Diabetes – beyond the routine tests

If you are a diabetic, remember it is not sufficient to merely check your blood sugar at fasting and post prandial. There are a whole range of tests which, if performed regularly, can keep a person free from complications, improve his quality of life and even lifespan.

“Of the total number of people who are detected with diabetes, only about 20 per cent go in for the kind of comprehensive testing that is required annually,” says A.Paneerselvam, diabetologist, Aruna Diagnostics Lab, and Aruna Diabetes Centre. The rest, are irregular with the check-ups, or do only blood sugar counts regularly, he adds. “Diabetes and its complications will silently creep upon you. Testing will ensure that we pick up complications early.”

V. Mohan, chairman, Dr. Mohan's Diabetes Specialties Centre, says it is important to keep a close watch on the eyes, kidneys, heart and feet, the four areas that are hit hard by diabetes. A detailed retinal examination with dilated pupils, testing for micro albuminaria and creatinine, a detailed foot examination to check sensitivity and blood circulation, and an ECG, all on an annual basis, would be part of the list of tests he writes out for a patient.

In addition, all diabetologists insist on the HbA1C test to be performed every three months. This is an indicator of the glucose level in the body over the period, and is a good indicator of how good or bad control has been. “A high HbA1c level indicates poor control, ideally, if your count is 6.5 or less, you have a better chance of avoiding complications,” according to Dr. Paneerselvam.

Kidney function can be measured by doing tests to pick up microalubumin, and creatinine levels in the urine. While the former sounds an alarm even when the kidney function is affected by merely five per cent, creatinine levels will pick up kidney damage at a later stage, he adds. But as very few actually take these tests, patients come in an emergency or with puffy feet and faces, when kidney damage has been pretty extensive.

“From the day of diagnosis of diabetes, irrespective of the age of onset, these annual tests are necessary. In our country, patients cite a number of reasons for not doing their annual tests and think doing occasional blood sugar tests would suffice. An annual package may cost Rs.3,000 or about that. What we need to tell them is that you can pick up complications very early, and even reverse them. That makes it completely worth the effort and time,” Dr. Paneerselvam added. “About 60 per cent of our patients come back regularly,” Dr. Mohan adds. “The rest don't come back at all, for various reasons.” Some of them come in emergency situations, and those who do not come regularly are naturally more prone to complications. “Early and aggressive treatment of diabetes will help patients prevent the avoidable build of sugar in the system. The burden keeps accumulating for as long as you don't do the tests, with the organs getting imprinted with high blood sugar, leading to deterioration.”

Dr. Paneerselvam adds that diabetes medication must be titrated and adjusted according to blood sugar values. “Some people keep taking the same dosage for years on end without review. Testing cholesterol levels once a year is also important to keep vascular events at bay,” he explains.

Good blood sugar control with lifestyle modifications – including following the recommended diet and exercising – comes on the prescription. Take that seriously, but also take what the doctor writes at the bottom of the sheet – the date for your next annual review or HbA1c test.