Diabetes nurse educator, Christine Manga, explains why screening for diabetes complications should form part of your diabetes healthcare plan.
Screening for diabetes complications
Diabetes is a disease that affects and damages the vascular system, large and small blood vessels. It is damage to the vascular system that leads to diabetic complications.
Large blood vessel damage is associated with increased risk of heart attack and strokes. Small blood vessel damage is associated with increased risk of kidney failure, retinopathy (blindness) and peripheral neuropathy.
Maintaining good blood glucose control can help with delaying and possibly preventing complications. But this alone is not enough. Blood pressure and cholesterol levels also need to be managed.
Screening for diabetes complications should form part of your diabetes healthcare plan. Regular screenings allow for early detection of complications before you are aware of the problem.
Most of the complications are ‘silent’ with symptoms developing after damage has occurred. All people with diabetes should undergo screening for complications.
Screening for retinopathy
Eyes should be screened annually. An ophthalmologist usually does the screening, though some optometrists have the training and equipment required to perform the test.
Drops are placed into the eyes to dilate (widen) the pupils so that the examiner can see the retina of the eye. The drops may cause your vision to blur and driving would not be possible for a few hours after the procedure.
Any abnormal blood vessels, scar tissue, new blood vessels, swelling, bleeding or fatty deposits in the retina will be detected. In addition, any damage to the optic nerve and cataract development would be observed.
A separate test will be done to measure the pressure of the eye. Increased eye pressure, a condition called glaucoma, can also cause blindness.
The results of the screening will show:
- No signs of the complications.
- Early signs of complications.
- Follow-up and treatment decision required. Treatment may not improve sight, but it can prevent further deterioration.
- More frequent check-ups required.
Early detection and treatment of eye complications is usually successful and can prevent vision loss.
Screening of peripheral neuropathy
Peripheral neuropathy is pain, weakness or numbness in the feet and, occasionally, hands caused by nerve damage. It can also present as a burning sensation or pins and needles.
Due to damage of the small blood vessels, the nerves can’t receive nourishment. The blood vessel damage will cause ischaemia (poor blood circulation) in the lower legs and feet. This can further cause redness or a blueish tinge, swollen and sore feet. It also increases the risk of developing skin infections and skin ulcers.
Seeing a podiatrist (foot specialist) at least once a year is recommended. A podiatrist will examine your feet for blood flow, temperature, sensation and general condition. They may detect a ‘silent’ loss of sensation.
You will also be educated on good foot care. This will include the teaching of self-foot examination, proper nail cutting technique and the importance of foot moisturisation. Footwear choices as well as the appropriate type of shoes for your feet and how to wear in new shoes will be discussed.
Blood pressure and cholesterol screening
Blood pressure should be checked at least every three months. This can be tested at a routine visit to the doctor, your local chemist or at home on a home device.
Blood pressure targets should be personalised and discussed with your doctor. There are general guidelines that he/she will follow. Blood pressure and cholesterol management go hand in hand.
A lipogram, a full cholesterol test, checks all aspects of the cholesterol and should be performed annually. The reference ranges of results are different for people with diabetes who have more risk factors compared to the general population. Medication and dietary modification will be prescribed to manage these conditions if necessary.
People with poorly-controlled diabetes are at a greater risk of developing dental problems, such as periodontal disease. Other oral manifestations could include a very dry mouth, a burning sensation in gums, delayed healing of mouth sores as well as an increased frequency and severity of infections.
Poor glucose-control exacerbates dental complications. The reverse is also applicable, periodontal disease worsens blood glucose control.
Dental treatment may need to be delayed until blood glucose levels are under control. A dental screening should be performed at least every six months.
Early detection is key
It is vital that screening is done on a regular basis for all possible complications. As stated earlier and cannot be emphasised enough, early detection is key to early management.
MEET THE EXPERT
Christine Manga (Post Grad Dip Diabetes and Msc Diabetes) is a professional nurse and a diabetes nurse educator. She has worked with Dr Angela Murphy at CDE Centre, Sunward Park since 2012.