Updated October 11, 2007

Avoiding Complications:
Nurturing Your “Health Bank”

by Amy Tenderich, M.A.

Blood pressure. This test, which is usually done by placing an inflatable cuff around your upper arm, determines the force of blood flow through your blood vessels. High blood pressure raises the risk of stroke, heart problems, and kidney disease.

Lipid profile. This is a group of blood tests that measure (or enable the lab to calculate) your total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides (another type of blood fat). Results are used to help determine your risk of heart attack or stroke.

Microalbumin. This urine test searches for small amounts of a protein called albumin, which leaks into the urine when the kidneys are becoming damaged. This is the test most frequently neglected in people with diabetes, yet it is by far the most sensitive test for identifying risk of future kidney problems.

Eye exam. A yearly dilated eye exam (in which the pupils are enlarged using eye drops) allows the eye doctor to see the backs of the insides of your eyes to check for diabetes-related eye problems (as well as non-diabetes-related eye problems).

If you don’t already have copies of your most recent test results, you will need to call your doctor’s office and ask for them. Remember that you have the right to obtain copies of your medical records, so don’t take no for an answer if you encounter resistance. In addition, don’t accept the answer that your test results are “OK” or “fine.” At least for HbA1c, blood pressure, cholesterol and triglyceride levels, and microalbumin, you want a numerical answer—just as you would if you went to the bank and asked for an update on your account balance. Your eye exam results, which you may need to get from your eye doctor rather than your primary diabetes care doctor, are less straightforward, because there are no numerical results for diabetes-related eye problems, and it’s unusual for eye doctors to provide patients with written records. However, your eye doctor is required to provide you with a report if you request one, and there are some standard terms that eye doctors use to describe the most common diabetes-related eye problem, retinopathy. The doctor should be able to explain the significance of your results to you.

As you collect your results, note when the tests were last done. Anything over a year old is too old, and you should schedule new tests immediately. According to the Joslin Diabetes Center, the frequency of these tests should be as follows:

• HbA1c test: every three months
• Blood pressure: at least every six months, but you can take advantage of every doctor’s appointment to have your blood pressure checked
• Microalbumin, lipids, and eye exam: all annually, unless you have concerns that might require more frequent checks

Once you have your test results in hand, you can start thinking about how to respond to them.

Setting priorities
Knowing where to focus your efforts may be the hardest part of managing diabetes. Many people feel overwhelmed, believing they have to do everything at once. But doing everything at once is just too difficult, and it may not even make sense from a health standpoint since you may expend a lot of effort toward achieving a goal that has little impact on your health. You need to know what your real health risks are so that you can pinpoint your efforts to make the biggest impact on improving or maintaining your health.

Once your five tests are current and you’ve obtained the results, compare your results to the ideal target ranges to see where you stand and where you need to take action. The results that are furthest from the ideal target ranges are your “debts.” These are the numbers that require action first.

Amy Tenderich is the author of the blog Diabetes Mine, which can be read at www.diabetesmine.com, and coauthor, along with Richard Jackson, M.D., of Know Your Numbers, Outlive Your Diabetes, published in 2007 by Marlowe & Company. Dr. Jackson is Director of Outreach at the Joslin Diabetes Center in Boston and an Assistant Professor of Medicine at Harvard Medical School.

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