A silent killerDiabetes mellitus has been called a silent killer. Left untreated, it can lead to damage of the kidneys, nerves, eyes and heart. This damage may be silent. For instance, heart disease may be silent, without even chest pain till, one day; the patient suffers a catastrophic heart attack. Good control of Diabetes can prevent complications.However, not all people with good control are complication-free. This is because though the blood sugar levels may be normal once a month when checked, but in the interim period, blood sugar fluctuations may pass undetected. These silent fluctuations in the day or night can predispose to complications. Every person with Diabetes, whether his blood sugar is controlled or not, therefore should undergo an annual check-up to look for Diabetes related complications.Constant monitoring requiredYour first step is to know your risk. Visit your health care provider and ask about your risk of developing any complications associated with Diabetes. Most of us have risk factors that raise our risk for these deadly diseases. For many of the risk factors, there are things we can do to lower our risk.Having Diabetes can lead to serious health problems called “complications of Diabetes”. They include heart disease and stroke, kidney problems, nerve damage, problems with eyesight, sores and skin infections on feet and gum disease that can lead to loss of teeth.Many people with Diabetes believe that only when complications occur, they need to be treated. This is wrong. By the time a complication like kidney failure or loss of vision occurs, they are virtually difficult to reverse. Therein lies the importance of screening for complications. If a patient undergoes testing and a problem is detected in the pre-complication stage, treatment is effective.It is important -Not to ignore any warning signs with regards to our health when they present themselves.That every patient prepares themselves to face reality whenever they meet a doctor. Take a step back, relax and look at the situation objectively.To not delay your diagnosis or treatment for an excessively long period.Diabetes related health checkupThe aim of these additional tests is to detect the Diabetes related complications at early stages which are often asymptomatic. These tests provide a fair understanding of risks and complications that may arise, they often fail to pinpoint on some serious complications often associated with Diabetes. In addition to the fasting and post prandial blood tests, people with Diabetes must also undergo these routine tests for follow up -HbA1c every 3 monthsLipid profile with measurement of fractions like LDL and HDL cholesterol levels and triglyceride levels every 6 to 12 monthsSerum Creatinine every 12 months if normal n every 3 to 6 months if abnormal.Urine micro albumin every year if normal and every 3 to 6 months if abnormal.ECG - to be checked every yearStress test, ECHO and cardiology consultation depending on the ECG test resultRetina check-up- to be done every year if normal, every 6 months if mild to moderate retinopathy and every 3 months for severe retinopathy or if laser treatment is done.Neurovascular evaluation of foot - This involves testing for fine touch (by monofilament), vibrations (by biothesiometry or tuning fork) for evaluation of neurological sensation and Ankle brachial index for evaluation of circulation of feet to be done at least once every one year. If required, the doctor may advise you to do a foot scan.Dental check-up - Once every 6 monthsHbA1cThe HbA1c is a blood test which gives average blood sugars of past 3 months. It can never be overemphasized that a person with Diabetes should regularly check his or her HbA1c and maintain it at a level as advised by the doctor. If done every 3 to 6 months it gives information regarding the blood sugar control and indicates if the patients have been regularly taking medicines.Normal <5.7 per centPre Diabetes 5.7-6.4 per centDiabetes ≥ 6.5 per centThe advantage of HbA1c test is that it can be given at any time of the day, no special preparation like fasting is required. The test should be done from a standardised lab which frequently does the test and also has a good quality control program.Lipid profile testLipid is another word for "fat”. Cholesterol and triglycerides are lipids. Lipids are easily stored in the body. They serve as a source of fuel and are an important constituent of the structure of cells. Cholesterol is oil-based and is a soft waxy substance found in every cell of your body.Lipid profile test (lipid panel or lipid profile) is a blood test that can measure the amount of cholesterol and triglycerides in your blood. It requires a 12 hour of overnight fasting (no food, drinks, except water) prior to the test. If you have Diabetes, then you should check your cholesterol levels once every year.A lipid profile typically includes:Total cholesterol - this test measures all of the cholesterol in all the lipoprotein particles.High-density lipoprotein cholesterol (HDL-C) - measures the cholesterol in HDL particles; often called "good cholesterol" because it removes excess cholesterol and carries it to the liver for removal.Low-density lipoprotein cholesterol (LDL-C)- calculates the cholesterol in LDL particles; often called "bad cholesterol" because it deposits excess cholesterol in walls of blood vessels, which can contribute to atherosclerosis. Usually, the amount of LDL-C is calculated using the results of total cholesterol, HDL-C and triglycerides.Triglycerides - measures all the triglycerides in all the lipoprotein particles; most is in the very low-density lipoproteins (VLDL).Very low-density lipoprotein cholesterol (VLDL-C) - calculated from triglycerides/5; this formula is based on the typical composition of VLDL particles.Non-HDL-C - calculated from total cholesterol minus HDL-C.Cholesterol/HDL ratio - calculated ratio of total cholesterol to HDL-C.An extended profile (or advanced lipid testing) may also include low-density lipoprotein particle number/concentration (LDL-P). This test measures the number of LDL particles, rather than measuring the amount of LDL-cholesterol. It is thought that this value may more accurately reflect heart disease risk in certain people.Blood pressure testingBlood pressure is the force of blood flow inside your blood vessels. Your blood pressure is recorded with two numbers, such as 130/80 mmHg. Both numbers are important. The first number is the pressure as your heart beats and pushes blood through the blood vessels. Health care providers call this the "systolic" pressure. The second number is the pressure when the vessels relax between heartbeats. It's called the "diastolic" pressure.When your blood moves through your vessels with too much force, you have high blood pressure. Your heart has to work harder when blood pressure is high and your risk for Diabetes problems goes up. High blood pressure is a problem that won't go away without treatment.The recommended target for blood pressure are:Normal BP - less than 120 / 80Pre-hypertension 120 to139 / 80 to 89High BP (stage 1) 140 to159 / 90 to 99High BP (stage 2) higher than 160 / 100Slight variation to these numbers is quite normal, but very high blood pressure (Hypertension) poses health risks such asHeart attackCongestive heart failureStrokeKidney failurePeripheral artery diseaseHypertensive retinopathy (eye damage)Serum creatinineCreatine is a compound that is made primarily in the liver and then transported to the muscles. It functions as an energy source for muscle activity. Once in the muscle, some of the creatine is spontaneously converted to creatinine. The amount of both creatine and creatinine depend on muscle mass, so men usually have higher levels than women.This blood test measures the level of creatinine in the blood which provide your doctor with information about how well your kidneys are working. Creatinine is one of the substances that kidneys normally eliminate from the body. High levels of creatinine may indicate that your kidney is damaged and not working properly.Results of the creatinine blood test are measured in milligrams per deciliter or micromoles per liter. The normal range for creatinine in the blood may be 0.6 to 1.3 milligrams per deciliter, although this can vary from lab to lab, between men and women and by age.Microalbuminuria testThe blood vessels in the kidney filter waste from the blood and this waste is expelled from the body in form of urine. Proteins are normally retained in the bloodstream by the kidneys. When these blood vessels are damaged, it may cause excess of protein (albumin) to spill in the urine. Albumin excretion in urine increases in patients with Diabetes, especially those with uncontrolled blood sugar levels over a period of time. This condition is known as Diabetes Nephropathy. Positive urine micro albumin is the earliest indicator of diabetic nephropathy.ECGElectrocardiography (ECG) is the process of recording electrical activity of the heart by placing electrodes on the body. These electrodes detect tiny electrical changes on the skin that arise during each heartbeat. The electrocardiogram can measure the rate and rhythm of the heartbeat, as well as provide indirect evidence of blood flow to the heart muscle.The ECG is a relatively simple test to perform. It is non-invasive and does not hurt. An electrode lead, or patch, is placed on each arm and leg and six are placed across the chest wall. The signals received from each electrode are recorded. The printed view of these recordings is the electrocardiogram.Stress testStress tests are tests performed to determine the amount of stress that your heart can manage before developing either an abnormal rhythm or evidence of ischemia (not enough blood flow to the heart muscle). The most commonly performed stress test is the tread mill exercise stress test. As your body works harder during the test, your heart has to pump more blood. The test detects whether there is adequate blood supply reaching your heart during a stress inducing event. The following is monitored during the test:Your heart rateYour breathingYour blood pressureYour electrocardiogram (ECG)How tired you feelECHO testAn echocardiogram is a test that uses sound waves to create pictures of the heart. The picture and information it produces is more detailed than a standard x-ray image. There is no exposure to radiation during an echocardiogram. It is a non-invasive and painless procedure. Echo also can pinpoint:heart muscle that aren't contracting well because of poor blood flow or injuryblood clots inside the heartfluid buildup in the pericardium (the sac around the heart)Structural abnormalities in the heart valvesproblems with the aorta (The aorta is the main artery that carries oxygen-rich blood from your heart to your body)flow of blood through your heart's chambers and valves (in case of Doppler echocardiogram)Retina examEye check-up for people with Diabetes focusses on the retina. The retina, through which we perceive the external world, is classically affected by Diabetes. Fundoscopy allows a doctor to see the retina and other structures. Retinal fundoscopy may detect some signs of other eye diseases like retinal changes due to high blood pressure, cataract as well as Glaucoma. It is considered to be 90-95 per cent accurate and can detect the early signs of many serious diseases like brain tumour. Retinal photography screening monitors your eye health though accurate photographic documentation which remains available for future reference. Normal results show normal retina, blood vessels and the optic disc appear normal.Diabetes and your feetDiabetes, a disorder of high blood sugar levels, can harm various organs of the body if it is uncontrolled or there is a lack of proper care management. Long duration of uncontrolled blood sugar levels in the blood stream damages the nerves. This is known as peripheral neuropathy. It also affects the blood vessels resulting in decreased or complete obstruction of the blood flow towards the extremities especially feet. This is called peripheral arterial disease.Neuropathy and peripheral arterial disease either individually or together result in serious problems like non-healing ulcer, infections and even amputation. People with Diabetes often don’t realise or know that they have problem until the resulting pain becomes apparent. There are many factors which contribute to the increasing incidence and severe Diabetes related foot problems. Primary cause is lack of proper annual foot assessment and foot examination. Foot is an often ignored organ in Diabetes management.Colour doppler testThe Colour doppler ultrasound is a non-invasive test. It estimates the amount of blood flow by bouncing high-frequency sound waves (ultrasound) off the red blood cells. Colour doppler imaging allows better visualization of vertebral arteries compared to conventional ultra-sonography It is widely available, easy-to-use and less expensive than other imaging methods. Colour doppler is extremely safe and does not use any ionising radiation. Colour doppler examination presents a clear picture of soft tissues that do not show up well on x-ray images. A doppler ultrasound on the lower limbs helps diagnose the following conditions:Blood clotsPoorly functioning valves in your leg veins, causing blood or other fluids to accumulateA blocked arteryDecreased blood circulation into your legsBulging arteries (aneurysms)Varicose veinsBiothesiometry testBiothesiometer is an instrument which aids the podiatrist (foot specialist) to detect early nerve damage. It delivers minute but identifiable vibration to the feet. A probe is placed on the big toe. The probe which is controlled by a dial can be made to vibrate in varying intensities. The person being tested has to indicate whether s/he is able to feel the vibration and the reading on the dial at that point is then recorded. The reading is in the range of 0 to 50 volts.Monofilament testThis test determines whether the person is at the risk of developing a neuropathic ulcer. The test is inexpensive as compared with the other tests. A filament is pressed on specified parts of the foot. As the filament bends it exerts a pressure of 10 grams on the area of the foot where it has been pressed. Lack of resulting sensation indicates that the person has lost sensation in that part of the foot. Foot care education and advice is determined with the help of these three tests.Dental check-upPeople with Diabetes who have regular high blood sugar levels are more likely to get dental problems. There are several possible reasons:An increase in sugars in gingival fluid (fluid between teeth and gums) can lead to an increase in dental cavities.High blood glucose levels can cause dehydration, leading to reduced saliva in the mouth. This can cause an increase in plaque and tartar, which in turn can lead to gum disease.Long-term high blood glucose levels can cause the narrowing of blood vessels to gums, which can lead to reduced blood supply, causing increased rate of infection.It is therefore especially important for people with Diabetes to take care of their teeth and gums and have regular check-ups. Your dentist will recommend how frequently to visit. You should tell your dentist that you have Diabetes and find out if you’re going to have any treatment that means you can’t eat or drink for a few hours afterwards, as you may need to alter your Diabetes medication.To concludeFor health check-ups to be meaningful there are three important factors:Tests need to be conducted with a target in mind based on a person’s age, gender, health concerns.Testing must be conducted within established international guidelinesUnnecessary testing ought to be avoided to lower harm through radiation. Also, appropriate medical counseling must be made available to every patient to correctly interpret test results and determine the further line of treatment.Try and make the most of your check-up so that it benefits you. Keeping these simple points in mind will enable you to manage your time better as well as benefit from the consultation. Also, remember that doctors are here to help you lead a better life so be as honest as you can during your visit.