Q: Dr. Stanislaw, I've had type 1 diabetes for 10 years and want to stay as healthy as I can be. What tests should I have each year to make sure my body stays healthy?
A: Great question! Besides the A1c, there are many other tests that you should do proactively to stay on top of your health. I will detail them below.
Basic tests that should be done regularly include: height, weight, thyroid exam, injection/infusion site assessment, a visual + microfilament foot exam, hypoglycemia assessment, depression screening, alcohol/tobacco/drug use, sexual issues/contraception, digestive assessment (to screen for celiac disease), nutritional habits, and diabetes self-management skills.
Blood tests include: A1c, thyroid (TSH + free T3 + free T4), antithyroid antibodies and celiac antibody panel (done once, and then as-needed dependent on symptom presentation), and cardiovascular tests.
Baseline cardiovascular tests include: blood pressure, HDL (good) & LDL (bad) cholesterol (total value is less useful), and triglycerides. However, medicine is realizing that cholesterol tests are less useful given their poor accuracy of predicting cardiovascular risk given the fact that the majority of people experiencing heart attacks have normal cholesterol levels.
Thus other blood tests to ask your doctor about to assess your cardiovascular risk are lipoprotein(a), LDL-P (particle number), apolipoprotein B, and inflammation markers, such as hsCRP. Further examination can be done via a treadmill stress test, a coronary artery calcium score + calcium density study, and/or a CT angiography of the coronary arteries (to check for any blockage). The determination of which tests are applicable to you must be determined via a discussion with your doctor given your individual characteristics and risk factors.
Urine tests to exam kidney function include: microalbumin, and others are creatinine clearance, urine albumin-to-creatinine ratio, and estimated glomerular filtration rate (GFR).
Further exams include that should be done by a specialist include: a full-dilation eye exam
Lastly, once someone has one auto-immune condition, such as type 1 diabetes (type 2 is not auto-immune), there is a higher chance for having another. The most common ones associated with type 1 are auto-immune thyroiditis, called Hashimoto's, and celiac disease, which is an auto-immune reaction against gluten thus it must be eliminated from the diet. There is also a condition called common variable immunodeficiency that can be hard to diagnosis. CVID is an immune disorder characterized by recurrent infections and low antibody levels, (which can be detected by a blood test). Symptoms can include high susceptibility to infections, or chronic lung disease, or inflammation and infection of the gastrointestinal tract, however symptoms vary greatly between people. Thus periodic assessment of other auto-immune conditions may be warranted in type 1’s.
More information can be found at the ADA website via this link: http://care.diabetesjournals.org/content/37/7/2034
Finally, a key question that is often left out of doctor visits is this very important question, "How are you doing with all of this?" Managing diabetes takes a lot. I understand! I myself have had it for 36 years, since I was 7. Sometimes the most important support we need is simply to talk with someone who understands how challenging it can be. If you don't already have this kind of emotional support, I encourage you to seek it out. If you have questions for me, email firstname.lastname@example.org
Here's to your health!