1. A1C / eAG
WHAT TO EXPECT: Your health care provider will test your blood to measure your average blood glucose level over the past few months. A high reading can indicate that your diabetes is not well controlled. Sometimes AlC results are shown as an estimated average glucose, or eAG, which is translated into the kind of mg/dl reading you see on your meter.
TARGET: Generally less than 7 percent for A1C and less than 154 mg/dl for eAG. You may have lower or higher targets based on factors such as your age and other medical conditions.
HOW OFTEN: Twice a year if your A1C is in your target range. If your A1C is off target or you're adjusting medications or other treatments, this test is recommended four times a year.
2. Dilated Eye Exam
WHAT TO EXPECT: An ophthalmologist or an optometrist will put drops in your eye to dilate the pupil and then use magnifying equipment to look at the retina, the tissue in the back of the eye that sends the images we see to the brain. This screens for diabetic retinopathy, which includes changes to the retinal blood vessels and can damage vision.
HOW OFTEN: At the time of diagnosis for people with type 2 and within five years of diagnosis for those with type 1. If annual eye exams are clear for at least two years, then exams may be appropriate every two years. If any level of retinopathy is detected, an eye exam should be done at least once a year.
A HOME CARE: Control your blood glucose, cholesterol, and blood pressure to help lower the risk of retinopathy.
3. Blood Pressure
WHAT TO EXPECT: A cuff is a wrapped around your upper arm and inflated to measure your blood pressure. High blood pressure can lead to heart disease, stroke, and kidney disease.
TARGET: Less than 120/80 mmHg is ideal, but people taking blood pressure medication should aim for less than 140/90 mmHg. If your blood pressure is over 120/80 mmHg and you're not on medication, your doctor will recommend lifestyle changes such as improving fitness, losing weight, and eating a healthful diet. If your blood pressure is over 140/90 mmHg, your doctor may prescribe blood pressure medication.
HOW OFTEN: Every doctor visit.
4. Cholesterol
WHAT TO EXPECT: A fasting blood test will measure fats in your blood: LDL, HDL, and triglyceride levels.
ACTION POINTS:
LDL ("bad") cholesterol can stick to artery walls and raise your risk for heart attack and stroke. Are you between the ages of 40 and 75? If you don't have other heart disease risk factors, your doctor will likely recommend a moderate-intensity statin and healthier lifestyle. If you have heart disease, you may need high-intensity statin treatment.
HDL ("good") cholesterol is carried in particles that help remove bad cholesterol from the artery walls and reduce the risk of heart disease. If levels are below 40 mg/dl in men or below 50 mg/dl in women, your doctor may encourage you to step up healthy eating and exercise to increase HDL.
Triglycerides are a measure of fat in the blood and help LDL cholesterol harm the arteries. If your level is 150 mg/dl or higher, your doctor may recommend lifestyle changes, including improved fitness and nutrition. Better blood glucose control may also lower triglyceride levels.
5. Serum Creatinine/eGFR
WHAT TO EXPECT: This test, which measures a specific protein in the blood, screens for kidney disease and monitors its progression.
ACTION POINT: In general, if your estimated GFR is less than 60 ml/min/1.73m2, your kidney function is abnormally low, and your doctor will begin to look for the cause of the decline. If the cause is diabetic kidney disease, medication and better blood glucose and blood pressure control might slow the progre_ssion of kidney damage.
HOW OFTEN: At least once a year if you have high blood pressure, if you have type 2 diabetes, or if you've had type 1 diabetes for five years or more.
HOW OFTEN: It does depend, but at least every five years. Talk to your doctor about when to get your next cholesterol test.
6. Urine Albumin-to-Creatinine Ratio
WHAT TO EXPECT: Using your urine sample, this test screens for kidney disease and monitors its progression.
ACTION POINT: If your results are greater than 30 mg/g and the cause is diabetic kidney disease, using certain medications and improving blood glucose and blood pressure control may slow the progression of kidney damage.
HOW OFTEN: At least once a year if you have high blood pressure, if you have type 2 diabetes, or if you've had type 1 diabetes for five years or more.
7. Foot Evaluation
WHAT TO EXPECT: Your doctor will inspect your feet for any abrasions, ulcers (open sores), wounds, and signs of nerve damage (neuropathy), such as loss of ankle reflexes and loss of sensation in your feet and toes. ·
HOW OFTEN: Once a year -or- more, if you are at high risk for foot problems, such as if you've had an ulcer in the past, have decreased sensitivity, or have peripheral artery disease (PAD).
HOME CARE: Inspect your feet between doctor exams. If you are unable to see the bottoms of your feet, put a mirror on the floor to check them, or ask someone who knows what to look for to check the bottoms of your feet on a daily basis.
8. Ankle-Brachial Index
WHAT TO EXPECT: Your doctor will use an inflatable cuff to measure your blood pressure at your arm and ankle to check for PAD. The condition occurs when arteries in the limbs narrow and reduce circulation, increasing the risk for heart attack, stroke even amputation, if PAD is severe. Testing should be done in patients with symptoms of PAD, including decreased walking speed, leg fatigue, cramping pain brought on by exercise, and the absence of a pulse in the foot.
ACTION POINT: According to the National Heart, Lung, and Blood Institute, a normal result is between 0.9 and 1.3, which is determined by comparing the blood pressure at your arm with that at your ankle. If your results are lower than that range, your doctor may discuss treatment options.
9. Body Mass Index
WHAT TO EXPECT: Step on the scale and stand tall. Your weight and height will be recorded at your visit. Body mass index (BMI) is calculated as a ratio of weight to height and is used to determine if you are overweight or obese.
ACTION POINT: If your BMI is above 24.9, your doctor may discuss weight-loss options. If you have type 2 diabetes and a BMI of 27 or greater, you may be a candidate for weight-loss medications. If you have type 2 and your BMI is greater than 35, you may be considered for bariatric surgery. The risk for weight-related health problems rises with increasing BMI.
HOW OFTEN: Every doctor visit
Diabetes Forecast, July/August 2016
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