Diabetes? Don’t forget these important health checks

Many of us think of diabetes as a “blood sugar disease.” But when blood sugar levels aren’t controlled over time, it can also damage several organ systems in the body, says Michigan-based internist Philip Kadaj, M.D., a medical expert at JustAnswer. That can lead to other serious health problems, including heart disease, kidney disease, eye issues, nerve pain and more.¹

If you have diabetes, the good news is that managing it and fending off other health issues is often well within your control.² There are everyday habits like exercising and eating well that can help keep your blood sugar levels in a healthy range.² You should also see your health care provider regularly — every three to six months, depending on how well you’re meeting your treatment goals, according to the Centers for Disease Control and Prevention.³

It’s also important to line up some additional screenings throughout the year to make sure the rest of your body is in good shape.^2,3 Here are eight health checks every person with diabetes (and their caregivers) should know about.

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1. Blood pressure

People with diabetes have a greater risk of high blood pressure. In turn, high blood pressure can raise the risk of heart attack, stroke, vision loss and kidney failure. For that reason, it’s very important that you aim to keep your blood pressure at a healthy level. The goal, according to the American Diabetes Association, is below 140/90. (For people with diabetes who are at a greater risk of heart disease, below 130/80 is the recommended target.)⁴

Between checkups, it’s a good idea to check your blood pressure regularly at home, Dr. Kadaj adds. Your doctor can show you how to get accurate readings with a home device. They can also tell you what to look for and when to call your doctor with any concerns.⁴

2. Body composition

Weight and body mass index (BMI) are two numbers your health care provider may use to figure out your diabetes risk or manage your condition.^5,6 BMI is a measure of body fat based on height and weight.⁶ But why do these numbers matter?

Being overweight increases a person’s risk of type 2 diabetes.^5,6 And weight gain in people who have diabetes can make it harder for their body to keep their blood sugar levels under control.⁷ Losing even a little weight can help you manage your blood sugar more easily, with less medication. Just a 5 to 10 percent loss is enough to make a difference.⁸

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3. A1C blood test

An A1C screening is a blood test that measures your average blood sugar level over the past two or three months. Here’s what the results mean:⁹

• Below 5.7 percent: normal
• Between 5.7 and 6.4 percent: prediabetes (That means your blood sugar is too high, but you don’t yet have full-blown diabetes.)
• 6.5 percent and higher: diabetes

If you fall into the diabetic category, your doctor may change your A1C target number based on your age, sex and diabetes type. People with diabetes should get an A1C test every six months if their last A1C was within the healthy target range. Those whose results were too high should repeat the test after three months.^3,9,10

4. ACR urine test

This test looks at the health of your kidneys. It’s the kidneys’ job to filter your blood. If blood sugar builds up in the blood, the kidneys may become overworked and start leaking a protein called albumin.^10,11 Left untreated, Dr. Kadaj says, that can cause damage to the kidneys and even kidney failure.^10,11

To keep an eye on this, your doctor may order an ACR, also known as a microalbumin test. This is generally done once a year. But sometimes it’s done more often if your last test result was too high. Less than 30 milligrams is considered a normal result. A higher number may point to kidney disease.^10,11 That requires treatment with medication, as well as dietary changes.¹²

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5. Foot exam

Uncontrolled blood sugar can damage the small nerves in the feet and legs, causing a condition called diabetic peripheral neuropathy. In people with diabetes, the damage can show up in the feet in the following ways:¹³

• Nerve pain
• Numbness
• Tingling
• Less sensitivity to touch
• Wounds or ulcers that are slow to heal

Diabetes can also damage the lining of your arteries. Over time, fatty deposits, or plaque, can develop where the damage is, blocking blood flow to the legs. This can lead to pain when walking, numbness or weakness, and one foot being colder than the other.^14,15

Once a year, your doctor should do a complete foot exam. They’ll check blood flow and nerve function. They’ll also look for stubborn wounds that you might not have sensed due to nerve damage, Dr. Kadaj says.¹⁶ In people with similar symptoms in their legs, a doctor may also do an ankle-brachial index test, which measures blood pressure at the ankle.

6. Dilated eye exam

People with diabetes can develop eye problems, including:¹⁷

• Cataracts
• Glaucoma
• Diabetic retinopathy, a condition in which elevated blood sugar damages blood vessels in the retina. That is the part of the eye that senses light and sends images to the brain.

All of these issues — especially diabetic retinopathy — can cause vision loss. So it’s important for people with diabetes to get their eyes checked every year, or as recommended by their doctor.^10,17

In a dilated eye exam, a specialist can see the blood vessels in the eye and check for injuries. Surgery is often needed to treat diabetic retinopathy. But injections and adjusting blood sugar medication can help slow the condition’s progression.¹⁷ “There are treatment options,” Dr. Kadaj says. “But the key is controlling blood sugar tightly to prevent it.”

7. Lipid profile

Levels of LDL or “bad” cholesterol tend to be higher in people with diabetes. This is the sticky kind if cholesterol that builds up in arteries and causes heart problems and other health issues. At the same time, people with diabetes often have lower levels of HDL cholesterol. This is the “good” type that helps remove cholesterol from the bloodstream.

Because of this, Dr. Kadaj says, “diabetic patients are at increased risk of heart attack and stroke.” To stay on top of your heart health, your doctor may order a lipid profile. This is a blood test that determines:^10,18

• Total cholesterol (the total amount of cholesterol in your blood)
• HDL
• LDL
• Triglycerides (another type of fat in your blood)
• VLDL (another type of cholesterol)

For people under the age of 40 who don’t have high cholesterol, the American Diabetes Association (ADA) recommends repeating cholesterol testing every five years. For people taking a statin, which is a common medication for high cholesterol, the ADA recommends annual cholesterol testing.¹⁰

8. Estimated glomerular filtration rate (eGFR) test

An eGFR test is another measure of the function of your kidneys. It estimates how much blood your kidneys filter per minute. The higher the number, the faster your kidneys are able to work^.10,19 Results of 80 ml/min/1.73 m2 or lower can point to kidney damage.¹⁰ Type 2 diabetes patients and type 1 patients who’ve had diabetes for five years or more should have this test once a year, the ADA says. But patients whose past tests indicated kidney damage should have it more frequently.¹⁰

If this sounds like a lot of screenings, take heart. If you have diabetes, your diabetes care team can help you stay on top of important health checks. And many of them can be done at the same time as your regular doctor visits, to save you a trip to the office. Remember that sticking with your diabetes treatment plan and keeping your blood sugar levels steady is one of the best ways to stay healthy from head to toe and reduce the need for extra screenings.

Aetna D-SNP members who have diabetes can get help tracking and managing their blood sugar levels from their care team. Visit AetnaMedicare.com/DSNPInfo to learn more about D-SNP plans.

¹National Institute of Diabetes and Digestive and Kidney Diseases. What Is Diabetes. December 2016. Accessed June 13, 2022.

²National Institute of Diabetes and Digestive and Kidney Diseases. Managing Diabetes. Accessed June 13, 2022.

³Centers for Disease Control and Prevention. Your diabetes care schedule. May 25, 2021. Accessed June 13, 2022.

⁴American Diabetes Association. Cardiovascular disease and risk management: standards of medical care in Diabetes—2022. Diabetes Care. 2022; 45(1): S144-S174. Accessed June 13, 2022.

⁵American Diabetes Association. Extra weight, extra risk. Accessed June 13, 2022.

⁶American Diabetes Association. No more guessing: BMI calculator. Accessed June 13, 2022.

⁷Mayo Clinic. Obesity. September 2, 2021. Accessed June 13, 2022.

⁸Centers for Disease Control and Prevention. Healthy weight. April 28, 2021. Accessed June 13, 2022.

⁹Centers for Disease Control and Prevention. All about your A1C. August 10, 2021. Accessed June 13, 2022.

¹⁰American Diabetes Association. Health checks for people with diabetes. Accessed June 13, 2022.

¹¹Mayo Clinic. Microalbumin test. January 19, 2021. Accessed June 13, 2022.

¹²Cleveland Clinic. Kidney disease / chronic kidney disease. December 18, 2020. Accessed June 13, 2022.

¹³National Institute of Diabetes and Digestive and Kidney Diseases. Peripheral Neuropathy. Accessed June 13, 2022.

¹⁴Society for Vascular Surgery. Why diabetes can damage your blood vessels, and how to know if you’re at risk. November 25, 2019. Accessed June 13, 2022.

¹⁵Mayo Clinic. Peripheral artery disease (PAD). Accessed June 13, 2022.

¹⁶National Library of Medicine, MedlinePlus. Diabetic foot exam. September 13, 2021. Accessed June 13, 2022.

¹⁷National Library of Medicine, Medline Plus. Diabetes and eye disease. February 4, 2022. Accessed June 13, 2022.

¹⁸National Library of Medicine, MedlinePlus. VLDL cholesterol. March 29, 2018. Accessed June 13, 2022.

¹⁹National Library of Medicine, Medline Plus. Glomerular filtration rate (GFR) test. September 9, 2021. Accessed June 13, 2022.