How can Diabetes be Monitored

Diabetes is a chronic metabolic disorder that is responsible for long term chronic complications like heart attack, stroke (paralysis), kidney failure, gangrene, etc. If not managed well, it can also lead to life threatening acute complications like diabetic ketoacidosis, hypoglycemia, and a variety of infections. Diabetes is often associated with other conditions like obesity, hypertension (high blood pressure), dyslipidemia (high cholesterol), hypothyroidism, fatty liver, PCOD, etc.

Lifestyle modification in the form of a diabetic diet, regular exercise, and weight control are the cornerstones of therapy in addition to medicines as prescribed by a doctor. In addition to blood sugar control, it is important to regularly monitor for other associated conditions and complications, as listed above. Early diagnosis and timely intervention can be very helpful in preventing the progression of disease.

Monitoring in diabetes 

• Home monitoring of blood sugar and blood pressure: Every diabetic patient must monitor his/her blood sugar and blood pressure regularly at home and prepare a chart to be shared with the treating doctor. The frequency of monitoring depends on various factors and can be best guided by the treating physician.
• Fasting and Postprandial plasma glucose: The home monitoring devices are useful for home monitoring but are not very accurate. Blood sugar must be checked in a good laboratory at least once a month before visiting the treating doctor.
• HbA1C: HbA1C is a very good marker of the overall glycemic control in the preceding 3 months. This is one of the most important blood tests that must be done every 3 months.
• Lipid Profile: Diabetic patients often have deranged lipid profiles. This test must be done at least once a year, even if the cholesterol levels are normal. In patients with dyslipidemia, more frequent testing is needed until the lipid profile values settle on a particular dose of medicine.
• Thyroid function test: Hypothyroidism, which is more common in females, is also seen more often in diabetic patients. It should be checked at least once a year and more often if the values are abnormal.
• Liver function test: Diabetic patients are also at a higher risk of fatty liver, which may progress to NASH and liver cirrhosis if not managed on time. Liver function tests must be done at least once a year.
• Kidney function test: Diabetes is the most common cause of kidney failure. This test should be done as part of an annual health checkup. Urine for microalbuminuria is another test that can diagnose diabetic nephropathy at a very early stage. Timely intervention at this stage can help in retarding progression of kidney failure.
• Other blood tests: Other investigations like the CBC (complete blood count), CRP, S Vit D3 levels, and S Vit B12 levels are often advised along with the routine investigations.
• Other investigations: For early diagnosis of heart disease, it is advisable to do the CTMT (treadmill test) and 2D echo on an annual basis. Ultrasound of the abdomen can be very helpful in the early diagnosis of fatty liver. Diabetic patients are also at risk for diabetic retinopathy, for which a fundus examination or fundus photography must be done on an annual basis.

In addition to these basic investigations the treating doctor may advise additional investigations based on examination findings and his clinical judgment. With regular monitoring, timely intervention, and regular treatment, the risk of various acute and chronic complications of diabetes can be reduced to a great extent. 

Author 

Dr. Kirti Pandia 

(MBBS DNB Pathology)