes raises the risk for high blood pressure, which increases your chances of heart disease, stroke, vision loss, and kidney disease.

Target Number: Less than 140/90 mmHg

Learn More: A goal of under 140/90 mmHg is fine if you have a low risk for heart disease (you’re not overweight, you don’t smoke, and you don’t have a family history), but your doctor may adjust that target if you have heart disease or a high risk for it. In that case, strive for under 130/80 mmHg.

How Often: Get checked at every visit with a health care provider.

6. Body Mass Index (BMI)

What It Is: A measure of body fat based on your height and weight. 

Why You Need It: Body mass index can indicate whether you’re at a healthy weight, overweight, or obese. Added weight increases your chances of a range of conditions, including prediabetes, type 2 diabetes, and heart disease.

Target Numbers: 18.5 to 24.9 

How Often: Get checked at every visit with a health care provider. If you know your height and weight, you can determine your BMI with the calculator found at cdc.gov/bmi.

7. Dilated Eye Exam

What It Is: An eye doctor (ophthalmologist or optometrist) will examine your eyes for signs of diabetic eye disease or diabetic retinopathy. The doctor will also check for other eye problems, such as glaucoma and cataracts.

Why You Need It: Diabetes puts you at risk for eye diseases such as diabetic retinopathy and glaucoma.

How Often: It depends on your type of diabetes and how long you’ve had the disease. Some guidelines:

  • People with type 1 diabetes: within five years of diagnosis, then every one to two years after that, provided you have no signs of eye disease
  • People with type 2 diabetes: at diagnosis, then every one to two years after that, as long as you don’t have signs of eye disease
  • People with any type of diabetes who have eye disease: at least annually

8. Estimated Glomerular Filtration Rate (eGFR)

What it is: An estimate of how well your kidneys function. Your eGFR is based on the level of creatinine in your blood and other factors, such as your age and gender.

Why You Need It: People with diabetes have an increased risk for kidney disease.

Target Number: An eGFR higher than 60 ml/min/1.73 m2; (normal is around 100 to 120 ml/min/173 m2)

How Often: Once a year, if you have type 2 diabetes or have had type 1 diabetes for at least five years. At least twice a year if your previous test showed signs of kidney disease.

9. Cholesterol & Triglycerides

What It Is: A series of blood tests, known as a lipid panel, that measures your cholesterol—the waxy, fat-like substance in your blood—and your triglycerides, blood fats that circulate in your bloodstream. The results are broken down into:

  • LDL (“bad”) cholesterol
  • HDL (“good”) cholesterol
  • total cholesterol
  • triglycerides.

Why You Need It: Diabetes puts you at greater risk for high LDL cholesterol and triglycerides, both of which raise your chance of developing cardiovascular disease.

Target Numbers:

  • An LDL of under 100 mg/dl (under 70 mg/dl if you have heart disease)
  • An HDL that’s higher than 40 mg/dl for men and 50 mg/dl for women
  • Triglycerides under 150 mg/dl

Learn More: The ADA recommends statin therapy for most adults with diabetes, regardless of their specific lipid levels, based on their cardiovascular risk.

How Often: It depends on your age and other health factors. Some guidelines:

  • Adults with diabetes under age 40: at diagnosis and at least every five years afterward. If the results are abnormal, or if you have long-standing diabetes, you may need more frequent screenings.
  • At age 40 and/or when you start statin medications to treat high cholesterol. Four to 12 weeks after beginning medication, you’ll get retested to make sure you’re on the right dose. If your numbers look good, you’ll repeat it annually.
 

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