Persistently high glucose damages blood vessels — the tiny ones feeding the eyes, kidneys and nerves, and the large ones feeding the heart and brain. The damage is slow, painless, and largely preventable. Almost every one of these conditions is far more treatable when found by a screening test than when found by symptoms.
The annual schedule
| Check | How often |
|---|---|
| HbA1c | Every 3 months if not at target, every 6 if stable |
| Blood pressure | Every visit |
| Dilated eye examination | Yearly |
| Urine albumin-to-creatinine ratio | Yearly |
| Serum creatinine and eGFR | Yearly |
| Full foot examination with sensation testing | Yearly, more often if neuropathy present |
| Lipid profile | Yearly |
| Dental examination | Every 6 months |
Eyes
Retinopathy produces no symptoms until it is advanced, and by the time vision blurs, significant damage has usually occurred. A dilated examination — or retinal photography — finds it years earlier, when laser treatment or injections preserve sight very effectively. Type 2 should be screened at diagnosis, since it may have been present unnoticed for years. Type 1 from five years after diagnosis. Pregnancy accelerates retinopathy, so screening becomes more frequent.
Kidneys
The first sign is small amounts of albumin in the urine, long before any change in how you feel. Caught at that stage, an ACE inhibitor or ARB, tight blood pressure control, and newer medications such as SGLT2 inhibitors can slow or halt progression. Blood pressure control matters here at least as much as glucose control.
Feet
Nerve damage removes the pain that would normally make you notice a blister or a stone in your shoe. Reduced blood flow then makes the resulting wound slow to heal. That combination is how most diabetic foot ulcers begin, and ulcers are the leading cause of non-traumatic amputation. It is also almost entirely preventable.
- Look at your feet every day, soles included — use a mirror or ask someone.
- Wash daily and dry carefully between the toes.
- Moisturise the skin but not between the toes.
- Never walk barefoot, indoors or out.
- Check inside your shoes with your hand before putting them on.
- Cut nails straight across.
- Do not treat corns or calluses yourself, and never use corn plasters.
- Test bath water with your elbow, not your foot.
Any new ulcer, unhealing wound, spreading redness, warmth, swelling, or foul smell needs to be seen the same day. Foot infections in diabetes escalate quickly, and a delay of a few days genuinely changes the outcome.
Heart and circulation
Cardiovascular disease is the leading cause of death in diabetes, and glucose is only one of the drivers. Blood pressure, cholesterol and smoking each contribute at least as much. Statins are recommended for most adults with diabetes over 40 regardless of cholesterol level, and several diabetes medications — SGLT2 inhibitors and GLP-1 agonists — have been shown to reduce cardiovascular events independently of their glucose effect. Ask whether one is appropriate for you.
Heart attacks in diabetes more often present atypically — breathlessness, unusual fatigue, nausea, jaw or arm discomfort — without classic crushing chest pain, because neuropathy blunts the signal. Take those symptoms seriously.
Nerves
Peripheral neuropathy typically starts as burning, tingling or numbness in the feet, worse at night. Autonomic neuropathy can affect digestion, bladder function, sexual function, and the heart rate response to standing. Both are worth reporting; there are effective treatments for the pain, and knowing about it changes other management decisions.
Vaccinations
Diabetes raises the risk of complications from infection. Annual influenza vaccination, pneumococcal vaccination, and hepatitis B are generally recommended. Ask your doctor what applies where you live.