Tests to stay healthy with Diabetes

Diet, Exercise, Medicine and monitoring are the 4 pillars for management of diabetes. To know if one is effectively managing diabetes, one needs the help of monitoring.

Microvascular and macrovascular complications¹

Eye fundus examination : Diabetic retinopathy is the most common eye disease for people with diabetes. One can have diabetic eye disease and not know it as it is painless and often has no symptoms. Although there are a variety of treatments to treat diabetic retinopathy, the earlier it is diagnosed the more effective is the treatment. Screening for retinopathy should start from 10 yr of age, or at onset of puberty if this is earlier, with 2–5 yr diabetes duration

Urine Microalbuminurea and Serum Creatinine : To detect kidney damage at earliest, urinary protein/microalbuminura should be checked start from 10 yr of age, or at onset of puberty if this is earlier, with 2–5 yr diabetes duration. This test detects if the kidneys are leaking small amounts of protein. If detected early doctors can prescribe medication to delay damage to the kidneys.

Annual screening for albuminuria should be undertaken by any of these methods: first morning urine samples for urinary albumin/creatinine ratio (ACR) or timed urine collections for albumin excretion rates (AER)

Blood Pressure : Blood pressure (BP) should be measured at least annually. Hypertension is defined as average systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) that is >95th percentile for gender, age, and height on more than three occasions. The blood pressure target for adolescents is <130/80 mmHg. Confirmation of hypertension may be assisted by 24 h ambulatory blood pressure measurements.

Lipid Profile : Screening for dyslipidemia should be performed soon after diagnosis (when diabetes stabilized) in all children with type 1 diabetes aged >10 yr. If normal results are obtained, this should be repeated every 5 yr. If there is a family history of high cholesterol levels, early cardiovascular disease (CVD) or if the family history is unknown, screening should be as early as 2 yr of age.

Other Complications & Diabetes Associated Conditions²

1. Monitoring of growth and physical development.
2. Screening of thyroid function by measurement of thyroid stimulating hormone (TSH) and antithyroid peroxidase antibodies: is recommended at the diagnosis of diabetes and, thereafter, every second year in asymptomatic individuals without goiter or in the absence of thyroid autoantibodies. More frequent assessment is indicated otherwise.
3. Screening for celiac disease should be performed at the time of diabetes diagnosis, and every 1–2 yr thereafter. More frequent assessment is indicated if the clinical situation suggests the possibility of celiac disease or the child has a first-degree relative with celiac disease. (Coeliac diseases is caused by intolerance to gluten, a protein found in wheat and wheat products and may result in poor growth and poor blood glucose control. Many children do not show any symptoms and many have nonspecific vague abdominal complaints such as pain, flatulence, diarrhoea etc.)
4. Prevention of lipohypertrophy includes rotation of injection sites with each injection, using larger injecting zones and non-reuse of needles. There is no established therapeutic intervention for lipodystrophy, necrobiosis lipoidica, or limited joint mobility (LJM).
5. Screening for vitamin D deficiency, particularly in high-risk groups, should be considered in young people with type 1 diabetes and treated using appropriate guidelines.

Be an informed patient. One may need some tests more often than indicated or more advanced tests. By, following these tests a child with diabetes can enjoy a healthy and long life.

1 Donaghue et al. Microvascular and macrovascular complications in children and adolescents. ISPAD Clinical Practice Consensus Guidelines 2014 Compendium. Pediatric Diabetes 2014: 15(Suppl. 20): 257–269.

2 Kordonouri et al. Other complications and diabetes-associated conditions in children and adolescents. ISPAD Clinical Practice Consensus Guidelines 2014 Compendium Pediatric Diabetes 2014: 15(Suppl. 20): 270–278.