What are we talking about?
You went to
your trusted diabetologist for a follow-up visit and the doctor asked you for
routine surveys indicated in the diabetic. If you are not sure that he has asked
you enough, if you think that he has been hurried below, we
report the main checks that normally have to be prescribed to the
diabetic patient at least once in 1-2 years or before.
Keep in mind, however, that instrumental and laboratory investigations must be
targeted and have a specific indication. For example. a common place for the
diabetic patient is to have the mania of self-control, which is a good rule but
must also have a therapeutic sense. For example, if I take metformin and I have
a glycosylated hemoglobin of 6.0%, I do not need to check blood sugar every 2-3
hours with the meter, because it makes no sense to do this.
If, on the other hand, I am on insulin treatment and I have to adjust the dose
of insulin according to the glycemia, this practice makes sense. Recall that the
resources are few and must suffice for everyone.
Now let's talk about the checks that a diabetic patient should perform in the
course of a year or so.
• Fasting blood glucose and HbA1c
• Fasting lipid profile, including total cholesterol, HDL cholesterol,
triglycerides and LDL cholesterol
• Liver function tests and any investigations into the suspicion of steatosis or
hepatitis
• Microalbuminuria in all type 2 and in diabetics
Type 1 diabetics with duration of illness 5 years
• Creatininemia (in the child only in the presence of
proteinuria) and estimation of glomerular filtration
• In type 1 diabetics at diagnosis: screening of autoimmune thyroiditis and
celiac disease:
TSH, FT4, antithyroid antibodies, EMA or antitransglutaminase, IgA
• Urinalysis to evaluate ketonuria, proteinuria and sediment
| IFCC-HbA1c
|
HbA1c % | mean plasma glucose expressed in mg / dl |
| 42 | 6 | 135 |
| 53 | 7
|
170 |
| 64 | 8 | 205 |
| 75 | 9 | 240 |
| 86 | 10 | 275 |
| 97 | 11 | 310 |
| 102 | 12 | 345 |
• Electrocardiogram in adults, if clinically indicated
• Eye examination, if indicated
• Family planning for women of reproductive age
• Nutritional medical therapy, if indicated
• Specialist advice in educational therapy, if this is not guaranteed by the
doctor or by other figures of the diabetic team
• Specialist advice in behavioral therapy, if indicated
• Foot specialist advice, if indicated
• Other specialist visits if necessary
In particular, we will ask the diabetic patient:
Expression of glyco-metabolic control ie the ability to control their blood
sugar levels, making them fall, with the cure or with the diet for diabetes,
within acceptable parameters. The acceptable values of the glycate must be
<6%. HbA1c reflects the mean glycemia of the last 2-3 months, to determine if
metabolic control has been achieved and maintained in the target a measurement
is required approximately every 3 months. The regular carrying out of the HBA1c
allows to detect in a timely manner a departure from the therapeutic objective.
For the individual patient, the frequency of HbA1c dosage should depend on the
clinical situation, the type of therapy in place and the judgment of the patient.
Glycemic control is best evaluated if the results of glycemic self-monitoring
and HbA1c are combined; In fact, the latter should not only be used to evaluate
the glycemic control of the last 2-3 months, but also to check the accuracy of
the used reflettometer, the patient's diary and the adequacy of the
self-monitoring plan.
Correlations between HbA1c and mean plasma glucose levels on multiple tests
carried out over a period of 2-3 months in the DCCT study (see also diabetes
treatment goals)
The conversion between the two units of measurement can be calculated using the
following formula: IFCC-HbA1c (mmol / mol) = [DCCT-HbA1c (%) - 2.15] x 10.929
Home blood glucose controls, to be recorded in the appropriate diary if indicted
(e.g. in the patient treated by insulin)
The presence of albumin in the urine is considered normal if it does not exceed
25 mg over 24 hours; the increase of its quantity indicates a suffering of the
kidney (nephropathy) or an alteration of the surface of the vessels and in this
case indicates a high risk of cardiovascular accidents.
We can have the following values:
Values in the standard: less than 25 mg in the 24 hours Microalbuminuria: the
values exceed 25 mg in the 24 hours;
• Macroalbuminuria: the values exceed 200 mg / 24 hours. The amount of albumin in the urine, is influenced by many situations: presence of urinary tract infection, intense physical activity. For this reason, microalbuminuria is confirmed after three non-consecutive positive determinations. It should be performed, if in the standard, every 1/2 months or so
The dosage of creatinine in the blood is an expression of kidney health. In fact,
this molecule expresses the capacity of the kidney to cleanse the blood from the
protein metabolism scores; values above 1.4 indicate the presence of renal
failure. Its determination is important not only to document damage to the
kidney, but also to decide which drugs can be administered. Values in the
standard: less than 1.3 mg / dl. It should be performed, if in the standard,
every 8 months or so
It is an even more specific test that the doctor requires, especially in the diabetic, to further study renal function. Creatinine clearance expresses the ability of the kidney to release blood from the nitrogenous waste in the sense of an assessment of the volume of blood that the kidney manages to filter out per minute, expressing this value of the residual functional capacity of the kidney itself. In essence, the higher the value of ml per minute, the higher the detoxifying capacity of the renal excretion. the volume of blood that the kidney filters per minute is clearance; the correct collection of 24-hour urine is essential. Normal values: greater than 60 ml / minute Values less than 60 ml / minute indicate the presence of chronic renal failure. The normal value of creatinine clearance is between 95 and 140 ml / minute in humans and between 85 and 130 ml / minute in women.
Attention to lower values of clearance,
because they are an expression of initial damage of the kidney and careful
treatment is required to avoid the condition of chronic renal failure.
It should be performed, if in the standard, every 8 months or so
Examination of the fundus oculi to control diabetic retinopathy
It is an "old" but very important test: it allows us to understand the function
of the kidney, the presence of possible infections, bacteriuria, the presence of
sediments, the presence of cylinders, these expressions of a renal tubular
damage, and the presence of glycosuria, that is sugar in the urine.It is
performed, if in the norm, every 8 months or so
It is used to detect urinary tract infections; a sample of urine is "seeded" in
special plates (culture media) and the appearance of bacterial colonies is
evaluated. High concentrations of bacteria, even in the absence of urinary
disorders, require antibiotic therapy Values in the normal: negative It should
be performed, if in the normal way, every 8 months approximately
Cholesterol is harmful to the arteries and when its values are elevated over
time it determines the formation of atherosclerotic plaque, which in turn causes
cardiovascular accidents (heart attack and stroke); Values in the standard:
less than 190 mg%
And "good" cholesterol reduces the risk of cardiovascular accidents. Values in
the standard: more than 40 mg% in men, 50 mg% in women.
And the "bad" cholesterol, the one that causes atherosclerotic plaque
Values in the standard:
less than 100 mg%; if an LDL-cholesterol cardiovascular event is already present,
it should be kept below 70 mg%
They are often elevated in type 2 diabetes; these molecules also contribute to
atherosclerosis
Values in the standard: less than 180 mg%
Lipid trim control should normally be performed every 8 months