Living With Type 2
Living with Diabetes comes with many responsibilities. And one of these is the continual need for lab testing for management of Diabetes Type 2. These diabetes test results minimize the risk of long-term complications, like cardiovascular disease, hypertension, vision related problems and nerve damage, to name just a few.
A majority of these diabetes-related complications are a result of uncontrolled blood glucose levels over a prolonged period of time, particularly elevated blood sugar levels. Hence, it’s crucial that diabetics understand how crucial self-monitoring of blood glucose really is. Every Diabetes Type 2 patient should have easy access to a blood glucose testing kit and must strive to get educated about how to make use of the results. This is true even for patients with type 2 diabetes who are on non-insulin diabetes treatments.
Self-testing provides real-time data on blood sugar levels that helps patients better understand the impact of the lifestyle changes they have made on glycemic control. The American Diabetes Association recommends testing twice a day, or more often, if your healthcare provider feels it is necessary. According to them, the target results should be:
Some of the more conservative doctors, who feel that damages from complications of diabetes begin to silently happen even at lower levels of blood sugar, prefer to have stricter targets. For example, the Diabetes UK Council of Healthcare Professionals (2015) suggests that the above targets should actually be:
If your blood glucose levels are higher, you may need to talk to your healthcare provider and discuss changes in diet and/or diabetes medication/insulin therapy regime. Blood glucose levels lower than 70 mg/dL indicate hypoglycemia and require immediate attention. Maintain a glucose test results chart to keep track of your blood sugar levels.
In adults with type 2 diabetes, it’s a good idea to test HbA1c levels at:
If you are managing your diabetes type 2 through diet and lifestyle, or through a combination of both, along with a drug that doesn’t lead to hypoglycemia, aim for HbA1c level of 48 mmol/mol (6.5%).
If you are on diabetes drugs associated with hypoglycemia, aim for HbA1c level of 53 mmol/mol (7.0%).
If your HbA1c level is lower than target goal but you’re not experiencing hypoglycemia, maintain it. However, you should know that sudden weight loss or deteriorating renal function can also result in low HbA1c level. Discuss your results with your doctor to decide a suitable course of action.
It’s a good idea to get a complete heart health check-up once a year. By getting checked each year, you’ll put yourself in the best position to beat the threat of complications. If your tests reveal any signs of cardiovascular disease, your doctor may advise you to get tests done more often.
If you have Diabetes Type 2, you should get your cholesterol levels tested once a year. High levels of cholesterol increase your risk of stroke and cardiovascular diseases. The test is done via a fasting blood test sample.
If your cholesterol levels are high, your doctor may recommend lifestyle changes with a focus towards a healthy diet and regular exercise. Sometimes, cholesterol-lowering medication, called statins, may also be prescribed. Cholesterol-lowering therapy is beneficial for people with diabetes even if they do not already have manifested coronary disease or high cholesterol concentrations.
Diabetes Mellitus increases the risk of cardiovascular disease by a factor of two to three at every level of systolic blood pressure. Hypertension, or high blood pressure, is common in patients living with type 2 diabetes. It can lead to, or worsen, many diabetes-related complications, including kidney disease and eye disease.
A word of warning: Anxiety can affect blood pressure reading. Some patients can frequently get high blood pressure readings because they are stressed by the concept of ‘tests’. This is called “white coat syndrome,” and is not uncommon. If your doctor believes this may be the reason your BP readings are higher at the lab as compared to at-home checks, try some relaxing and deep-breathing techniques before your test.
Diabetic retinopathy is the most common form of diabetic eye disease, though diabetics are also susceptible to Glaucoma and Cataract. Retinopathy can affect all diabetics and increases the risk of blindness when left untreated. The risk of developing diabetic retinopathy increases with age as well with less well-controlled blood sugar and blood pressure level. If you are a diabetic over the age of 12, you should be screened for diabetic retinopathy every year.
If you have diabetic retinopathy, you are also at increased risk of glaucoma. In its early stage, glaucoma has very few symptoms, and this is why it’s often left unchecked for too long. As someone living with diabetes, an eye specialist should test you for glaucoma at least once each year.
Diabetes is also one of the key factors that result in the development of cataracts, which affects the lens of the eye and leads to cloudy or blurred vision. Research shows that diabetics who lower their HbA1c level by just 1% can reduce their risk of cataracts by 19%.
Diabetes Neuropathy, a nerve disorder, can be of three types – sensory neuropathy, motor neuropathy or autonomic neuropathy. Over time, people with uncontrolled diabetes may develop damage to the nerves around the body, though incidents are also higher in diabetics who are overweight, have high blood pressure, and those who are over the age of 50. The longer you live with diabetes, the greater your risk of developing neuropathies.
The symptoms of diabetic neuropathy are varied and may differ depending on the affected nerves. Pain, numbness and tingling are common symptoms. Diagnosis is based on your individual symptoms coupled with a physical exam. If you have diabetes type 2, yearly foot examinations are a must for you. Foot complications are relatively common, especially foot ulcers, which are said to affect 1 out of every 10 diabetics.
It is estimated that about 50% of patients with insulin-dependent diabetes mellitus develop diabetic nephropathy – a general term that means deteriorating functioning of the kidneys. Genetic factors have been suggested as risk markers for development of nephropathy in diabetes. Kidney disease in people with diabetes is associated with higher blood glucose levels over a prolonged duration of time. Diabetic nephropathy is also influenced by hypertension. Reducing your HbA1c levels and annual diabetes health checks help in early identification of kidney damage and reduce the risk of nephropathy.
A blood test, as well as a urine test, is performed to screen for diabetic nephropathy. These tests are done to check the glomerular filtration rate of your kidneys to determine optimal functioning. If there are signs of reduced kidney function, your healthcare provider will decide the necessary course of treatment based on the severity of the condition.
Depending on your health, age and medical history, you may require other screening tests. If you are over the age of 60 and have been living with diabetes type 2 for a while, you may also need additional screening for mental health problems, gum diseases and cancer. Your doctor will advise you should additional tests be needed.
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2. Glycemic Control and Heart Failure Among Adult Patients With Diabetes – http://circ.ahajournals.org/content/103/22/2668.short
3. MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomized placebo-controlled trial – http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(03)13636-7/abstract
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8. Diabetes, peripheral neuropathy, and old age disability – http://onlinelibrary.wiley.com/doi/10.1002/mus.1217/full
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