Diabetes is a disease impacting blood sugar, but its impact stretches far beyond just that. The whole body is fueled by blood and blood vessels.
Having high amounts of sugar in the blood over a prolonged period of time can cause damage to these vessels and the organs fueled by them.
While diabetes can be well-managed to minimize its effects on other systems of the body, it’s recommended for everyone with diabetes to keep up with specific diabetes tests and procedures to promote overall health and reduce the risk of diabetes-related complications.
What Is Diabetes?
Diabetes mellitus, or diabetes, is a disease affecting the pancreas and its ability to produce the hormone insulin. More specifically, the beta cells of the pancreas are responsible for producing insulin.
Diabetes occurs when the beta cells of the pancreas are destroyed when the beta cells don’t produce enough insulin to keep blood sugar levels regulated, or when the body doesn’t respond to insulin effectively.
Insulin helps blood glucose (blood sugar) enter our cells, where it’s used as fuel to support all of the body’s functions. Without enough insulin, sugar remains in the bloodstream and can become dangerously high.
Having high blood sugar over a prolonged period of time is detrimental to health. Our bodies make sugar, and we also obtain it from certain foods we eat, such as carbohydrates.
High blood sugar damages arteries and blood vessels, which supply blood to all of our organs and body systems. It also damages nerves and can result in loss of sensation in limbs, which can lead to serious wounds and amputations.
There are different types of diabetes, including type 1, type 2, and gestational diabetes.
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What Are The Symptoms Of Diabetes?
When someone has borderline high blood sugar (hyperglycemia), such as prediabetes, there usually aren’t any symptoms. This is why getting screened for blood sugar problems regularly, starting at age 45 (earlier for people with multiple risk factors), is so important.
Some of the symptoms of diabetes include:
- Unintentional weight loss: The body isn’t able to use glucose as energy when it’s high in the bloodstream. Glucose needs to move from the blood to our cells with the help of insulin in order to be used as fuel. When our cells are starved of fuel, weight loss can occur as our body breaks down muscles for alternative fuel. Weight loss can also be a result of dehydration from uncontrolled blood sugar.
- Increased urination: The body tries to rid itself of some of the high blood sugar by excreting it in the urine. People with high blood sugar often experience increased urination as the body rids itself of sugar while pulling fluids with it. This is why some healthcare providers order urine glucose tests to diagnose blood sugar problems; a normal test result would show no glucose in the urine.
- Increased thirst: Increased urination can be dehydrating, which can cause an increased thirst sensation.
- Increased hunger: When the food we eat isn’t able to be converted into usable energy, it can cause hunger due to the cells starving from lack of fuel.
- Fatigue: When the body isn’t able to use glucose as energy due to high blood sugar, it can result in a noticeable decline in energy levels.
For chronic high blood sugar (including undiagnosed diabetes), more symptoms can occur, such as:
- Poor wound healing: High blood sugar delays wound healing, which is one of the many reasons long-term diabetes can increase the risk of wounds requiring amputation.
- Numbness and tingling of the hands and feet: Prolonged periods of high blood sugar can cause nerve damage. One of the more well-known types of nerve damage, peripheral neuropathy, can cause numbness or tingling sensation in the hands and feet and spreading to the arms and legs. Those with neuropathy may not feel a wound on their feet, which can lead to diabetic foot ulcers.
- Increased infections: High blood sugar interferes with the immune system, which can increase susceptibility to illness and infection.
Diagnostic Tests For Diabetes
Diagnostic tests for type 1 diabetes:
Type 1 diabetes is an autoimmune disease. The body mistakenly views the beta cells of the pancreas as invaders, and it works to destroy them. People with type 1 diabetes have little to no beta-cell function left and must inject insulin in order to live a healthy life.
Type 1 diabetes is typically diagnosed using one or more of the following tests:
- Hemoglobin A1c: This test measures the average blood sugar over the last 60-9o days. It’s reported in a percentage, with a normal A1c being less than 5.7%. Diabetes is diagnosed with a hemoglobin A1c of 6.5% or higher.
- Fasting blood sugar: Blood sugar is tested when the person hasn’t eaten anything for at least eight hours. A normal fasting blood sugar is below 100 mg/dL. Diabetes is diagnosed when the fasting blood sugar is greater than or equal to 126 mg/dL.
- Random plasma glucose test: A blood sugar of 200 mg/dL or greater at any time can be used to diagnose diabetes, though most providers prefer to order a hemoglobin A1c as well to ensure it wasn’t a one-time high blood sugar.
- Oral glucose tolerance test: The individual being tested drinks a solution with 75 grams of glucose in it. A blood test measures how much glucose is in the blood 2 hours after consuming the drink. A normal result is 139 mg/dL or lower, whereas diabetes is diagnosed when the result is 200 mg/dL or higher.
- Antibody tests: Because type 1 diabetes is an autoimmune disease, there are specific antibody tests that can be ordered, including: C-peptide, IAA, IA-2A, ZnT8Ab,ICA, GADA, or anti-GAD.
Diagnostic tests for type 2 diabetes:
The same criteria used to diagnose type 1 diabetes are used to diagnose type 2, with the exception of the antibody tests.
Diagnostic tests for prediabetes:
Fasting blood sugar and hemoglobin A1c are used to diagnose prediabetes or borderline diabetes. However, the threshold for the results is different, since prediabetes falls in between normal blood sugars and full-on type 2 diabetes.
- Hemoglobin A1c: A hemoglobin A1c between 5.7% and 6.4% indicates prediabetes.
- Fasting blood sugar: Blood sugar between 100-125mg/dL is indicative of prediabetes.
- Oral glucose tolerance test: After drinking 75 grams of glucose, blood sugar between 140-199 mg/dL indicates prediabetes.
Diagnostic tests for gestational diabetes
Gestational diabetes occurs during pregnancy and often affects people without a personal history of diabetes.
Women are typically screened for gestational diabetes between weeks 24 and 28 of pregnancy, or sooner for women with a history of gestational diabetes. Gestational diabetes is diagnosed using a diabetes test known as the oral glucose tolerance test (OGTT). There are variations of this test, including the one-, two- and three-hour tests.
- One-hour test: The woman is given a drink containing 50 grams of glucose. Blood sugar levels are checked one hour later and should be less than 130 or 140 mg/dL, according to The American College of Obstetricians and Gynecologists (ACOG).
- Two- and three-hour tests: The woman is given a drink containing 100 grams of glucose. Blood sugars are checked one, two, and three hours later. Gestational diabetes is diagnosed if blood sugar is >180 mg/dL after one hour, >155 mg/dL after two hours, and/or >140 mg/dL after three hours.
Routine Checkups For Type 1 And Type 2 Diabetes
People with type 1 and type 2 diabetes are recommended to have a series of regular health tests and checkups to get an accurate picture of their overall health. The following tests are recommended for people with existing diabetes:
- Microalbumin: This test measures protein in the urine, which is a sign of kidney damage. It’s recommended to check for microalbuminuria at diagnosis and then annually for type 2 diabetes. For type 1 diabetes, it should be tested 5 years after diagnosis and then annually.
- Hemoglobin A1c: The American Diabetes Association (ADA) recommends checking the A1c at least twice yearly for those meeting blood sugar goals and quarterly for those not meeting blood sugar goals.
- Cholesterol and blood lipids: People with diabetes often have elevated levels of cholesterol and increased risk of heart disease. Therefore, it’s recommended to have a cholesterol screening annually in those with diabetes.
- Eye exam: Having diabetes increases the risk of retinopathy, which is damage to the vessels of the eye. Retinopathy can increase the risk of blindness. For type 1 diabetes, a dilated eye exam is recommended 5 years after diagnosis and then annually. For type 2 diabetes, it’s recommended at diagnosis and then annually.
- Foot exam: According to the ADA, patients with diabetes should have their feet inspected during every visit to assess signs of neuropathy and other complications. However, healthcare providers may only perform foot checks annually.
- Comprehensive health exam: People with diabetes should visit with their healthcare provider for a preventative visit at least annually, similar to people without diabetes.
- Routine blood glucose monitoring: Depending on the type, severity, and duration of diabetes, different regimens for checking blood sugar levels at home exist. Some people with diabetes may not check their blood sugar at home, whereas people with type 1 diabetes often check their blood sugar 4-5 times or more per day. Blood sugar levels are checked at home using a glucometer kit, which uses a fingerstick blood sample versus a venous blood draw at a doctor’s office.
Routine Checkups For Prediabetes
People with prediabetes usually don’t need to follow such strict guidelines for routine health exams as those with type 1 and type 2.
However, having prediabetes is a major risk factor for developing type 2 diabetes later in life. According to the ADA, people with prediabetes should be tested for diabetes every 1-2 years, whether that’s a hemoglobin A1c, fasting blood glucose test, or oral glucose tolerance test.
People with prediabetes may choose to check their blood sugar at home, while others don’t. This comes down to both personal and healthcare provider preferences. Some people prefer the peace of mind of knowing what their blood sugar levels are and taking action if their blood sugars are increasing.
Routine Checkups For Gestational Diabetes
Gestational diabetes usually goes away after pregnancy. Women with a history of gestational diabetes are at increased risk of developing type 2 diabetes later in life.
Because of this increased risk, it’s been recommended by both ADA and ACOG to perform a diabetes screening in women with a history of gestational diabetes at 6-12 weeks postpartum, and once every 3 years after that.
Women with gestational diabetes usually check their blood sugar several times per day to ensure the health of themselves and their babies. Many obstetric providers recommend checking pre-meal blood sugars as well as 1-2 hours after meals (postprandial.)
Blood sugar targets are usually more strict in gestational diabetes compared to type 1 and type 2, due to the risks of high blood sugar during pregnancy for both mother and baby.
Blood sugar goals for gestational diabetes are:
- Before a meal: 95 mg/dL or less
- 1 hour after a meal: 140 mg/dL or less
- 2 hours after a meal: 120 mg/dL or less
Conclusion
There are different types of diabetes, including type 1, type 2, gestational and borderline, or prediabetes. The different types of diabetes are diagnosed using tests with distinct thresholds.
Having diabetes increases the risk of other health complications over time. Because of this, people with type 1 and type 2 diabetes are recommended to undergo a series of routine health checks, such as cholesterol screenings, eye exams, kidney checks, and foot exams.
Routine day-to-day testing for those with diabetes is done by checking blood sugar levels with a glucometer kit. Depending on the individual and their treatment plan, people with diabetes may check their blood sugar once to 5+ times daily.
Participating in routine screening and health checks can help ensure that people with diabetes remain healthy as they can be.
These proactive tests and preventative measures can help to avoid diabetes-related complications, improve diabetes management and increase the quality of life.
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