Essential health checks
This site is dedicated to prevention rather than cure by developing awareness of prediabetes and the potential path to Type 2 diabetes. Preventative action, such as improving diet and exercise, is a constant theme on our news, tools, food and exercise pages.
But a common sense and positive attitude to healthcare is of course just as important for the wellbeing of people who have developed diabetes. Indeed, there is a set of commonly-acknowledged healthcare essentials - including nine important checks - that should be adhered to.
Yet the latest National Diabetes Audit (2014/15) carried out by the NHS's health and social care information centre (HSCIC) revealed the following:
- Among people under 40, only 27% of those with Type 1 diabetes and 40% with Type 2 diabetes received all nine recommended tests every year
- The number of people having all nine checks annually has fallen to its lowest level in six years (2009-10) when records began
The nine annual checks are as recommended by NICE, the National Institute for Health and Care Excellence. Missing them can increase the risk of developing diabetes-related complications, including heart disease or stroke.
Here are the nine checks, and why they are important.
1. Blood pressure test. Check!
It is important for someone with diabetes to have their blood pressure measured and recorded at least annually. People with diabase are more likely to have the condition, which can increase the risk of complications like diabetic retinopathy (also known as diabetic eye disease) and kidney problems.
Diabetes affects the arteries, making it more likely that someone could develop narrowing of the arteries, or atherosclerosis. This can lead to high blood pressure, which if left untreated could bring about blood vessel damage, stroke, and heart or kidney failure.
The blood pressure test measures the force of blood exerted within blood vessels. The result is expressed as a ratio. An average pressure would be shown as 120/80 and expressed verbally as 120 over 80. The first number is the systolic pressure, caused by the heart pushing blood into the arteries while the second, the diastolic, is the pressure when the heart is at rest.
2. Weight and BMI measurement. Check!
Being overweight or obese is a factor linked to increased risk of developing Type 2 diabetes. Watching their weight and pursuing an active lifestyle is sound advice for anyone as it helps diminish the chances of health problems.
Studies show that fat can cause cells to release pro-inflammatory chemicals, which can make the body less sensitive to the insulin it produces. Known as insulin resistance, this is a trigger for Type 2 diabetes. Having an overlarge waistline is called central or abdominal obesity, and regarded as a high-risk form.
BMI stands for Body Mass Index and is a number based on someone's weight and height. (As a general rule, the higher the number, the more body fat a person has.) You can test your BMI here. [link to Equalibras BMI page] Used as a screening tool, the BMI measurement will reveal if someone is a healthy or unhealthy weight and whether they are putting themselves at increased risk of diabetes.
3. Serum creatinine test. Check!
Creatinine is a by-product formed when creatine breaks down in muscles. By checking the amount of creatinine in the blood, doctors can establish how well someone's kidneys are functioning. So the serum creatinine test, which checks both blood and urine, is helpful for tracking diabetic kidney disease.
Signs of kidney disease include: fatigue and sleeping problems, appetite loss, swelling around the face, wrists, ankles or abdomen, lower back pain, changes in urine amounts and frequency, high blood pressure and nausea and vomiting.
Diabetic kidney disease, or nephropathy, is caused by high blood glucose levels and high blood pressure. It can lead to kidney failure. The serum creatinine test is important because taking steps such as controlling blood glucose levels and blood pressure, can reduce the risk of kidney failure. It is important to take action against diabetic nephropathy as early as possible.
4. Urinary albumin test
As we have seen when discussing the serum creatinine test, diabetes is a common cause of kidney failure. Studies have proved that identifying early kidney disease in diabetic patients can help treatment be adjusted appropriately. This can be established by demonstrating an abnormal ACR, or urine albumin to creatinine ratio.
Albumin is a protein found in blood. If a kidney is healthy, albumin is not passed into the urine. But if the kidney is damaged, some albumin does get through. The albumin test is used to check urine for the protein. The fewer albumins there are in the urine the better. But when abnormal amounts are found, doctors are able to take appropriate action against kidney disease.
5. Cholesterol test. Check!
Checking for raised levels of cholesterol is vital. It can show an increased risk of cardio vascular disease. A lipid (the main constituent in cells) and fatty in substance, cholesterol is important for a body to function normally. It comes predominantly from the liver, both is also derived from some foods. Abnormally high levels of lipids in blood can harm heath, and while high cholesterol doesn't usually cause symptoms, it increases risks of health problems.
High cholesterol is of particular concern for people with diabetes. High-density lipoprotein (HDL) cholesterol is known as "good cholesterol" while low-density lipoprotein (LDL) is known as "bad" cholesterol. Yet lowering levels of the "bad" LDL and increasing HDL may lower risk of heart disease.
Diabetes can upset the balance between levels of the two cholesterols. People with the condition often have LDL particles that stick to arteries and damage blood vessel walls more easily. Glucose attaches to lipoproteins, so sugar-coated LDL remains in the blood stream longer and can form plaque. People living with diabetes tend to have low HDL and high triglyceride blood fat levels, both of which increase the risk of heart and artery disease.
6. Eye test. Check!
Retinopathy screening - or an eye test - is vital because diabetic retinopathy is a common complication of diabetes. Annual screening is recommended because high blood sugar levels can damage the cells in the retina.
So if blood glucose levels are left untreated, diabetic eye problems can occur. Other problems that may be hereditary, such as cataracts and glaucoma, can be exacerbated by diabetes.
Retinopathy is the most common eye problem for people with diabetes. A series of studies have shown that risk of developing it increases with higher HbA1c (blood glucose levels) values, higher blood pressure and an increasingly lengthy period of living with diabetes. The dilated eye examination that is recommended is a simple one carried out by an ophthalmologist.
7. Foot test. Check!
Diabetes can limit blood flow to the feet and cause a loss of feeling. So it is important for people to have diabetes to have an annual check of their skin, circulation and nerves. With limited blood supply in the feet, healing of injuries can be compromised. Another concern is that patients are more likely to have a limb amputated when they have diabetes.
8. Blood test (HbA1c blood glucose levels). Check!
The HbA1c test provides the vital average measure of how well someone's diabetes is being controlled at the end of a two to three month period. The blood test measures overall blood glucose control and helps the patient and healthcare team set ongoing targets.