Type 2 diabetes monitoring: Blood sugar tests and health screenings

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.

                                                                                                                   Getty Images

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.

https://mcpress.mayoclinic.org/diabetes/type-2-diabetes-monitoring-blood-sugar-tests-and-health-screenings/

Screening all children for type 1 diabetes is effective, study says

From bbc.co.uk 

All UK children could be offered screening for type 1 diabetes using a simple finger-prick blood test, say researchers who have been running a large study.

Currently, many young people go undiagnosed and risk developing a life-threatening complication called diabetic ketoacidosis that needs urgent hospital treatment.

Identifying diabetes earlier could help avoid this and mean treatments to control problematic blood sugar levels can be given sooner.

Some 17,000 children aged three to 13 have already been checked as part of the ELSA, external (Early Surveillance for Autoimmune diabetes) study, funded by diabetes charities.

Imogen, who is 12 and from the West Midlands, is one of those found to have diabetes thanks to the screening.

Her mum Amy says knowing what's coming, rather than being taken by surprise, has made a massive difference to their confidence and peace of mind.

"Imogen took part in the study to further research and help others, but it has helped her too – being forewarned is being forearmed.

"She was always going to develop type 1 diabetes, but through ELSA we've been able to slow down the process and prepare. We know what's coming, but we're not scared."

Imogen is being given ongoing support to prepare her for what is to come.

Amy, who is 44 and has type 1 diabetes herself, is aware of the risks with the disease. She was diagnosed aged 13 after developing diabetic ketoacidosis.

"When I was diagnosed, I had no warning and ended up quite poorly in hospital," she recalls.

Imogen is now trying a new type of drug designed to delay her diabetes. It's an immunotherapy called teplizumab that helps calm her immune system to slow its attack of her pancreas.

In trials, external, the drug has been shown to delay the onset of diabetes by about three years, on average. It is not yet widely available on the NHS. Imogen is only the second child in the UK to get it.

              Doctors hope the immunotherapy drug will delay Imogen's diabetes          Diabetes UK

How the diabetes screening test works

The finger-prick blood test checks for autoantibodies - proteins that the immune system makes which can attack the body's own tissues.

In diabetes, these autoantibodies attack the pancreas - the organ which has the job of making insulin to control blood sugar.

Family history can increase your risk of type 1 diabetes and scientists believe some things in the environment, like viruses, play a role in triggering it.

Preliminary findings from ELSA in the 17,283 children, published in The Lancet Diabetes & Endocrinology, external journal and funded by Diabetes UK and Breakthrough T1D, show:

• 75 children had one autoantibody, signalling increased future risk of type 1 diabetes

• 160 had two or more autoantibodies but did not yet require insulin therapy, indicating early-stage type 1 diabetes

• 7  were found to have undiagnosed type 1 diabetes, with all needing to start insulin immediately

Children without autoantibodies are unlikely to develop type 1 diabetes.

Dr Elizabeth Robertson from Diabetes UK said: "For too many families, a child's type 1 diabetes diagnosis still comes as a frightening emergency. But that doesn't have to be the case.

"Thanks to scientific breakthroughs, we now have the tools to identify children in the very earliest stages of type 1 diabetes - giving families precious time to prepare, avoid emergency hospital admissions, and access treatments that can delay the need for insulin for years."

Rachel Connor, from Breakthrough T1D, added: "The findings from ELSA's first phase signal a major step towards a future in which type 1 diabetes can be detected early, managed proactively, and potentially delayed through immunotherapy."

The next phase of the study - called ELSA 2 - will now expand the screening offer to children aged 2 to 17. The finger-prick test can be done at home, in school or at a GP surgery.

Several other countries are also exploring whether to introduce diabetes screening for children. Italy already has for those aged 1 to 17.

It would be up to UK ministers, advised by the National Screening Committee and studies like ELSA, whether to do the same.

Symptoms of type 1 diabetes

The NHS says the most common symptoms of type 1 diabetes are:

• peeing more than usual, especially at night

• feeling very thirsty and drinking more than usual

• feeling very tired

• losing weight without trying to or looking thinner

Children may have heavier nappies or they may start wetting the bed because they're peeing more.

https://www.bbc.co.uk/news/articles/c3684zddgl0o

5 Heart Disease and Diabetes Risk Factors That Should Be on Your Radar

From healthline.com

Regular screenings in these five areas can help you reduce your risk for developing heart disease and type 2 diabetes.

Rates of diabetes and heart disease in the United States continue to rise.
The Endocrine Society is working to combat these statistics through earlier intervention and prevention by recommending new guidelines for regularly assessing the five major risk factors.
These include measurements for your waistline, blood pressure, cholesterol, triglycerides, and blood sugar.
To get a diagnosis of metabolic syndrome, a person would need to meet three out of these five criteria, explains Dr. Eugenia Gianos, director of cardiovascular prevention at Northwell Health in New York City.

The Endocrine Society’s new recommendations are aimed at people 40 to 75 years old. However, experts say a growing number of young people are also at risk.
“More and more young patients are developing heart disease and type 2 diabetes,” Gianos told Healthline. “I’m astounded on a daily basis when I come to work to find blockages or heart attacks in people in their 30s and 40s. They may have a genetic predisposition, but it wouldn’t have presented until their 60s if it weren’t for poor lifestyle habits.”
Here’s what people of all ages need to know about regularly assessing the five major risk factors of heart disease and diabetes.

1. Your waist circumference

Your waistline is the first and foremost indicator of your risk for developing heart disease or type 2 diabetes. This typically happens when the waistline is greater than 102 centimetres (cm) for men or 88 cm for women.
Reducing the waistline through weight loss will likely also reduce blood pressure, cholesterol, triglycerides, and blood sugar.
“Certainly, I’d choose to focus on your waistline first,” Gianos said. “Two-thirds of this country is overweight or obese. For some it’s a predisposition, but your lifestyle habits still play the central role.”
Gianos recommends starting with a predominantly plant-based diet consisting of vegetables, fruits, whole grains, nuts, legumes, and lean animal proteins.
“It’s what you put in your mouth,” added Mara Schwartz, CDE, RN, coordinator of the diabetes program at Self Regional Healthcare in Greenwood, South Carolina.
Schwartz says this can become particularly problematic for people when many members of their family are also overweight and an unhealthy diet is normalized by those around them.
“If you’re not willing to make changes in your diet, particularly by eating fewer processed foods and cutting out sugar-loaded beverages entirely, you will struggle to prevent that type 2 diabetes diagnosis,” Schwartz said.

Cutting sugary drinks — which include soda, juice, sweet tea, and sweetened coffee beverages — is one of the most impactful changes a person can make to lose weight and reduce their risk for developing type 2 diabetes.
“But you’ll have to ween yourself off slowly,” Schwartz cautioned, “because you’ll get headaches and you’ll go through tremendous sugar withdrawal. Sugar is addictive.”
Schwartz has seen patients lose 10 pounds in a few weeks and 20 pounds within a few months just from cutting sugary beverages from their diet.

2. Blood pressure

“Often referred to as ‘the silent killer,’ patients are usually unaware of how high their blood pressure is and their risk until they’ve suffered repercussions like a stroke or advanced kidney disease or a heart attack,” explained Gianos.
Two numbers are used to measure a person’s blood pressure, according to the Centres for Disease Control and Prevention Trusted Source.
The first number, systolic blood pressure, measures the pressure in your blood vessels when your heart beats.
The second number, diastolic blood pressure, measures the pressure in your blood vessels when your heart rests between beats.

A person’s blood pressure can be a sign that they’re at risk for heart disease or diabetes when they have greater than 130 mm Hg systolic or greater than 85 mm Hg diastolic.
A number of factors can contribute to high blood pressure, including untreated sleep apnea, excessive alcohol consumption, smoking cigarettes, lack of physical activity, regular consumption of NSAIDs (nonsteroidal anti-inflammatories like aspirin, including Motrin and Advil), and a diet high in processed carbohydrates, salt, and sugar.
Gianos recommends following a plant-based diet as one of the best ways to reduce your risk for developing high blood pressure.
She points out that fresh vegetables actually work to lower blood pressure by oxidizing the fats in your bloodstream, which would otherwise lead to plaque build-up in your arteries.

3. Cholesterol

The Endocrine Society currently recommends that HDL (good) cholesterol should be greater than 40 mg/dL in men and 50 mg/dL in women.
However, while the latest guidelines focus on HDL levels, Gianos says she feels LDL (bad) cholesterol numbers should be regularly monitored as well.
“In the past, we’ve talked about cholesterol levels in terms of the ratio of LDL (‘bad’) versus HDL (‘good’),” explained Gianos.
“Technically, your HDL cholesterol actually clears the LDL out of the blood, but we’re seeing many patients come in with heart attacks and their HDL is as high as 100. This means it’s not just about the number, but how functional that cholesterol is,” she said.

Gianos adds that drugs designed to increase a patient’s HDL levels have proven ineffective at reducing their risk for a heart attack.
“The LDL itself is truly the most predictive of what your health outcomes will be, and reducing your LDL has a tremendous impact on reducing your risk of a heart attack,” Gianos said.

Statins, a class of drugs prescribed to treat high cholesterol and blood pressure, are one of the first things a doctor will prescribe to help a patient lower these numbers.
Recent research, however, concluded that statins actually double a patient's risk for developing type 2 diabetes by way of increasing insulin resistance.
Despite the study, both Gianos and the American Heart Association believe the benefits of statins outweigh the risks.
“[The risk is] slight but not dramatic, and usually in patients who were already borderline diabetic,” explained Gianos.
Deciding whether or not to use statins to treat your own cholesterol should be a careful discussion with your doctor about the risks and benefits for your personal health.

4. Blood fats (triglycerides)

According to the Endocrine Society, blood fats could be a sign that a person is at risk for developing heart disease or diabetes if levels are greater than 150 mg/dL.
“Triglycerides are just slightly different cholesterol molecules than LDL and HDL,” explained Gianos. “High triglycerides do tend to be more associated with obesity and diabetes — and a very clear marker for increased cardiovascular risk.”

While there are medications designed to specifically lower triglyceride levels, Gianos says they haven’t proven to actually reduce a patient’s risk for heart disease or heart attack.
Instead, she recommends focusing on improving your cholesterol levels, which will then improve your triglyceride levels largely by improving your diet with a plant-based focus.
She also cautions against severe low-carbohydrate diets that encourage eating large quantities of saturated fat. She says she’s seen first hand the negative effects of strict low-carbohydrate diets like keto and paleo, which can actually increase insulin resistance and your risk for a heart attack.
“I’m appalled at the large following of ketogenic diets recently,” Gianos said. “Yes, people lose weight quickly in a short turn, but it’s not in a healthy way or a sustainable way. And there is no evidence to support that it’s safe or healthy. A plant-based diet is key.”

5. Blood sugar

The most dangerous aspect of slowly developing prediabetes or type 2 diabetes is that daily high blood sugar levels gradually damage your entire body — and that damage can’t usually be repaired.
Ignoring the earliest signs of diabetes means creating the potential for retinopathy in your eyes, neuropathy in your feet, and nephropathy in your kidneys.
Persistent high blood sugars are also linked to depression, a variety of skin conditions, chronic yeast infections, and major oral health problems.
Your blood sugar levels may be a sign of a bigger problem if:

• fasting glucose is greater than 100 mg/dL
• two-hour oral glucose tolerance test is greater than 140 mg/dL
• HbA1c is greater than 5.7 percent
• you’re currently on oral drug treatment for high blood sugars without a diabetes diagnosis.

A 2016 study published in Diabetes Care concluded that approximately 40 percent of people with prediabetes or type 2 diabetes will be able to completely reverse the condition by making drastic changes in their habits around diet and exercise.
However, Schwartz emphasizes that all patients with prediabetes or type 2 diabetes will benefit and protect their health by improving their eating habits.
“I’ve seen patients go from an A1C of 10 percent down to 6 or 7 percent within six months just from cutting soda out of their diet,” Schwartz said.

She also warns of dismissing a prediabetes diagnosis just because your weight is normal.
“I see patients all the time with high A1Cs who aren’t even being diagnosed because their weight is normal thanks to a high metabolism, but their blood sugar is still spiking after every meal,” Schwartz said.

The bottom line

Assessing the five major risk factors of heart disease and type 2 diabetes include measuring your waistline, blood pressure, cholesterol, triglycerides, and blood sugar.
Talk with your doctor to make sure you’re regularly being screened in each of these areas to properly assess your risk.
Experts advise avoiding highly processed foods and sugary drinks, which can greatly increase a person’s risk for developing heart disease, type 2 diabetes, or both.
Following a plant-based diet is also an effective way to lower your risk.

https://www.healthline.com/health-news/5-heart-disease-and-diabetes-risk-factors-that-should-be-on-your-radar#The-bottom-line