Understanding Diabetes: Part 2 of a Three-Part Series
Friday, November 08, 2013

Dr. Jacqueline Riedel

In last month’s article, we discussed the organs and body systems at play in the development of Type II diabetes. Today, I want to address the necessary screenings and health interventions recommended to keep the diabetic patient healthy and protected from illness. Generally speaking, these interventions can be broken into two categories: immunizations and routine screening tests.

Let’s begin by explaining why these additional interventions are necessary. It is important to understand that diabetes essentially leads to a weakened immune system, so immunizations become especially important. Elevated blood sugar levels interfere with the correct function of many of the body’s systems, including those designed to detect and fight off infections. While many illnesses may be relatively easy for the non-diabetic body to manage, the same infections can pose a much greater health risk to the person with diabetes. Immunizations help prepare the body to deal with infections in a more efficient and effective manner.

Currently recommended vaccines for diabetic patients include: influenza, pneumonia and hepatitis B. The flu and pneumonia vaccines are recommended for groups of patients with reduced immune function and increased likelihood of severe illness, including those with diabetes. The influenza vaccine should be administered yearly, before the onset of the flu season, typically in September or October. People with diabetes should receive the pneumonia vaccine once, at the time of diagnosis, and again after age 65 if it has been more than five years since their first immunization.

Recent studies of people with diabetes revealed the rate of acute hepatitis B infection was twice that of the non-diabetic population, even among people with no other risk factors for hepatitis. Government surveys have also shown a 60% higher prevalence of past or present hepatitis B infection among diabetics versus non-diabetics. With these statistics in mind, the Advisory Committee on Immunization Practices issued a recommendation that all unvaccinated diabetic adults aged 19-59 receive the hepatitis B vaccine series. People with diabetes older than 60 are encouraged to discuss the benefits and risks of vaccination with their health provider.

In addition to the vaccines discussed above, there are a number of recommended routine screening tests for diabetics. These include hemoglobin A1c every 3-6 months; fasting lipid panel, creatinine and urine test for protein yearly; annual dilated retinal exam and diabetic foot exam; and baseline EKG.

The hemoglobin A1c is essentially a three-month average of the blood sugar; normal A1c levels are less than 5.7%, while diabetes is typically diagnosed if the level goes above 6.4%. People with diabetes are at increased risk for heart disease, so a lipid panel should be checked at least yearly to monitor cholesterol levels and treat high cholesterol if necessary to lower cardiac risk. Diabetics who do suffer heart attacks tend to have unusual symptoms, so a baseline EKG is helpful to have for comparison if the physician feels a diabetic patient is presenting with symptoms of cardiac damage. Kidney damage is also more likely in diabetic patients, so tests to monitor kidney function (creatinine and urine protein) should be monitored on a regular basis.

Elevated blood sugar levels in diabetes can eventually lead to damage of the very small blood vessels and nerves. To some degree, these changes can be monitored by your primary physician; however, the blood vessels in the back of the eye can be difficult to examine unless the eye is dilated, so diabetic patients are advised to see an ophthalmologist once a year for a retinal exam. Additionally, a thorough exam of the small nerves in the foot should be performed once a year by a podiatrist; diabetics should check their own feet every day to monitor for any breaks in the skin that could progress to infections.

Screening tests and periodic labs and physical exams allow your provider to document the extent to which diabetes is controlled or uncontrolled, and to make decisions regarding interventions to prevent further worsening of the disease. If you are a person with diabetes and have questions about the testing you receive, be sure to talk to your family physician.

Dr. Jacqueline Riedel is a Family Medicine physician and a member of the Kennedy Health Alliance. She practices in West Deptford, NJ, and can be reached by calling (856)384-0210.