If you have diabetes, you need to always be aware of possible complications in the feet, eyes, kidneys, and other parts of the body. If symptoms such as neuropathy, diabetic eye disease, or kidney damage develop, your doctor may recommend appropriate testing. Early diagnosis can help manage these conditions in a timely manner.
Glycosylated hemoglobin (HbA1c) level testing
Most complications of diabetes are associated with high or low blood glucose levels, and HbA1c testing is a key way to assess the extent of abnormal blood glucose levels.
Your doctor may order HbA1c testing 4 times a year until your blood glucose levels are stable. Once blood glucose is stable, 2 tests per year are required.
The doctor will take a blood sample from your arm or finger to test the average blood glucose level over the past 3 months.
If you are on insulin or your blood glucose levels have not stabilized, your doctor may also recommend testing multiple times a day at home. You need to prick your finger and put a drop of blood on a disposable blood glucose test strip, which you can insert into your portable blood glucose meter to take a reading.
Cholesterol and blood pressure testing
At each visit, your doctor will pay special attention to factors that are associated with diabetes and may increase the likelihood of heart disease.
The doctor will tie a cuff to the patient’s upper arm to measure blood pressure, and will take a small blood sample from the arm to check blood levels of LDL cholesterol and triglycerides.
Foot exam
High blood sugar can lead to diabetic peripheral neuropathy, and this nerve damage can lead to pain in the legs and arms, or loss of sensory function. It can also lead to pain in the foot and even infection.
Diabetes can also induce impaired blood flow to the foot, making it difficult for the infection to heal.
So, a thorough foot exam should be done at least once a year. The doctor may use a nylon hairbrush-like tool to lightly scratch the surface of the foot, or may use a small needle to gently prick the foot. If you can’t feel it, then there may be nerve damage.
If you have been diagnosed with diabetic peripheral neuropathy, you should have your doctor examine your foot thoroughly at each visit. You also need to check your own feet daily to look for wounds, ulcers, and blisters.
Eye exam
High blood sugar can damage the structures of the eye, such as the retina, lens, optic nerve, and vitreous humor. This is called diabetic eye disease and is a complication that can lead to impaired vision and permanent loss of vision.
The first time you are diagnosed with diabetes, you will need to have a dilated pupil to get a complete examination of your eye, and then every 1 to 2 years thereafter.
During the exam, the doctor will put drops of medicine into the eye to temporarily dilate the pupil. The doctor will then use a special magnifying glass to examine the retina and optic nerve. The doctor will also test eye pressure, lateral vision, and distance vision.
Although this test is painless, sensitivity to light may occur after the test, and blurred vision may persist even for a few hours after the test. Therefore, the wisest course of action is to wear sunglasses and have a friend send them home.
Kidney disease screening
About 1 in 4 people with diabetes will have kidney damage. Blood and urine tests may be needed once a year to be sure that the kidneys are functioning properly. If you have a family history of high blood pressure, heart disease, or kidney failure, you are more likely to have kidney disease and may need to be tested more often.
If the kidneys are damaged, your doctor may detect albumin in the urine sample, which normally would not be present in the urine.
Doctors also take a blood sample to test the glomerular filtration rate (GFR), which is a measure of the kidney’s ability to filter blood waste.
Teeth and gum exam
Diabetes can cause dryness in the mouth and increased levels of sugar in the saliva, which can encourage the growth of plaque (harmful bacteria).
Over time, untreated plaque can lead to tooth decay, gum disease (gingivitis), periodontitis, and tooth loss. Therefore, attention should be paid to gum problems, including swollen, tender or bleeding gums. Your doctor may recommend visiting your dentist 2 times a year for cleaning and examining your mouth.
Urine screening for diabetic ketoacidosis (DKA)
When the body’s cells cannot get enough glucose, they use fat for energy, producing substances called “ketone bodies”. High ketone levels in the body indicate poorly controlled diabetes or a worsening condition. This can lead to diabetic ketoacidosis (DKA), a life-threatening complication of diabetes.
Your doctor may recommend taking a urine sample at home and checking ketone levels by using a special test strip if:
- Have very high blood glucose levels (usually more than 240 mg/dl);
- Have other medical conditions;
- If dry mouth and frequent urination are present, the possibility of DKA should be highly suspected.
Thyroid examination
Diabetic patients are often associated with hypothyroidism. In combination with hypothyroidism, the thyroid gland is unable to synthesize enough hormones to regulate the body’s metabolism.
To determine if there is a combination of hypothyroidism, doctors take blood samples from patients about once every 5 years to check thyroid hormone levels.
Women over 40 years old or with a family history of thyroid disease are more likely to have hypothyroidism and may need to be tested every 1 to 2 years.
Gastrointestinal function testing
Gastroparesis is a complication of diabetes caused by chronic hyperglycemia. If you feel full after eating a small amount of food or vomit up undigested food, your doctor may recommend testing for this. One or more of the following tests may be needed:
- Upper gastrointestinal endoscopy;
- Barium meal of the upper gastrointestinal tract;
- Gastric emptying scintigraphy;
- Capsule endoscopy;
- Gastric emptying breath test.
Most of these tests require eating or taking something by mouth, or imaging (such as an x-ray) to help your doctor determine if there is a problem with your digestive system.