3 Diabetes Tests You Must Have

Even before you notice symptoms, high blood sugar can damage parts of your body.
That's why certain diabetes tests to check blood sugarcontrol and to catch problems
early are so crucial.
But many patients aren't getting key diabetes tests at least annually, such as
the hemoglobin A1c test, a dilated eye exam, and a foot exam.
"If you look at the nationwide data, it's sobering," says Enrico Cagliero, MD, a diabetes
researcher and assistant professor of medicine at Harvard Medical School. "A lot of
diabetic patients are missing essential checks."
"People with diabetes should know that complications aren't inevitable," Cagliero says.
"Unfortunately, we still see a lot of complications, and a lot of those could have been
prevented. It's absolutely essential to get into this preventive mode as soon as possible.
It definitely pays down the road."
Don't miss these diabetes tests.

Diabetes Test #1: Hemoglobin A1c

This diabetes bloodtest, 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.
Here's how this test works. Your red blood cells contain hemoglobin, which allows cells
to transport oxygen to tissues. As a cell ages, the hemoglobin becomes increasingly
"glycated," meaning that more glucose molecules stick to it. Higher glucose levels in the
blood mean higher glycated hemoglobin, which translates into a greater HbA1c reading.

Normal HbA1c is 5% or less.

An HbA1c value above 7% means diabetes is poorly controlled. People with
diabetes should aim for an HbA1c value below 7%.
You don't need to fast or prepare for an HbA1c test. Ask your doctor how often you need
to be tested. Doctors usually recommend every 3 to 6 months.
Keeping blood sugar under control has been proven to reduce risk of complications. In
the landmark, 10-year Diabetes Control and Complications Trial (DCCT), researchers

studied how careful blood sugar control affected the rate of complications from type 1
diabetes. Among 1,441 subjects, those who received intensive treatment to achieve
tight blood sugar control had an average HbA1c of about 7%, while those on standard
therapy averaged about 9%. The group with tight control had much lower risk of
complications:

76% reduced risk of eye disease

50% reduced risk of kidney disease
60% reduced risk of nerve disease

Diabetes Test #2: Dilated Eye Exam

If you have diabetes, your ophthalmologist or optometrist should perform a dilated eye
exam, in which the pupils are widened with drops, to check for signs of diabetic
retinopathy.
With diabetes, high blood sugar damages tiny blood vessels in the retina, the lightsensitive tissue at the back of your eye. In a more advanced form called proliferative
retinopathy, new blood vessels grow along the retina and in the clear, gel-like vitreous
that fills the inside of the eye. Without treatment, these new vessels can bleed,
blurvision, severely damage the retina, and lead to vision impairment or blindness.
In this country, diabetic retinopathy is the top cause of blindness in adults under age 65.
Each year, as many as 24,000 people with diabetes lose their sight, according to the
National Eye Institute (NEI).
The good news: when doctors detect diabetic retinopathy, they can help prevent vision
loss with timely and highly effective treatments, such as laser surgery to seal leaking
blood vessels.
"Prevention is absolutely the key. If the patient waits until the vision is gone, it's probably
not going to be restored to normal," Cagliero says.

All people with type 1 or type 2 diabetes should have a dilated eye exam at least once a
year as part of a complete eye exam. Early retinopathy may cause no noticeable
symptoms, so regular eye examsare crucial for detecting emerging problems.
"A lot of patients tell me, 'I see fine. Why should I go and see the eye doctor?'" Cagliero
says. "I tell them, 'That's exactly the time to go see the eye doctor because you can
keep your vision great.'"

Diabetes Test #3: 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.

Diabetes Test #3: Foot Exam continued...

Remove your socks and shoes each time you visit your doctor as a reminder for him or
her to check your feet for sores and infections.
Once or twice a year, your doctor should do a more thorough foot exam. Ask him or her
to make sure your foot nerves and blood circulation are all right.
Between doctor's visits, follow a daily routine of caring for your feet and inspecting them.
Carefully check the top and bottom of your feet and between your toes. Look for sores
or ulcers, breaks in the skin,blisters, redness that suggests an infection,
ingrown toenails, or any other changes that worry you. Report any problems to your
doctor right away.
Other preventive tips:

Protect your feet with comfortable shoes that fit well. Before you put on shoes,
always check to make sure there are no pebbles or other objects inside.
Test water temperature before you put your feet in to prevent burns.
Wash your feet daily with soap and water and dry them thoroughly to help
prevent infection.

After bathing, moisturize dry skin on your feet with lotion, petroleum jelly, lanolin,

or oil to prevent skin from cracking, which can lead to infection. Don't put lotion between
your toes.
Ask your doctor to show you how to trim toenails. Soak your feet in lukewarm

water to soften nails and trim them straight across to avoid ingrown toenails.
If you have corns or calluses, have them checked and removed by a podiatrist,

a health care professional who specializes in managing foot diseases.

Exercise regularly and avoid smoking to promote good circulation.
Don't walk around barefoot.

Other Diabetes Tests

In addition to these three diabetes tests, the National Institute of Diabetes and Digestive
and Kidney Diseases (NIDDK) recommends that you also get these tests:

Blood lipids tests. This test checks your LDL (bad cholesterol) and HDL

(good cholesterol) and triglyceride levels. Lipid profilescreening should be done at least
once a year.
Kidney function tests. 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 check. 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

Diabetes - tests and checkups

Routine diabetes tests

Description
People who take control of their own diabetes care by eating healthy foods and living an
active lifestyle often have good control of their blood sugar levels. Still, regular health
checkups and tests are needed. These visits give you a chance to:

Ask your doctor or nurse questions

Learn more about your diabetes and what you can do to keep your blood sugar in
your target range

Make sure you are taking your medicines the right way

See your doctor

See your diabetes doctor for an exam every 3 to 6 months. During this exam, your
doctor should check your:

Blood pressure

Weight

Feet
See your dentist every 6 months, also.

Eye exams
An eye doctor should check your eyes every year. If the exam shows no problems
developing, you can have your eyes checked every 2 years. See an eye doctor who
takes care of people with diabetes.
If you have eye problems because of diabetes, you will probably see your eye doctor
more often.

Foot exams
Your doctor should check the pulses in your feet and your reflexes at least once a year.
Your doctor should also look for:

Calluses

Infections

Sores

Loss of feeling anywhere in your feet (peripheral neuropathy)

If you have had foot ulcers before, see your doctor every 3 to 6 months. It is always a
good idea to ask your doctor to check your feet.

Hemoglobin A1c tests

An A1c lab test shows how well you are controlling your blood sugar levels over a threemonth period.
The normal level is less than 6%. Most people with diabetes should aim for an A1c of
less than 7%. Some people have a higher target. Your doctor will help decide what your
target should be.
Higher A1c numbers mean that your blood sugar is higher and that you may be more
likely to have complications from your diabetes.

Cholesterol
A cholesterol test measures cholesterol and triglycerides in your blood. You should have
this kind of test in the morning, after not eating since the night before.
Adults with type 2 diabetes should have this test every year. People with high
cholesterol may have this test more often.

Kidney tests
Once a year, you should have a urine test that looks for a protein called albumin.
You will have more of this protein in your blood if you have early kidney damage due to
diabetes. But the level of this protein in urine can also be higher for other reasons.
Your doctor will also have you take a blood test every year that measures how well your
kidneys work.

DIABETIC FOOT PAIN

by Kenneth B. Rehm, DPM
Includes photo of Dr. Kenneth B. Rehm, DPM

Diabetes is one of the most common reasons people seek relief for painful feet.
With diabetes, four types of foot problems may arise in the feet.

Nerve Problems due to Diabetes

The most common contributor to diabetic foot pain is a nerve problem called
Peripheral Neuropathy. This is where the nerves are directly affected by the disease
process. There are basically three types of peripheral neuropathy: sensory, motor,
and autonomic neuropathy.
A large percentage of pain diabetic patients complain of is due to sensory
neuropathy. This can show up as "sensitive pain," where the amount of pain is not
proportional to the amount of insult that is causing it. For instance, just touching
the skin or putting a sheet over your feet in bed could be painful. This can be
present at the same time as numbness in the feet. Sensory neuropathy symptoms
can include burning, tingling or a stabbing pain.
Relief is foremost on someone's mind when painful neuropathy has raised its ugly
head. The first thing to do is to check your blood sugar for the past several weeks
to see if there has been a trend toward high blood sugar (Editor's Note: The A1c
test is traditionally employed to determine this, and should be repeated about every
three months.) Persistent high blood sugar can contribute to this type of pain.
Massaging your feet with a diabetic foot cream, or using a foot roller, often takes
the edge off the pain. Vitamin B preparations are often recommended; and there are
a variety of prescription medications that do work. Using cushioned, supportive
shoes and foot support inserts is always needed to protect the feet from the
pounding, rubbing and irritating pressures that contribute to neuropathic pain.
Motor neuropathy can contribute to another painful diabetic condition. The nerves
to the muscles become affected by the disease process. This makes the muscles feel
weak and achy. Some of the first muscles to become affected are those in the thigh;
other common muscles include the shin muscle and the small muscles of the feet.
When motor neuropathy is present, walking imbalances can result. These can cause
increased rubbing of the foot in the shoe, inflammation of the skin, increased
callous formation, and pain.
Helping yourself against the ravages of motor neuropathy involves correcting those
walking imbalances with supportive shoes and foot support inserts. Foot exercises,
massage and using foot rolling devices are excellent ways to help keep those
muscles and joints from becoming stiff.

Keep the muscles working and the joints moving!

Autonomic neuropathy affects the nerves to areas that are not under our conscious
control. The sweating mechanism is altered -- so the person who suffers with this
condition may have thickened, dry cuticles and nails; as well as dry, stiff, cracked
skin -- which is subject to a buildup of thicker calluses with more pain. Bacterial
and fungal infection could be more likely; an additional source of pain and
concern.
Daily use of toenail oil and conditioning foot cream made specifically for diabetic
foot care can play an essential role in preventing these problems.

Circulation Problems
Circulation problems in the feet may cause intense pain, even though the feet may
feel numb to the touch. This is due to the effect of high blood sugars on the
arteries, capillaries and veins. Arteries feed fresh blood away from the heart. This
fresh blood nourishes and provides oxygen to the tissues. The blood enters and
leaves the tissues through capillaries and goes back up to the heart to get refreshed
with oxygen and nourishment by way of the veins.
The arteries most commonly affected are those behind the knee and the calf. These
arteries are subject to the same fatty deposits that most people have, however, the
process can be accelerated in diabetes. These fatty deposits thicken the walls of the
arteries, and may develop calcium deposits. Blood flow to the feet could then be
partially or totally blocked. Because the tissues are starving for oxygen, this can be
an extremely painful process. Such pain is often described as though the feet are in
a vise, and are being strangled.
The capillaries are known to get thickened and stiff from diabetes -- thus not as
efficient in delivering oxygen and nutrients to and from the tissues.
The veins can get swollen and painful. This happens when the arteries cannot
handle the blood flow, and little channels are created to direct the blood over to the
veins instead of trying to push the blood through closed arteries. Sometimes there
is more blood than the veins can handle. They become so full that the valves
become broken. Blood then pools in the feet and legs and can leak out into the
skin, creating ulcerations, which can be very painful.

With the approval of your medical doctor, support hose, exercise, massage,
physical therapy, medications and various surgical procedures can be used to
improve the circulation.

Muscle & Joint Problems

Muscle and joint problems in the diabetic patient are a frequent source of
discomfort and pain. The muscles are affected by diabetic neuropathy, circulation
problems and atrophy. The tendons (attachment of the muscle to the bones) may
become stiff and contracted due to the walking imbalance associated with
peripheral neuropathy.
This walking imbalance forces the foot and joints to move in ways that are not
healthy and that Mother Nature never intended. In addition, they may stiffen in this
bent position because of the excess blood sugar combining with the proteins in the
joints. This is called diabetic glycosylation of the joints.
This, combined with the normal imbalance all people, including non-diabetics, are
subject to, can lead to stiff hammertoes, bunions, spurs, and tiny fractures with
dislocation of the bones (called Diabetic Charcot Deformity). These problems can
be sources of pain, infection, ulceration and major medical concern.
With consent from your foot healthcare provider, foot rollers, massage and
specially made shoes and inserts might be the best way to deal with these muscle
and joint problems.

Frequent Infections
Diabetic persons become more susceptible to bacterial, fungal and yeast infections
due to medical and nutritional changes that takes place in the body.
Bacterial infections show up in areas on the foot that become irritated, ulcerated or
injured. The signs of a bacterial infection include redness, swelling, warmth, pain
and tenderness as well as the presence of pus. (Editor's Note: Blind diabetics can
detect foot infections by touch, and, in some cases, by smell.) This kind of
infection can either be on the skin, called cellulitis, or can spread to the bone.
When infection has spread to the bone it is called osteomyelitis. It is interesting
that even though a diabetic may have numbness in their foot, they could sometimes
feel pain when they have a bacterial infection. When a diabetic suddenly develops
pain while their feet are numb, it could be a sign that an infection is present -- and
a health care provider should be contacted without delay.

Fungal or yeast infections in the foot commonly occur as athlete's feet or fungal
toenails. Athlete's feet can cause the skin to become blistered, scaly, red, inflamed
and painful. A bacterial infection can occur on top of this because the irritated skin
serves as a good place for germs to thrive. Fungal toenails can become very thick,
powdery and ingrown. These thick nails can leave debris under the nails and cause
severe irritation to the skin surrounding the nails. They can even become ingrown
with callused nail grooves. This can cause infection to the areas surrounding the
nail and is a source for medical concern.
In order to maximize a person's ability to fight off infections, think strengthen the
immune system. This comes from good blood sugar control, moderate exercise,
good nutrition and supplements, if recommended by your health care professional.
Fungus can make the skin raw and fungus toenails can become thick, irritating,
painful and infected with bacteria. Self-inspection and daily maintenance of the
skin and nails is essential to prevention. Once your toenails or skin on the feet
become infected with fungus, it is important to treat it right away to prevent
ulceration and bacterial infection. Medications prescribed by your foot healthcare
professional are recommended, but various over-the-counter and home remedies
have found success. The use of tea tree oil, sesame oil, garlic, grapefruit seed
extract, and galberry root soaks are among them.
It is important to note that not all diabetics can detect the pain of these problems -and therefore should have their feet visually and manually inspected every day. Be
Prudent, Be Cautious and Follow the Rules of Good Health!
From the Editor: Dr. Kenneth B. Rehm, DPM, is a podiatrist whose practice is
limited to the diabetic foot. He is the medical director of the Diabetic Foot and
Wound Care Center, in San Marcos, California; telephone (760) 744-6226. Along
with expert care and instruction, he offers several products he has developed for
the diabetic foot. Originally from Cleveland, Ohio, Dr. Rehm graduated from
California College of Podiatric Medicine in 1976, and has been in practice for
more than 25 years. Consulting Editor to Podiatry Management magazine, he is
also an active lecturer, and has been keynote speaker for our Diabetes Action
Networks annual meeting

Diabetic Nerve Pain: 10 Foot Care Tips to

Protect Yourself
In this article

1. Check both feet daily.

2. Wash with warm -- not hot -- water.

3. Make sure your shoes fit well.

4. Skip the barefoot look.

5. Speak up.

6. Stay soft, but dry.

7. Try non-impact exercise.

8. Fix bunions, corns, and hammertoes.

9. Consider fitted orthotics.

10. Control your blood sugar.

Protect Your Feet

Diabetes can mean double trouble for your feet. First, diabetes can reduce blood flow to
your feet, depriving your feet of oxygen andnutrients. This makes it more difficult
for blisters, sores, and cuts to heal. And second, the diabetic nerve
damage called peripheral neuropathy can cause numbness in your feet. When you can't
feel cuts and blisters, you're more likely to get sores and infections.
If you don't notice or treat the sores, they can become deeply infected, and lead
to amputation.
Diabetic peripheral neuropathy can also cause sharp pain in your feet. You may become
excruciatingly sensitive to the lightest touch, like the sheets on your bed.
Fortunately, a little TLC goes a long way in preventing foot problemsfrom diabetes.

Diabetes Testing

Three blood tests are available to diagnose prediabetes and diabetes:

Casual plasma (blood) glucose
Fasting plasma glucose (FPG)
Oral glucose tolerance test.

To make a diagnosis, the results of each test must be confirmed by repeat testing on
a different day, unless you have obvious symptoms of elevated blood glucose
(hyperglycemia). If diabetes is diagnosed, you'll need periodic hemoglobin A1c
(HbA1c) tests to monitor your blood glucose control.
- See more at: http://www.healthcommunities.com/understanding-diabetes/lab-tests-fasting-plasma-glucose-oralglucose-tolerance-a1c.shtml#sthash.U8s73N79.dpuf

Casual plasma (blood) glucose test

This test measures blood glucose levels at any time of day, no matter when you had
your last meal. It is most often used in people who have classic diabetes symptoms
such as excessive thirst, frequent urination, and unexplained weight loss. The
criteria for a diagnosis of diabetes with this test is the presence of diabetes symptoms
and a blood glucose level of 200 mg/dL or higher.

Fasting plasma glucose (FPG) test

he fasting plasma glucose test is the preferred method for diagnosing diabetes in
children, men, and nonpregnant women. The test measures blood glucose levels
after an overnight fast (no food intake for at least eight hours). A diagnosis of
diabetes is made when the fasting blood glucose level is 126 mg/dL or higher on at
least two tests. Values of 100125 mg/dL indicate prediabetes. A normal fasting
blood glucose level is less than 100 mg/dL.

Oral glucose tolerance test

This test is done when diabetes is suspected, but you have normal results on a
fasting plasma glucose test. For the test, you'll have to fast overnight and then drink
a very sweet solution containing 75 g of glucose. A sample of your blood will be
drawn two hours later. Normal glucose levels are less than 140 mg/dL at two hours.
The criterion for a diagnosis of diabetes with this test is a two-hour blood glucose
level of 200 mg/dL or higher. Prediabetes is diagnosed if the two-hour blood glucose
level is 140199 mg/dL.

- See more at: http://www.healthcommunities.com/understanding-diabetes/lab-tests-fasting-plasma-glucose-oralglucose-tolerance-a1c.shtml#sthash.U8s73N79.dpuf