From mcpress.mayoclinic.org
If you have type 2 diabetes, measuring your blood sugar level, also called blood glucose level, is a useful way to track the status of your condition. But because high blood glucose can cause issues in your heart, kidneys, and even your eyes and feet, the best management strategies include additional tests to check for complications.
Keeping up with recommended testing and understanding test results empowers you to make informed decisions about your diabetes care. By working alongside your care team to refine your diabetes management plan, you can take steps to improve your health and happiness.
Blood sugar monitoring tests for type 2 diabetes
When you eat, your body breaks down the food into glucose, a type of sugar that fuels the cells throughout your body. The glucose enters your blood and gets into your cells with help from a naturally occurring hormone called insulin.
All types of diabetes stem from an issue in the interaction between blood glucose and insulin. If you have type 2 diabetes, your body doesn’t make enough insulin, can’t use insulin effectively or both. This causes glucose to build up in your blood. If your blood glucose level is too high too often, it can cause issues throughout your body.
There are a few methods for measuring your blood glucose level. Each serves a unique purpose. Using them together can create a clearer picture of your diabetes.
The A1C test measures blood sugar levels over time
The A1C blood test offers an overhead view of your average blood glucose level. “It’s a nice barometer for a three-month period,” explains Jessica R. Wilson, M.D., M.S., an endocrinologist and diabetes expert at Mayo Clinic in Jacksonville, Florida. The A1C test’s broad perspective is most useful for diagnosing diabetes and determining whether changes in your diabetes management plan, such as a new medicine or exercise routine, are affecting your condition.
The A1C test is sometimes called the glycated haemoglobin test. This is because the test doesn’t directly examine blood glucose levels. Instead, it measures what percentage of haemoglobin, a protein in your red blood cells, is coated with sugar in a process called glycation. The more glucose there is in your blood, the more haemoglobin gets glycated.
Any factor that influences your haemoglobin can interfere with A1C test accuracy. This can include having low iron, kidney disease, a low red blood cell count or a gene that influences the shape of your red blood cells.
If you have type 2 diabetes, the American Diabetes Association (ADA) recommends getting an A1C test at least twice every year. The best A1C test result to aim for depends on your age and diabetes history. An A1C result of less than 7% is a common goal for adults who have diabetes. If your A1C results are lower than this benchmark, “there’s a lower risk of eye damage, kidney damage, nerve damage and other complications,” Dr. Wilson says.
A blood glucose meter: A “snapshot” of blood sugar levels
While the A1C test is an important tool, people who have diabetes also need a quick way to check their current blood glucose levels. Using a blood glucose meter enables you to independently and accurately check your level within seconds.
To use most blood glucose meters, you first insert a test strip into the device. Then you poke the side of a clean fingertip with a small needle, called a lancet, to release a drop of blood. When you touch the test strip to the blood, the meter shows your blood glucose level on a screen.
“The challenge is that doesn’t tell you how long it was at that level,” Dr. Wilson says. Everyone’s blood glucose levels naturally rise and fall throughout each day. Seeing a high or low result on a blood glucose meter could indicate that you took a snapshot during a natural swing. Or it could be evidence of a sustained issue. With a blood glucose meter, the only way to measure your level over time is to repeat the test throughout a certain period. This can be inconvenient and time-consuming.
Continuous glucose monitors track blood sugar throughout the day
Efforts to fill in the gap between the A1C test’s big picture and a blood glucose meter’s snapshot led to the development of the continuous glucose monitor. This device estimates the glucose level in the fluid between your cells, also called interstitial glucose, over time. The level of interstitial glucose is usually similar to the glucose level in your blood.
A continuous glucose monitor includes a tiny sensor inserted under your skin. The sensor transmits data to a receiver or your smartphone, which allows you to review your estimated glucose level minutes after the measurement was collected.
Automatically gathering a set of data points allows both you and your care team to build a clearer understanding of how your blood glucose changes throughout each day, Dr. Wilson says. Pairing a continuous glucose monitor with a log of day-to-day events — such as eating, taking a medicine or exercising — can help you optimize your diabetes management plan, especially if you’re using insulin therapy.
Like other glucose measuring tools, continuous glucose monitors aren’t always accurate. Compressing the sensor, which may happen while you’re sleeping, can cause the device to falsely indicate low blood glucose. Certain medicines also can affect readings.
Why is screening for type 2 diabetes complications important?
Measuring blood glucose is critical for tracking diabetes. But because type 2 diabetes can affect many parts of the body, testing for other health risks is just as crucial.
Dr. Wilson recommends that people who have type 2 diabetes start screening for complications as soon as they’re diagnosed — even though that may seem premature. “Most likely, there’s already been a period of time during which blood glucose was higher than the expected range,” Dr. Wilson says. Testing to detect any emerging issues can help you and your care team “get on the front end of it.”
The ADA’s current recommendations for people with type 2 diabetes include guidance for the following areas:
Heart and blood vessel health
People who have type 2 diabetes often have a higher risk of cardiovascular disease. The ADA recommends getting your blood pressure measured during every routine clinical visit, or at least once every six months. A lipid panel, which measures your cholesterol and triglycerides, is another important test for heart health. The ADA recommends getting a lipid panel when you’re diagnosed and at least once every year after.
Kidney health
Kidney disease also is common among people who have type 2 diabetes. The ADA recommends testing your urine albumin-creatinine ratio (uACR) and estimated glomerular filtration rate (eGFR) to check your kidney health at least once a year.
Nerve health and peripheral neuropathy
High blood glucose can cause nervous system issues. The ADA recommends an assessment for peripheral neuropathy by a healthcare professional after you’re diagnosed with type 2 diabetes and once every year after.
Eye and sight health
To monitor any vision issues, the ADA recommends having a dilated and comprehensive eye examination by an eye doctor after you’re diagnosed. Getting checked once every year helps your care team catch emerging issues.
Foot health
The ADA recommends an annual foot health examination. If you have a high risk of foot issues, a foot doctor might be able to offer specialized care.
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