Diabetes can cause a variety of long-term complications involving various parts of the body. In the North America diabetes is the leading cause of adult blindness, kidney failure and non-traumatic, lower extremity amputation. However, like many other medical problems, complications from diabetes are easier to treat if identified before they advance to late stages.
SCREENING FOR DIABETES COMPLICATIONS
We now know that high blood glucose levels are directly related to the development of diabetic medical complications. Therefore, maintaining blood glucose levels as close to normal as possible is the first step in preventing the onset of complications.
For some people, completely avoiding diabetic related illnesses may be difficult, for a variety of reasons. Other people may already have complications when they are diagnosed with their diabetes, which suggests the diabetes had been present for many years before it was discovered. So, it is also critical to regularly check for possible complications.
THE COMPONENTS OF REGULAR SCREENING
1: Screening for diabetic eye disease (retinopathy): This should be performed annually by an eye doctor (ophthalmologist or optometrist). Patients with diabetic retinopathy have bleeding or swelling on the retina, the part of the eye responsible for vision. In addition to blood sugar control, good blood pressure control can also prevent diabetic retinopathy. Additionally, treatment with laser therapy helps prevent vision loss.
2: Screening for diabetic kidney disease (nephropathy): Small amounts of a protein called "albumin" in the urine is the first sign that diabetes may be causing damage to the kidney. The special name of this protein in the urine is "microalbuminuria", and your physician should screen for this annually. Besides being the first sign of diabetic kidney disease, microalbuminuria is a risk factor for a heart attack, similar to other risk factors such as smoking and high cholesterol. If microalbuminuria is detected early on, treatment to slow or potentially stop further progression can be undertaken.
For those with type 1 diabetes, screening generally is not necessary until the diabetes has been present for 5 years. However, people with type 2 diabetes should be screened at diagnosis.
3: Screening for diabetic nerve disease (neuropathy): This is determined by how good the sensation is on the underside of your feet. This test should be done annually, at minimum.
4: Typically, your doctor will press a nylon filament against your feet. If you don't feel it, you likely have nerve damage and your risk of damaging one or both feet increases, by not feeling a cut or abrasion, for example. Alternatively, you may not know your shoes are too tight and could subsequently develop a blister.
If the sensation in your feet is abnormal, you should examine the bottoms of your feet at least once, and preferably twice daily. You need to make sure you don't have any new blisters, calluses or poorly tririmmed nails. For most people with this type of neuropathy, regular visits to a foot doctor (podiatrist) may be quite helpful.
5: Screening for heart disease: Since people with diabetes have an increased risk of heart attack, many doctors are now recommending formal screening for heart disease. This is typically done with an exercise stress test, where you are wearing the leads to an electrocardiogram (measuring the electrical activity of your heart) and exercising on a treadmill or bicycle. Changes in the electrocardiogram while exercising may indicate heart disease, even if there is no chest pain or pressure present.
When early screening for these complications is done, more effective treatments may be started. You should feel free to discuss these different screening recommendations with your physician.
