I met an old friend who had diabetes for 2 years and usually took his medication from the community hospital. I asked him how his blood glucose was, and he said he would check it every once in a while, and it was around 7. During the follow-up questioning, I learned that he had not checked his fasting blood glucose in the past 2 years, but only checked his liver and kidney function and abdominal ultrasound during his physical examination a year ago. In clinical practice, we also found that some diabetic patients can basically adhere to their medication after the diagnosis of diabetes, but they do not know much about when to do the physical examination and what items to check, or they do not think it is necessary, thinking that as long as the fasting blood sugar is normal, nothing will happen.
Diabetes is a series of metabolic disorders such as sugar, protein, fat, water and electrolyte syndrome caused by a variety of pathogenic factors acting on the body leading to hypoglycemia and insulin resistance, etc. Clinically, hyperglycemia is the main characteristic, and once diabetes (blood sugar) is not well controlled, it will lead to complications, resulting in heart, brain, kidney, eye and foot lesions, which bring great pain to patients and are difficult to treat. Therefore, it is especially important to do the necessary examination regularly.
1.Glucose monitoring
Diabetes is a long-term, regulatory treatment, the type and dosage of medication is important, both to achieve control of blood sugar, but also to maximize the protection of pancreatic islet function. Medication is only a means to an end, reaching the target is the goal, so monitoring blood sugar is crucial. Daily monitoring of blood glucose should vary from person to person. Patients with poorly controlled blood glucose or those with critical conditions should have their blood glucose profile monitored daily (i.e., seven time periods in a day should be selected for blood glucose monitoring, which are fasting blood glucose before breakfast, blood glucose before lunch, blood glucose before dinner, blood glucose after three meals and blood glucose before bed) until the condition is stable and blood glucose is controlled.
Those using insulin therapy should monitor their blood glucose at least five times a day at the beginning of treatment, and once a day after reaching the treatment goal, and once a week for blood glucose profiles; patients using oral medication and lifestyle interventions should monitor their fasting blood glucose once a day after reaching the goal, and once every two weeks for blood glucose profiles. In addition to self-monitoring of blood glucose, it is recommended that venous blood be drawn every 2 to 3 months at a regular hospital to monitor blood glucose and insulin release. A simplified glucose tolerance test can be done, which is to check fasting blood glucose and 2-hour postprandial blood glucose and insulin release.
2.Urinary routine, urine microprotein
The urine microprotein test is the most sensitive and reliable diagnostic indicator for early detection of kidney disease. When a patient has hypertension or diabetes or both (often at the same time), the kidney blood vessels become diseased, changing the function of the kidney to filter protein (especially albumin), which makes protein leak into the urine. The presence of trace amounts of albumin in the urine indicates that the kidneys have been damaged. For diabetic patients with kidney damage, it is very important to strengthen the control of blood sugar and blood pressure and adjust the treatment plan in time.
Microalbuminuria is an early sign of diabetes affecting the kidneys, an early indication of kidney damage in the early stages of diabetic nephropathy, and an early indication of cardiovascular changes. If the physical examination is normal, urine microalbumin should be checked every 3 months; if there has been intermittent microalbumin, which disappears after treatment, urine microalbumin monitoring can be done once every six months. If it is the first examination, there are no obvious previous complications and urine protein is found, it should be rechecked. In other words, do not place the diagnosis of proteinuria because of the results of one urine test.
3.Glycosylated hemoglobin
Glycosylated hemoglobin is the combination product of hemoglobin and sugar, which is inextricably linked to the level of blood sugar. At the same time, glycosylated hemoglobin is an indicator of good or bad blood sugar control two to three months before blood sampling. For every 1% decrease in glycosylated hemoglobin, the incidence of stroke and myocardial infarction decreases by 12% and 14%, respectively, among the various complications of diabetes; cataract extraction decreases by 19%; microangiopathy decreases by 37%; and amputation or mortality due to peripheral vascular disease decreases by 43%. Once glycated hemoglobin exceeds 7%, the risk of cardiovascular disease increases by more than 50%.
As the internationally recognized “gold standard” for diabetes monitoring, only when glycosylated hemoglobin meets the standard can diabetes complications be prevented and patients can benefit in the long run. For “old patients” who have had the disease for many years, the glycosylated hemoglobin index helps to understand how the disease is being monitored and to adjust the treatment plan in a timely manner, so regular testing is even more important.
Patients with diabetes whose blood glucose control has reached the standard and is relatively stable should have their glycosylated hemoglobin checked twice a year. Those who need to change their treatment plan, those with unstable blood glucose control status and those who are on insulin therapy should have their glycated hemoglobin checked once every three months.
4.Blood pressure
High blood pressure is undoubtedly an aggravating factor for diabetic patients. This is because hypertension can promote and aggravate diabetic complications, such as fundopathy and nephropathy. Diabetic patients with combined hypertension are advised to buy a blood pressure monitor, learn to self-measure blood pressure at home, and insist on measuring it once a week, which can measure blood pressure at different times to figure out the pattern of blood pressure fluctuations. Patients with high and unstable blood pressure can be monitored by ambulatory blood pressure, and the correct treatment and guidance can be provided by a cardiovascular physician.
5.Lipid series include cholesterol, triglyceride, HDL cholesterol and LDL cholesterol.
More than half of diabetic patients have combined dyslipidemia. Patients with combined hypercholesterolemia, hypertriglyceridemia and high LDL or low HDL are at higher risk of cardiovascular disease and aggravate insulin resistance, therefore, correction of dyslipidemia is an important part of diabetes treatment.
Patients with diabetic hyperlipidemia should be reviewed once every 1 to 3 months during treatment. If the lipids are reduced to normal, they can be checked once every three months to six months. If the lipids are normal, monitoring once or twice a year is usually sufficient. If it is not normal, it is necessary to increase the number of monitoring, 3 to 4 times a year, and under the guidance of the doctor, select or adjust the medication according to the type and degree of lipid abnormality.
6.Liver and kidney function monitoring
Diabetic patients have glucotoxicity to important organs due to long time elevated blood sugar, which can damage their vascular endothelial cells and lead to atherosclerosis, and then damage the function of organs. Those with normal liver and kidney function can be rechecked every six months to a year, and those with problems should ask professional physicians to give guidance and increase the number of rechecks.
7. Cardiovascular, cerebrovascular and limb artery related examinations.
Cardiovascular complications are common complications in diabetic patients and are the first factor affecting the survival rate of diabetic patients. Many patients can have cardiovascular complications without symptoms. In other words, some diabetic patients are not aware that they have cardiovascular problems. Regular checkups of some relevant indicators for timely attention and prevention can delay the occurrence and development of complications. These examinations include electrocardiogram, cerebrovascular imaging, vascular ultrasound, etc., which can be done every six months to a year according to the professional physician’s recommendation. Patients with a history of diabetes for more than 5 years should undergo carotid ultrasound at least once a year, and once stenosis or plaque is detected in the carotid artery, stenting can be performed according to the condition, along with the use of plaque stabilizing drugs, statin lipid-lowering drugs and low-dose aspirin. Patients with hypertension should also pay attention to antihypertensive treatment.
8. Eye examination
Long-term hyperglycemia and hypertension can damage the blood vessels and nervous system of the eyes, causing various eye lesions such as diabetic retinopathy, diabetic cataract, diabetic optic neuropathy, etc., which eventually lead to serious damage of vision. Early treatment is more effective, however, once vision is significantly reduced or even proliferative retinopathy develops, it can lead to intraocular hemorrhage and retinal detachment.
Patients with diabetes should visit their ophthalmologist regularly. 5 years after the onset of type 1 diabetes, the fundus should be examined once a year; from the onset of type 2 diabetes, the fundus should be examined once a year; if retinopathy is present, the ophthalmic follow-up should be shortened, such as once every six months or three months. With the progress of medicine, the life expectancy of diabetic patients can already reach the average level of the population, the prerequisite of which is the prevention of various complications. Maintaining a healthy lifestyle, a correct and standardized treatment plan, and regular and necessary monitoring are the right choices for diabetic patients to live with the disease.