By Dr. Ann Lima

Diabetes is a complicated disease process – with multiple types, causes, and treatments available. However, monitoring control of blood sugar (glucose) and surveillance for effects from diabetes is what I will focus on, and can be more generalizable across the spectrum of diabetes.

Hemoglobin A1c is a common test used to monitor the long-term control of glucose, and it is based on the concentration of glucose in the red blood cells during the cell’s lifespan, which is around 3-4 months. In 2010 the American Diabetes Association (ADA) added an A1c of 6.5% or higher as a way to diagnose diabetes.

We also use a trend in finger stick blood sugars, or continuous glucose monitor (CGM) readings, to help monitor daily patterns, like fasting glucose in the morning, or rising levels after meals. This helps patients learn how their habits and medicine affect their blood sugar, and helps providers make recommendations for food selection and treatments.

It is important to also be checked for complications from diabetes, like kidney failure, retinopathy (eyes), and neuropathy.

At least once a year diabetic patients should get the deep part of their eyes (retinas) checked for blood vessel changes caused by diabetes, which can be done with a dilated eye exam at your eye doctor as part of a comprehensive eye exam or a retina screen at your primary care clinic if you are unable to see an eye doctor.

Similarly, the urine should be checked for small particles of protein that can indicate kidney damage from diabetes, and the feet should be checked for decreased sensation that may be a signal of nerve damage from poor blood sugar control (neuropathy).  If a diabetic person has neuropathy it is extremely important to do daily foot checks to make sure there are no wounds that could get lead to serious infection.

There is also a much higher risk of cardiovascular disease – think heart attacks, strokes, poor circulation – and diabetics should be working with their healthcare provider to monitor and screen for these complications.

Although diabetes is a serious disease, patients can control blood sugars and prevent and treat the complications of the disease along with the help of their team of providers, including diabetes educators, dieticians, pharmacists, physicians, physician assistants, nurse practitioners, optometrists, and others.