Eye disease (diabetic retinopathy)

Every year, have:⁵

• A complete dilated eye exam (ophthalmoscopy).
• Vision tests.
• Test for glaucoma.

If you are at low risk for vision problems, your doctor may consider follow-up exams every 2 years.

As often as indicated, have:

• Pictures taken of the back of your eyes (fundus photography), to monitor diabetic retinopathy and evaluate your treatment.
• Fluorescein angiogram, an imaging test, to find any leaking blood vessels in the retina.

Kidney disease (diabetic nephropathy)

Every year, have one of the following:⁵

• A urine test for protein levels such as microalbuminuria, macroalbuminuria, or the albumin to creatinine ratio. These tests check for damage to your kidneys.
• Creatinine, a urine or blood test that checks kidney function.

As needed to check on your condition, have:

• A 24-hour urine test to check the total amount of protein leaking from your kidneys. A result of 300 mg or greater of protein in 24 hours shows that the kidneys are leaking large amounts of protein (macroalbuminuria).⁵
• Blood urea nitrogen (BUN) and creatinine levels, to help estimate how well your kidneys are removing wastes from the bloodstream.
• Blood electrolyte tests, to check whether your kidneys are keeping normal levels of electrolytes (salts) in your blood.

If you develop kidney failure, you may need other tests. For more information, see the topic Chronic Kidney Disease.

During every medical appointment, have:

• Your blood pressure checked. Your blood pressure should be less than 130/80 mm Hg.⁶

At least every year, or more often, if indicated, have a:⁵

• Cholesterol and triglyceride level test, to evaluate cholesterol levels in your bloodstream. Your LDL cholesterol level needs to be less than 100 mg/dL or aim for keeping it at 70 mg/dL, your triglyceride level needs to be less than 150 mg/dL, and if possible, your HDL cholesterol level needs to be more than 40 mg/dL. Women may consider an HDL goal of more than 50 mg/dL.

Have an:⁵

• Exercise electrocardiogram (treadmill EKG or cardiac stress test) if you have not been active and plan to begin a vigorous exercise program.

As indicated, have:

• Electrocardiogram (ECG or EKG), if you have had a heart attack or have symptoms of heart disease.
• Exercise electrocardiogram (treadmill EKG or cardiac stress test).

For more information, see the topics Heart Attack and Unstable Angina, Stroke, and Peripheral Arterial Disease of the Legs.

Nerve disease (diabetic neuropathy)

Periodically, have a:

• Physical examination to check your response to light touch, pressure, temperature, and vibration, particularly in your feet and legs. Simple tests can screen for loss of sensation. Have these tests done on both feet.
  • Touching the end of your toe with a cotton wisp or a thin plastic fiber (called a monofilament test) assesses your sense of light touch or pressure.
  • A cold metal tuning fork held to your leg evaluates your sensation of temperature.
  • A vibrating tuning fork touched to your foot assesses your sensation of vibration.
• Checkup on your muscle strength and reflexes, especially those in your ankles and knees.
• Careful exam of your feet for corns, calluses, infections, injuries, or bone and joint problems. Have a complete exam of your feet at least once a year.⁷
• Measurement of your blood pressure and pulse when lying down, sitting, and standing.

As indicated, have:

• Electromyogram (EMG), to measure how well and how quickly particular nerves and muscles are working.

Tests for autonomic neuropathy (internal functioning) are specific to your symptoms, such as:

• Urine test and urine culture, an ultrasound of the bladder, X-ray of the entire urinary system (intravenous pyelogram), or a cystometrogram (which measures bladder storage capacity), if you have a problem with bladder control.
• Endoscopy or upper GI series, if you have digestive system symptoms.
• Gastric emptying study, to evaluate how quickly your stomach empties. Nerve damage from diabetes can slow this rate.