Show When you have diabetes, you’re no stranger to tests that keep track of your disease. Most look at your blood, but there are others. Two simple ones that check your urine can help you and your doctor watch for kidney disease and severe high blood sugar. About one-third of people with diabetes have problems with their kidneys. But early and tight control of your blood sugar and blood pressure, plus help from certain medications, can keep these organs working like they should To check for problems, your doctor can do a test that measures the amount of protein in your urine, called microalbuminuria. It shows up when small amounts of albumin (the main protein in your blood) seep into your pee. Without treatment to slow the leak, your kidneys could be damaged and eventually fail. You should get this test every year starting as soon as you’re diagnosed with type 2 diabetes. That’s because high blood sugar is usually present many years before you find out you have the disease. If you have type 1 diabetes, you probably won’t get the test until you’ve been diagnosed for 5 years. If the test is positive, your kidneys are leaking protein into your urine. This is a sign that your kidneys are not working as well as they should -- even if you feel fine and have no symptoms. Your doctor will suggest medications or lifestyle changes to help control these conditions:
If you have type 1 diabetes, your doctor could ask you to check the urine for ketones. Your body makes them when it doesn’t have enough insulin and turns to fat stores to create energy for your cells. Ketones are toxic in large amounts. Too many of them can cause a life-threatening emergency condition called ketoacidosis. Your doctor can check for ketone levels, or you can do it at home with an over-the-counter kit. You simply dip a test strip into your urine. It will change color, and you’ll compare it to a chart to see what your reading means. If you have type 1 diabetes, you may need to check your urine for ketones if:
If you have type 2 diabetes, there isn’t much chance you’ll have too many ketones, even if you’re taking insulin. But it could happen during a severe illness. Your doctor may tell you to check your urine when:
A urine test for ketones should always be negative. Report a positive result to your doctor immediately. You should also let them know right away if your blood sugar remains high or if you have stomach pain, nausea, vomiting, rapid breathing, sweet-smelling breath, or if you’re peeing a lot. The doctor may tell you to:
Keep detailed records of any urine or ketone tests you perform. These can help alert you and your doctor to any problems. Bring them with you on every office visit. American Diabetes Association. 4. Comprehensive medical evaluation and assessment of comorbidities: standards of medical care in diabetes-2020. Diabetes Care. 2020;43(Suppl 1):S37-S47. PMID: 31862747 pubmed.ncbi.nlm.nih.gov/31862747/. Brownlee M, Aiello LP, Sun JK, et al. Complications of diabetes mellitus. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ,eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 37. Centers for Disease Control and Prevention website. Your diabetes care schedule. www.cdc.gov/diabetes/managing/care-schedule.html. Updated December 16, 2019. Accessed July 10, 2020.
Numbers are a fact of life for people with diabetes. There are blood glucose levels. Grams of carb. Units of insulin. Those are all important, but so are the target numbers for screenings that can help you stay healthy for years to come. If you have type 1 or type 2 diabetes, you’re at an increased risk of other serious health conditions, including heart, kidney and eye disease. Here’s a list of some important medical screenings for people with diabetes—and how to make sure you’re in the target zone based on our Standards of Medical Care in Diabetes.
What It Is: A blood test that measures your average blood glucose level over the past two to three months. An A1C of less than 5.7 percent is considered normal; 5.7 to 6.4 percent is considered prediabetes; and an A1C of 6.5 or higher indicates diabetes. Why You Need It: A high A1C is a sign of frequent high blood glucose, which puts you at risk for complications such as nerve damage, kidney disease and vision impairment. Target Number: Less than 7 percent for many adults. However, A1C is individualized, and your doctor may give you a higher or lower A1C goal, depending on your needs. For instance, women with diabetes should aim for an A1C as close to normal as possible before trying to get pregnant and during pregnancy. A more relaxed goal may be necessary for kids or adults who experience frequent low blood glucose (hypoglycemia) or who don’t experience symptoms of hypoglycemia (hypoglycemia unawareness). Older adults are more at risk for lows and may have other health complications, such as heart disease, that require extra caution. In these cases, an A1C of less than 8 percent may be appropriate. How Often: It depends on whether you’re meeting your treatment goals, but usually:
Learn More: Get the facts on A1C—and learn how it’s different from the number on your blood glucose monitor—at diabetes.org/A1C. 2. Albumin-to-Creatinine Ratio (ACR)What it is: A urine test that checks how much albumin is in your urine. Albumin is a type of protein, and too much is a sign of kidney damage. Why You Need it: Early treatment, along with well-managed blood glucose and blood pressure, can prevent or slow the progression of chronic kidney disease. Target Number: Less than 30 mg/g of urine creatinine How Often: Once a year, if you have type 2 diabetes or have had type 1 diabetes for at least five years. More frequently, if your previous test above the target. 3. Ankle-Brachial IndexWhat It Is: A blood pressure reading measured at your ankle. Results are compared with a blood pressure reading from your arm to screen for peripheral artery disease (PAD), a condition in which clogged arteries reduce blood flow to your lower limbs. Why You Need It: PAD can cause leg pain, weakness and numbness, especially when walking or doing exercises involving the legs. It can also make it more difficult for foot sores to heal, raising your risk for amputation. If you have diabetes, you have a greater chance of developing PAD. Target Numbers: 0.9 to 1.3 How Often: You need this test only if you have symptoms of PAD. 4. Blood PressureWhat It Is: A measurement of the force of blood flow inside your blood vessels. Why You Need It: Diabetes raises the risk for high blood pressure, which increases your chances of heart disease, stroke, vision loss and kidney disease. Target Number: Less than 140/90 mmHg Learn More: A goal of under 140/90 mmHg is fine if you have a low risk for heart disease (you’re not overweight, you don’t smoke and you don’t have a family history), but your doctor may adjust that target if you have heart disease or a high risk for it. In that case, strive for under 130/80 mmHg. How Often: Get checked at every visit with a health care provider. 5. Bone Mineral DensityWhat It Is: A scan that helps estimate the density of your bones—usually measured at the hip and spine—and how likely they are to break. Why You Need It: People with type 1 and type 2 diabetes are at a significantly higher risk for hip fractures and osteoporosis. If you have additional risk factors—such as having previous fractures or having gone through menopause—talk to your doctor about whether you need a bone density scan. Target Number: A T-score of -1.0 or above. (A T-score indicates how much higher or lower your bone density is than that of a healthy 30-year-old adult.) Learn More: A T-score between −1.0 and −2.5 indicates low bone density. If your T-score is below −2.5, you have osteoporosis and will need medication. How Often: Most providers suggest a baseline scan for women when they begin menopause and for men at around age 50. 6. Body Mass Index (BMI)What It Is: A measure of body fat based on your height and weight. Why You Need It: Body mass index can indicate whether you’re at a healthy weight, overweight, or obese. Added weight increases your chances of a range of conditions, including prediabetes, type 2 diabetes and heart disease. Target Numbers: 18.5 to 24.9 How Often: Get checked at every visit with a health care provider. If you know your height and weight, you can get your BMI using our calculator. 9. Cholesterol & TriglyceridesWhat It Is: A series of blood tests, known as a lipid panel, that measures your cholesterol—the waxy, fat-like substance in your blood—and your triglycerides, blood fats that circulate in your bloodstream. The results are broken down into:
Why You Need It: Diabetes puts you at greater risk for high LDL cholesterol and triglycerides, both of which raise your chance of developing cardiovascular disease. Target Numbers: Discuss the right target for you with your health care provider—and whether you should be taking a statin. Why? The American Diabetes Association (ADA) recommends statin therapy for most adults with diabetes, regardless of their specific lipid levels, based on their cardiovascular risk. How Often: It depends on your age and other health factors. Some guidelines:
7. Dilated Eye ExamWhat It Is: An eye doctor (optometrist or ophthalmologist) will examine your eyes for signs of diabetic eye disease, including diabetic retinopathy. The doctor will also check for other eye problems, such as glaucoma and cataracts. Why You Need It: Diabetes puts you at risk for diabetic eye disease. How Often: It depends on your type of diabetes and how long you’ve had it. Some guidelines:
Learn More: The American Diabetes Association has information and resources to help you take control of your eye health. Learn more about our eye health initiative, Focus on Diabetes™, at eyehealth.diabetes.org. 8. Estimated Glomerular Filtration Rate (eGFR)What it is: An estimate of how well your kidneys function. Your eGFR is based on the level of creatinine in your blood and other factors, such as your age and gender. Why You Need It: People with diabetes have an increased risk for kidney disease. Target Number: An eGFR higher than 80 ml/min/1.73 m2. Normal is around 100 to 120 ml/min/173 m2. How Often: Once a year, if you have type 2 diabetes or have had type 1 diabetes for at least five years. At least twice a year if your previous test showed signs of kidney disease. |
Routine checks for microalbuminuria help to determine whether diabetes is affecting the eyes
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