Eye disease (diabetic retinopathy)

Every year, have:⁵

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

As often as indicated, have:

• Pictures of the back of your eyes (fundus photography) taken, to monitor diabetic retinopathy and evaluate the effectiveness of your treatment.
• Fluorescein angiogram, to check for and locate any tiny leaking blood vessels in the retina.

Kidney disease (diabetic nephropathy)

Every year, have one of the following:⁵

• Urine tests for levels of protein (microalbuminuria), to detect early damage to your kidneys
• Creatinine test, to evaluate kidney function

As needed to monitor your condition, have:

• A spot urine or 24-hour urine test, to check the total amount of protein leaking from your kidneys over 24 hours. A result of 300 mg or greater of protein in 24 hours indicates that the kidneys are leaking large amounts of protein (macroalbuminuria).⁵
• Blood electrolyte tests, to evaluate whether your kidneys are maintaining normal electrolyte balance.

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

Heart and blood vessel disease (macrovascular disease)

During every medical appointment, have:

• Your blood pressure checked to see whether it is rising. Your blood pressure should be less than 130/80 mm Hg.⁶

Every 1 to 2 years 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 (2.60 mmol/L), your triglyceride level needs to be less than 150 mg/dL (1.7 mmol/L), and if possible, your HDL cholesterol level needs to be more than 40 mg/dL (1.02 mmol/L) for men, and 50 mg/dL (1.28 mmol/L) for women.

As indicated, have:⁵

• Exercise electrocardiogram (treadmill EKG test) or cardiac stress test if you are beginning a vigorous exercise program.

As indicated, have:

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

For more information on tests, 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 for your response to light touch, pressure, temperature, and vibration, particularly in your feet and legs. Simple tests can be used to screen for loss of sensation. These tests should be done on both feet.
  • Touching the end of your toe with a thin plastic fiber (monofilament test) can assess your sense of light touch or pressure.
  • A cold metal tuning fork may be held to your leg to evaluate your sensation of temperature.
  • A vibrating tuning fork may be touched to your foot to assess your sensation of vibration.
• Test of muscle strength and reflexes, especially those in your ankles and knees.
• Careful examination of your feet for infections, injuries, or bone and joint problems. A complete examination of your feet should be done at least once a year.⁷
• Blood pressure and pulse check when lying down, sitting, and standing.

As indicated, have:

• Electromyogram (EMG), to measure how well and how quickly particular nerves and muscles are working.
• Nerve conduction studies, to test how well specific nerves conduct electrical impulses.

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

• 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.
• Gastric emptying study to evaluate the speed at which your stomach empties. Nerve damage from diabetes (gastroparesis) can slow this rate.

More information

• What is the physical exam for diabetes complications?
• What tests diagnose diabetes complications?