Contributor: Dr. Staci-Marie Norman, PharmD, DCES

There is more to ensuring we stay healthy than just keeping annual, biannual, or quarterly doctor appointments. There are screening tests and lab work that can be vital in helping our health care team to know how healthy we are and to catch problems before they are out of control.

Living with diabetes can bring familiarity with certain blood tests:

• Hemoglobin A1c (A1C) gives your doctors a three-month average of your blood glucose levels. This is why A1C is done two to four times per year. The American Diabetes Association (ADA) says your A1C goal should be less than 7, although recommendations vary depending on other health issues.
• A cholesterol panel shows your total cholesterol and its components, such as HDL (good), LDL (bad), and triglycerides. Knowing your cholesterol levels is essential because diabetes increases your risk of cardiovascular disease. Higher levels of cholesterol, especially LDL, increase this risk because the LDL can collect under the surface of the vessel lining, forming a plaque. If this plaque ruptures out of the vessel lining, it can lead to a clot. Total cholesterol less than 200, LDL less than 100, and HDL greater than 35 may be results to work towards, but your goal may be based on whether you are taking a statin medication and how much it has lowered your cholesterol. Statin medications have been proven to decrease the risk of cardiovascular disease by helping to shrink the plaque in the vessel lining. So depending on your risks and your LDL level, your doctor may recommend a statin to lower your LDL level.
• The glomerular filtration rate (GFR) is a blood test used to help monitor kidney function and should be done annually to screen for nephropathy and to ensure your kidneys are working well. If your GFR decreases over time, your doctor may recommend a 24-hour urine collection to screen for protein in the urine.
• Your Vitamin B level is a newer addition to the standard of care regarding lab tests. Long-term metformin use can cause levels of vitamin B to diminish, leading to decreased energy and cognitive function. Your healthcare team may prescribe a vitamin B supplement if your levels are low.

Blood work is not the only thing that needs to be done at routine doctor appointments:

• Screening for depression is something you might not think about but is important. Living with a chronic illness is associated with an increased risk for depression, so an assessment is recommended at each appointment with your healthcare team.
• Peripheral neuropathy can cause numbness, tingling, or pain in your extremities. A monofilament screening should be done annually to assess if peripheral neuropathy is present or worsening. The screening is done by lightly touching your foot in multiple areas with a monofilament (about the thickenss of a fishing line) or a tuning fork to see if you feel it on your foot.

Your healthcare team should do some other essential health screens for general health:

• An annual mammogram should be done starting around age 40. Mammograms, although not perfect, are incredibly good at catching breast cancer early. But don’t forget your monthly self-breast exam as well.
• Bone mineral density (BMD) is particularly important at and after menopause. The post-menopausal decrease in estrogen stimulates an acceleration of bone loss which can lead to osteoporosis. A BMD is an easy ultrasound-type test that looks at how dense the bones are in your spine, hip, and forearm. Typically, BMD is done every two years to keep track of your bone health.
• Colon cancer screenings are recommended starting at age 45. When caught early, colon cancer is curable but can progress quickly. A colonoscopy will screen for any signs of cancer and is recommended every five or ten years, depending on your risk factors and rest results. Colonoscopy prep, while somewhat uncomfortable, has improved with concentrated liquids or tablets you can take instead of the four liters of fluid you once had to drink.

While this is by no means an exhaustive list of screenings or labs to keep you healthy, it is an excellent place to start. And sometimes, knowing what should be monitored and when makes it easier for us to take control of our health. I hope this is helpful in that way. And now, I'm off to schedule my own annual appointments.

Dr. Staci-Marie Norman, PharmD, DCES received her bachelors from Purdue University (’94) and her Doctor of Pharmacy from the University of Oklahoma (’96). In 2000 Dr. Norman added to her credentials by becoming a Certified Diabetes Care and Education Specialist. She is currently the Clinical Coordinator and staff pharmacist for Martin’s Pharmacy. Dr. Norman is a national faculty member for the American Pharmacist Association, teaching certificate programs in both diabetes and cardiovascular disease. She serves on the advisory board that oversees development and revision of these programs. Along with teaching and development responsibilities for APhA, Dr. Norman serves as a peer reviewer for research grants and publication submission. Dr. Norman has also spoken for Abbott, Bayer, Lilly, Mannkind, and Lifescan as a diabetes specialist.