# Diabetes: Tests/Exams you should have



## SamanthaNY (Aug 24, 2007)

While talking with some friends who happen to be diabetics, I was shocked to learn that they were not aware of some very important yearly tests they _should _be having. Shockingly, some of these tests are also missed or ignored by many doctors. If you have diabetes, here's what you should be doing:

*(Important note: these are in addition to tests and exams that should be part of a yearly physical)*

*Yearly eye exam:* _"diabetes is the leading cause of adult blindness in our country, the dilated eye exam is another important test that should be done every year to prevent blindness or eye damage"_

*Yearly foot exam:* _"Diabetes can cause nerve damage and numbness, as well as decreased circulation that makes it harder for your body to fight infection. Patients with numbness problems may not notice if they injure a foot. A resulting infection may not heal well, and skin and other tissue may die. In a small minority of cases, the problem progresses into a complication that requires amputation."_

*Daily at-home blood glucose testing:* _As recommended by your doctor. _

*Kidney function test:* _ Obesity and diabetes can both negatively impact kidney function. "Get an annual urine test to check for the presence of protein, as well as a blood test at least once a year to check for creatinine. These tests indicate how well your kidneys are working."_

*Blood pressure measurement:* _"Have blood pressure checked at every medical appointment. The goal for people with diabetes is less than 130/80 if they have no complications from the disease. If complications are present, the goal is lower: 125/75"_

*Hemoglobin A1c test: *_"This diabetes blood test, also called HbA1c, tells you and your doctor how well diabetes is managed over time. It measures your average blood sugar in the previous three months to see if it has stayed within a target range."_

*24-hour urine catch analysis:* (thanks to the lovely Michelle for adding this!) When done at first diagnosis, this sets baseline levels for kidney function - extremely useful in judging kidney function over time. 

*Colorectal exam:* At age 50 if there is no cancer in family members - earlier if there is a history of cancer in the family. _"A recent study of 200,000 Americans released in November 2005 by Donald Garrow, MD, a clinical research fellow at the Medical University of South Carolina, concluded that diabetics are 1.4 times more likely to be diagnosed with colon cancer than nondiabetics."_

*Yearly or bi-yearly dental exam/cleaning:* (credit to the lovely jamie for this one) _"Periodontal disease is often linked to the control of diabetes. For example, patients with inadequate blood sugar control appear to develop periodontal disease more often and more severely, and they lose more teeth than persons who have good control of their diabetes. It is possible to have periodontal disease and not have all of the warning signs. If you notice any of the warning signs of gum disease, see your dentist immediately."_ See here for a good faq on diabetes and your teeth. 

In addition, there are clinical tests that your doctor should be doing. A good list is here. 

Print out this list and discuss it with your doctor. Tests may be a nuisance, but learning how to protect yourself *before *conditions get out of hand is far preferable to dealing with the consequences of avoiding tests. 

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## jamie (Aug 24, 2007)

I just wanted to add one. Both of my diabetes doctors have me go for a yearly dental exam. Diabetes and consistently elevated sugars do a war dance on the gums. Gum disease can not only lead tot he loss of your teeth, but also to all kinds of infections that affect the entire body.

I am sad to admit I had never been to the dentist until about two and a half years ago. I had a horrible toothache/abcess that had to be dealt with. Now I am more careful and mindful of my mouth health as well.

And yay me...I went for my first eye exam just a couple of weeks ago. After our initial interview, he kept telling me that there was probably going to be some damage and that we would work with it. Luckily...there was nothing there, my eyes were perfect, behind my eyes was perfect and I have 15/20 vision. Whew.


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## SamanthaNY (Aug 24, 2007)

Wow, very good addition to the list, jamie... thank you! (I'll add it above, with credit to you)

It's shocking to me that people go so long without doctor visits. A friend told me that she had never had an eye exam. Never! And you had never been to a dentist. To me, these are part of basic care and begin in childhood or young adulthood. 

I'm so glad you had no lasting dental damage, and that your eyes are better than perfect. Lucky woman... may it continue!


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## Michelle (Aug 24, 2007)

Good post, Sammie. I'd like to add that a baseline 24-hour urine catch should be done after diagnosis.

And Jamie - yay you on the eye thing


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## SamanthaNY (Aug 24, 2007)

Michelle said:


> Good post, Sammie. I'd like to add that a baseline 24-hour urine catch should be done after diagnosis.



Thanks, Michelle... can you elaborate? I'm not sure what this test is, and the image in my head involves people squatting over a bucket, which I'm sure isn't correct, lol.


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## Miss Vickie (Aug 24, 2007)

What a great thread. Thanks, guys, for getting it going!

And Sammie, the 24 hour urine thing is simpler than it sounds. The way we do it at work is that we keep a large plastic container on ice and then our patients pee in a "hat" (the measuring thing you put in the toilet to catch pee for women -- urinals don't work so well for us) and pour it into the container. At 24 hours it gets sent to the lab and we test the total amount of protein.

We use it to diagnose preeclampsia. I'm frankly not sure what it would be used for with diabetes, other than to somehow check kidney function? (???)

Another thing to look at if you're diabetic or pre-diabetic is your insulin level. It's not a totally common test, (yet) but it does help determine how hard your pancreas has to work to maintain your blood sugar. Rising insulin levels are a sign the pancreas is stressed and could be an early warning sign not only for diabetes but also for PCOS, Syndrome X (aka Metabolic syndrome). Insulin is an important heart disease marker, one that the medicos are just starting to look at.


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## SamanthaNY (Aug 24, 2007)

Yikes, I was kidding about the bucket thing - but that's kinda what it is! LOL. I'm interested in how that's useful for diabetics too - so hopefully Michelle will elaborate. 

The insulin level test - that seems like it would be logical to perform on diabetics, yet I don't see anything like it on the list of clincal tests I linked above (unless I'm just not understanding the technical name). Do you know why it's not regularly used, Vick?


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## Miss Vickie (Aug 24, 2007)

SamanthaNY said:


> Yikes, I was kidding about the bucket thing - but that's kinda what it is! LOL. I'm interested in how that's useful for diabetics too - so hopefully Michelle will elaborate.



Yeah, it's a bucket -- kind of. It's more like a big ol plastic container with a wide lid. But, of course, we call it a bucket at work.



> The insulin level test - that seems like it would be logical to perform on diabetics, yet I don't see anything like it on the list of clincal tests I linked above (unless I'm just not understanding the technical name). Do you know why it's not regularly used, Vick?



I wish I knew, Sammie. I don't really know why they don't use it more. Several years ago, my alternative practitioner did a 3 hr glucose/insulin tolerance test and it gave her a much better picture of how I was doing; at the time there was only one lab that interpreted it, Great Smokies Lab. My sugars were pretty good (except that I became hypoglycemic) but my insulin levels were sky high, which is how I got diagnosed with insulin resistance. This was important to know because cranking out lots of insulin is hard on the pancreas over time, and also insulin is not a very nice hormone in some ways. It's great because it helps us store fat and increases our appetite, but if you want to lose weight it's not helpful (to say the least). 



missaf said:


> I'm doing 24 hour urines to check steroid levels. It's hard to do at home, though, the little cups they give you to pee in just don't hold enough, so I had to improvise with something I could burn after I was done with the test



Missaf, can you get one of those "hat" things to use? I'm sure one of the nurses can score one for you at the hospital, or maybe even a medical supply place. Of course, you're probably done now but if you do another one, maybe they can get you one.


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## Michelle (Aug 24, 2007)

I'm back to elaborate 

There is this thing that goes over the toilet to collect the urine which then is easily poured into a collection jug which is kept refridgerated (gross, I know). The reason they do this is to measure kidney function and use it as a _baseline_ for the future, as one of the serious side effects of diabetes is reduced kidney function over time. Then the annual tests such as micro albumin, creatinine and protein will tell if the kidneys are staying the same or getting worse.

Vickie mentions the insulin test. I think it's called a C Peptide. It's to measure how much insulin the pancreas is still making (by measuring beta cells). Type I diabetics make insulin for up to a year after diagnosis and then totally stop. Type II DM's may always make insulin. Knowing this information can help determine treament.


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## SamanthaNY (Aug 24, 2007)

Ah, okay... the c peptide test is part of the clinical tests I linked to, so we're good there. The urine test sounds valuable too, so I'll add that above. 

Thanks, Michelle!


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## Miss Vickie (Aug 24, 2007)

Michelle that's interesting about C peptide. It's not quite the same thing as measuring actual insulin levels but it somehow (don't know how yet but I'll look it up later) measures how much insulin the pancreas is making; I'm not sure why you'd do one test and not the other, or how the two tests relate to each other. 

As you say, DM II diabetics can still make insulin -- the problem is that their cells aren't receptive to it, which is why drugs like Metformin work because they re-sensitize the cells to insulin.

I have to run some errands but I'll look up the C peptide test and see what I can find. It's not something I use much at all, and frankly didn't know about it so I'm glad to learn more about it. Our diabetics are 99% gestational diabetics and we just use the 3 hour gtt to diagnose them along with lots of finger sticks in labor, unfortunately.


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## Michelle (Aug 24, 2007)

When I went on insulin and started seeing an endocrinologist, she immediately ordered a c peptide to see how much insulin, if any, my pancreas was still making. It's important to treatment. It was my impression, from diabetes education, that there are two kinds of type II's - those who are insulin resistant and those who aren't making enough insulin, thus the importance of measuring the beta cells.

One other thing I wanted to mention in this thread is that now diabetics are being treated as cardiac patients automatically upon diagnosis (or at least they should be). Target cholesterol numbers are lower than the general population targets and lipids are important to measure regularly. Blood pressure should be monitored closely, as high gluclose numbers can constrict blood vessels.

And something else that should be added to the list besides the tests - when one is diagnosed with DM, they should take a diabetes education class. These are normally covered by insurance and are about eight hours worth of education on causes, treatments, nutrition and all sorts of things that are relevent to the condition.


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## CAMellie (Aug 24, 2007)

SamanthaNY said:


> Wow, very good addition to the list, jamie... thank you! (I'll add it above, with credit to you)
> 
> It's shocking to me that people go so long without doctor visits. A friend told me that she had never had an eye exam. Never! And you had never been to a dentist. To me, these are part of basic care and begin in childhood or young adulthood.
> 
> I'm so glad you had no lasting dental damage, and that your eyes are better than perfect. Lucky woman... may it continue!



I am that friend that said she has never had an eye exam (I think), but now, thanks to Sam's urging, I go in on September 4th for my first one. I lurve Sam! :wubu:


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## SamanthaNY (Aug 24, 2007)

CAMellie said:


> I am that friend that said she has never had an eye exam (I think), but now, thanks to Sam's urging, I go in on September 4th for my first one. I lurve Sam! :wubu:



I lurve you too, Mellie! :wubu: 

And I think it's hysterical that we stole eachother's avatar pics, lol.


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## CAMellie (Aug 24, 2007)

SamanthaNY said:


> I lurve you too, Mellie! :wubu:
> 
> And I think it's hysterical that we stole eachother's avatar pics, lol.



It's 'cause we both have such AWESOME taste in pics. :bow: 

By the way, I am also doing the 24 urinalysis...because my kidneys are starting to shut down on me. It wasn't until I returned here to CA that I started to receive PROPER diabetic care. My doctor in GA never examined my feet, never suggested an eye exam, and never checked my creatine or ketones. My current doctor is a VERY brusque man (he would NEVER be invited to any party I throw!), but he knows his stuff.


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## SamanthaNY (Aug 24, 2007)

CAMellie said:


> By the way, I am also doing the 24 urinalysis...because my kidneys are starting to shut down on me. It wasn't until I returned here to CA that I started to receive PROPER diabetic care. My doctor in GA never examined my feet, never suggested an eye exam, and never checked my creatine or ketones. My current doctor is a VERY brusque man (he would NEVER be invited to any party I throw!), but he knows his stuff.



That's part of why I wanted to make up this list - I'm aghast that some doctors don't even mention this stuff! *shakes fist at sky*

It's sucky, but fat people almost have to be their _own _doctors in terms of overseeing our health, so whatever we can do to educate ourselves on forums like this one, we must. If we have to demand certain tests or exams, thank God we have big feet to stomp with.

I'm so glad you're now getting the medical care you need and deserve, Mellie. 

_QQQQQQQQQQQQQQQQ_


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## CAMellie (Aug 24, 2007)

SamanthaNY said:


> _QQQQQQQQQQQQQQQQ_



Qs! I'm in heaven! :wubu:


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## CAMellie (Aug 29, 2007)

I got my lab results today and wanted to share them.
My liver enzymes are back to within normal range now. I am SO happy because this has been an ongoing issue for a few years now. Liver transplant was even discussed at one point.
My total cholesterol level is still high at 259...BUT...that's down from 284 without medication of any kind. I couldn't take statins because of the liver issue. He put me on a medication now, though. My main concern about this medication is the high rate of flushing it causes...and the fact that I have to start a low-dose aspirin regimen with it. Meh...I was told by my doctor (and have read about it) that a type 2 diabetic should be on an aspirin regimen anyways to help prevent a stroke or heart attack.
My A1C is still high at 7.2 but it's down from 8.1 so I'm pleased. The doctor increased my insulin (Lantus) by only 5 units.
My initial urine screening (not the 24 hour urinalysis...that won't be ready for another week) was a-okay. That's quite a relief since previous results had prompted my doctor to discuss dialysis with me. Boy was THAT a scary conversation! My doctor has promised to call me ASAP with the 24 hour results. It's being tested for creatine and cortisol.

Okay...thanks for reading. Buh-bye now! :kiss2:


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## Mz Taz (Mar 5, 2010)

Hi folks

Just thought I would pop on and speak more about the hazards of diabetes and how it effects me. I have gone from being diet controlled to Type 2 tablets to Type 2 insulin and tablet regime in the space of 14 years. I have just passed my 1st year of being on the insulin which I had tried to avoid at all costs but after having the joys of thrush  for the 8th time in the space of 11 weeks last year I had to bite the bullet and get things sorted. 
I have to take a cholestrol tablet (as standard apparently) due to the amount of tablets I have to take an acid suppresant to stop the lining of stomach bleeding and ulcers an of course and again as a standard high blood pressure tablet.
My throid has become affected (underactive) as well as the usual loss of gum strength none of the teeth I have lost since becoming diabetic have been due to decay just gum strength. We don't heal as quick or as well as we use to and any cuts or abrasions leave scars. Another cracker I found out a few years ago is the fact that we are more prone to frozen shoulders and the surgery for this is ok, done via keyhole but still grim.

Maybe I should just asked to be rubbed out and started again


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