Tests/annual review

When you are diagnosed diabetic you should get a number of things automatically: these include a battery of tests, access to proper diabetes education, an appointment for a retinal photograph, the option of referral to a podiatrist, screening for any psychological issues and a welcome to contribute to decisions on your diabetes management. The reality may be somewhat different.

In any case, every diabetic should, at very least, have an annual review, which may be carried out by the GP and/or through referral to a specialist clinic. This is an important check on your general level of blood glucose control and general health. Some people may have particular tests carried out more frequently as is felt necessary. If you don’t get called for one automatically, do ask for one.

Always try to get and keep a printed record of your test results as it will make it much easier for you to make long-term comparisons.

This is what should be covered and what the tests mean*:

phlebology trayHbA1c (glycosylated haemoglobin) is an indication (often as shorthand referred to as an “average”) of blood glucose control over the past 2-3 months. The typical NHS target range is 6.5-7% or 48-53mmol/mol (the latter is the new unit of measurement) though there is a good argument that getting an HbA1c lower than 6.5% reduces risk of complications as long as this can be achieved without intensive medication or unnecessary hypoglycaemic episodes.

Discussion of your blood glucose control, including self-monitoring results and a discussion – with you as an equal member of your diabetes team – about future targets and strategies.

Blood pressure, checking how hard your heart has to work to keep your blood circulating. The NHS target is 140/80 or less.

Kidney function tests:
Micro-albuminuria (Albumin creatinine ratio – ACR).and proteinuria tests check on the health of your kidneys and looks for protein in the urine.
Serum Creatinine indicates how healthy your kidneys are. Target 62-106 ummol/L
Glomerular Filtration Rate (GFR) test also indicates how healthy your kidneys are. Target 60-999 mL/min

Total cholesterol (may be listed as serum lipids). A type of fat in your blood. Cholesterol levels that are too high could indicate risk of a heart attack. Target 4.0 mmol/L or less
Components of total cholesterol (it’s important to get this breakdown of good and “bad” cholesterol):
HDL cholesterol. A good type of fat in your blood. High levels can protect against heart disease. Target: 1 mmol/L (men) and 1.2 mmol/L (women) or more
LDL cholesterol “bad” cholesterol associated with increased risk of heart disease. Target: 3.0 mmol/L or less
Triglygerides. Another type of fat in the blood. Target: 1.7 mmol/L or less

foot checkWeight and Body mass index (BMI), a measure of how over or underweight you are. Ideal 18.5-25kg per m2

Foot Examination. This should look at circulation and nerve activity.

Eye examination (retinal screening) by means of a photograph of the back of your eyes checks for early signs of damage. This may be part of, or in addition to an annual check by your optometrist.

Injection site check, if you are on insulin.

Other checks that may be carried out include a thyroid test and liver function tests.

*Targets and numbers are those of the NHS guidelines. Forum members may argue, based on studies and reports, that some of these may not be ideal for all diabetics and your doctor, nurse or PCT may suggest slightly different targets than those quoted above for you to aim for.