Do you know your health numbers? Diabetes isn’t only about blood sugar! It is recommended that people with diabetes have regular visits with their healthcare provider and complete yearly labs to help prevent and manage any complications. Here is a breakdown of each test to help you feel more prepared at your next doctor's visit.
1. HbA1c
The HbA1c is our average blood sugar over the past 8-12 weeks. The "HB" in HbA1c stands for hemoglobin, which is the protein found in our red blood cells and attracts sugar molecules in the blood. The HbA1c measures how many of these sugar molecules are stuck to the hemoglobin. A1c is the average over the past 8-12 weeks because the average red blood cell lives for about 3 months. It's measured in the lab, at your doctors office, or you can even buy a kit from the pharmacy to measure at home. It’s expressed as a percentage value (e.x. 7%).
Remember, A1c is an average measurement. It cannot tell whether your glucose was steady at this level overall, or if you experienced a lot of hyperglycemia and hypoglycemia. The higher your blood sugar level and the longer they remain elevated, the higher the HbA1c is. Studies show that keeping your A1c close to target can help prevent the development of complications associated with diabetes.
Target: 7% or less for most people with diabetes, but should be individualized with your diabetes care team
Frequency: every 3 months
Tip: If you measure your blood sugar level at least 3 times a day for 7 days in a row, mySugr calculates an estimated HbA1c value directly in the mySugr app. This is an estimate, so it may differ a little bit from your HbA1c determined in the lab, but will at least give you an idea of how your diabetes management is doing right now.
2. Blood pressure
High blood pressure is commonly referred to as the "silent" killer because there are no symptoms. When your blood pressure is high, your heart has to work harder and your risk for heart disease and stroke increases. Be sure to have your blood pressure checked regularly. You can also log your blood pressure in the mySugr app to track it over time.
Target range: Blood pressure target should be individualized but a target blood pressure for most adults is 120/80.
Frequency: at least every 3 months in the doctor's office
Tip: If you already know that you have high blood pressure, you can also ask your doctor for a prescription for a blood pressure monitor and measure regularly at home.
3. Blood lipids
Once a year the blood lipid values, cholesterol (LDL and HDL) and triglycerides, should also be checked. Remember by “L”, because we want LDL to be Lower and “H” we want HDL to be Higher.” Think of HDL as a street sweeper, which cleans up LDL, taking it to the liver to be broken down. Too much LDL or not enough of HDL increases the risk clogging up big blood vessels that feed the heart and brain.
Triglycerides are a different type of fat found in the blood. We need them, just not too much. Too much triglyceride is associated with total body inflammation and can damage the liver, pancreas and arteries.
Target range:
- Cholesterol: less than 200 mg/dL
- HDL: Women greater than 50 mg/dL / Men greater than 40 mg/dL
- LDL: less than 100 mg/dL, below 70 mg/dL for increased risk of cardiovascular disease
- Triglycerides: less than 150 mg/dL
Frequency: 1x per year
4. Eye exam
Eye complications usually develop gradually. At first, there may be no noticeable symptoms or visual impairment, but if blood sugar levels are elevated for long periods of time, it can damage the eyes. Elevated blood sugar affects the tiny blood vessels of the retina, so there is a risk of damage to the back of the eye, also known as diabetic retinopathy.
Frequency:
- In eyes with no retinopathy: 1-2x/year
- In existing retinopathy: every 3-12 months, depending on condition
Tip: Double check your insurance to make sure you have vision coverage!
5. Kidney function test
Our kidneys are a sophisticated filtration system, which has a lot of small blood vessels. The kidneys can suffer damage from elevated blood sugars over time. Because of this, your urine should be checked for microalbumin. Microalbumin are very small protein particles that slip through the kidneys when the filtration system is damaged, so it is an early warning sign of kidney damage. In addition, the creatinine value and the glomerular filtration rate (GFR) can be checked in a blood test, which also give insight to how well the kidneys are functioning.
Target range:
- Urinary albumin excretion: below 30 mg/g
- Creatinine in blood: Women: below 0.9 mg/dl / Men: below 1.1 mg/dl
- GFR : over 90 ml/min x 1.73 m²
Frequency: at least 1x per year, every 3 months if kidney damage is present.
6. Foot exam
There are many blood vessels and nerves in the feet. Loss of sensation or a weak pulse in your feet can be a sign of nerve and blood vessel damage from elevated blood sugars, so it’s important to check your feet regularly. Your doctor should check your pulse and the sensitivity of the nerves by using a tuning fork that causes a vibration and a fine nylon thread that is pushed against your toes. Don't worry, this is absolutely painless, but it could tickle! Learn more about foot health in this article.
Frequency: at least 1x per year
Tip: check your feet at home daily to catch any sores or cuts before your doctor's visit.
7. Injection site check (for insulin therapy)
If you use the same needle and/or injection sites for too long, scar tissue can develop and thick tissue deposits harden in the area. If you continue to inject in these areas, the insulin absorption is not as predictable. This can cause crazy swings in blood sugar because accumulation of hardened or fatty tissue at frequently used injection sites interferes with the absorption of insulin into the body. You can do this examination yourself, but your diabetes team should also regularly check your injection sites.
Frequency: at least 2 x per year
Tip: to prevent this, rotate your injection and insulin pump sites often!
8. Dental exam
People with diabetes have a 3 times higher risk of gingivitis (severe gum inflammation) compared to people without diabetes. The higher the sugar levels, the more likely we are to have gum inflammation and, in some cases, tooth loss. The inflammation of the gums and the bacteria that enter the bloodstream raise glucose as well and increase insulin requirements. To prevent gingivitis, it’s important to brush your teeth and floss daily and never skip your dental check ups! Learn more about diabetes and dental health in this blog article.
Frequency: Twice yearly exam, more often in case of abnormalities
This article was updated in February 2020
The mySugr website does not provide medical or legal advice. mySugr blog articles are not scientific articles, but intended for informational purposes only.
Medical or nutritional information on the mySugr website is not intended to replace professional medical advice, diagnosis or treatment. Always consult a physician or health care provider with any questions you may have regarding a medical condition.
