Educating and Advocating for Ourselves: Tests Patients Should Receive (and Demand)

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Educating and Advocating for Ourselves: Tests Patients Should Receive (and Demand)

Diana IsaacsContributor: Diana Isaacs, PharmD, BCPS, BC-ADM, CDE Clinical Pharmacy Specialist, Diabetes Educator, Cleveland Clinic Diabetes Center

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There are several tests that people with diabetes should receive when diagnosed and through regular follow-up visits. These are recommended by the American Diabetes Association. As a person with diabetes, it’s helpful to be aware of these tests and ensure that you are receiving them. The results may provide you with motivation to make changes. For example, some people are motivated to increase physical activity and reduce portion sizes when they see a positive impact on their weight, blood pressure, and/or A1C. It is also important for medication monitoring and tracking any complications from your diabetes.

Routine Tests:

A1C: This represents an average blood sugar over the past 3 months. An A1C goal of <7% is recommended for many people and this represents an average blood sugar of 154mg/dL. However, other people may have more individualized goals. If your A1C results is not at your individualized goal, it’s recommended to recheck again in 3 months. If it is at goal, then it’s recommended to check at least every 6 months.

Cholesterol Panel: This is important to monitor for heart health. This is done through a fasting lab test, meaning no food or drinks, other than water for 8-12 hours before the test is performed. The LDL represents the “bad” cholesterol while the HDL represents the “good” cholesterol. Another component, called triglycerides, can put you at higher risk of heart attacks and strokes if it is too high. The cholesterol panel should be checked at least yearly, and will help your provider decide if you would benefit from increasing physical activity, making healthier food choices, or taking cholesterol medication.

Kidney Function: This is important especially when your provider decides which medications to use and what doses to treat diabetes and other conditions. This is done by a blood test to check the serum creatinine and estimated glomerular filtration rate. Additionally, it’s recommended to have a urine test to check for protein in the urine, which can be an early sign of kidney damage. Both the blood and urine tests should be monitored at least annually.

Liver Function: At diagnosis, it’s a good idea to have liver function tested. Since many drugs are metabolized through the liver, it’s important to know if there is any liver damage. It may also be useful to find out if there is a condition called fatty liver disease, which is a buildup of fat in the liver. This condition is more common in people with type 2 diabetes.

Electrolytes: These include tests such as sodium, potassium, and chloride. Many drugs used to treat high blood pressure can impact electrolytes. The drug class, called SGLT2 inhibitors, which causes more sugar to be released from the kidneys, can also cause dehydration and affect electrolytes.

Thyroid Levels: At diagnosis and periodically thereafter, it’s a good idea to have your thyroid levels checked. A thyroid that is working too slowly (hypothyroid) or too fast (hyperthyroid) can affect blood sugar levels, cholesterol levels, and cause other symptoms. Your doctor may also do a physical exam and palpate your thyroid located within the neck area.

Routine Office Visit Measurements:

Blood Pressure: This should also be regularly checked at every office visit. According to the American Diabetes Association, the blood pressure goal is <140/90mmHg and for some people, the goal is <130/80mmHg. Talk with your healthcare provider about what your individual goal should be.

Weight/Body Mass Index: This should be regularly checked at every office visit. Many medications may affect body weight: some increase while others decrease. Weight loss (for those that are overweight), can also improve blood sugar, blood pressure, and cholesterol.

Other Important Tests on an Individual Basis:

C-Peptide: A C-peptide is a test to see if your body is still producing its own insulin. This is low or undetectable in people with type 1 diabetes. Over time, c-peptide may become low in people with long-standing type 2 diabetes, meaning that insulin is needed to lower blood sugar levels.

Diagnostic Continuous Glucose Monitoring (CGM): CGM is a technology that measures glucose every 5 minutes to provide continuous information on levels throughout the day. This provides insight into how food, medications, physical activity, stress and other factors affect your blood sugars. Diagnostic CGM is typically worn anywhere from 3 days to 2 weeks and many insurance plans will cover this test at least twice per year. You can learn a lot from wearing one of these devices and it can help your provider to make medication adjustments.

Testosterone Levels: For our male friends with diabetes, low testosterone may be likely. Symptoms include decreased sexual desire or erectile dysfunction. If symptoms are present, the American Diabetes Association recommends checking a morning serum testosterone level. If it is low, your provider may suggest starting a testosterone medication.

Advocating For Ourselves

If you’re not sure if you have had these tests done, ask your provider about them. Sometimes these tests may be listed under another name or combined with other tests. For example, a Comprehensive Metabolic Panel includes tests for kidney function, liver function, and electrolytes. If you have had these tests done, ask your provider to explain the results to you. By knowing your results, you can better understand the state of your health and you will be empowered to make changes as needed to improve your health.

Reference: Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Medical Care in Diabetes. Diabetes Care 2018;41(Suppl. 1):S28–S37

Diana Isaacs, PharmD, BCPS, BC-ADM, CDE is an Endocrine Clinical Pharmacy Specialist and Certified Diabetes Educator.  Dr. Isaacs earned a Bachelor’s Degree in Chemistry from the University of Illinois at Chicago in 2004 and a Doctor of Pharmacy Degree from Southern Illinois University Edwardsville in 2009.  She also holds board certifications in pharmacotherapy and advanced diabetes management. Dr. Isaacs enjoys working on an interprofessional team and has established several clinical services within the Cleveland Clinic Diabetes Center. She is involved in a robust shared medical appointment program and coordinates the continuous glucose monitoring program.