I just hit 30 years with type 1 diabetes in October, and am thankful to have no complications that I know of. I see an ophthalmologist annually, my dentist twice a year, and get labwork done about twice per year to check my A1c, lipids, etc. (I order this package myself, adding thyroid testing once per year). And, I get routine vaccines, thanks to working in a hospital!
My regular PCP is now currently managing my diabetes care, and I’m not sure if she would order any other extensive testing unless I was having problems.
Are there other routine tests we should be doing with type 1? Nerve conduction, heart tests, etc?
There is also the Coronary artery calcium (CAC) scan - A type of CT scan that creates detailed 3D images of the coronary arteries to look for calcified plaque. It is supposed to be more precise than the lipid panel test. You might have to see a cardiologist to get this test. I have not gotten it but my endo told me that it can be a useful test even if one’s lipid panel is shows low cholesterol as in my case.
This is critical for T1 diabetics, or anyone for that matter. This is the only way they can see the actual blockages. I had this based on my physician advising since I stopped taking statins due to aches and memory issues. ( both symptoms are gone after I stopped taking statins). My physician was concerned that there could be cholesterol blockages that even though there’s side effects, statins could help and outweigh the risk. I did have a 40% blockage in one heart artery and near 600 level score which is a concern. I have started exercising daily instead of 3X a week, and stopped eating processed foods and heavily modified my diet for heart health. I highly recommend the free “Yuka” app for scanning foods and health products for unhealthy contents (surprisingly there’s a lot of bad ingredients in what I thought were healthy foods). I have worked with my doctor to closely monitor cholesterol using diet and exercise to improve levels and so far I’m slightly better than when I was taking statins. I also, through fasting, exercise, and diet, have dropped my weight from 206 to 153-155. This targets the lower BMI range for my age and 6’-2” height. The cholesterol test drove me to take better care of myself.
PS I don’t recommend stopping statins without physician guidance.
I talked to my PCP today about further testing for long-term diabetics and she recommended the CT calcium scoring! So I will look into it. Thankfully I feel ok but we have a lot of heart issues on my mom’s side of the family, so may be worth doing preventatively.
My endo called for one of these while he was trying to persuade me to take statins (he failed). My insurance would not pay for it; the insurance pre-requirement was for evidence of CVD.
What I get on a regular basis is HbA1c+Comp Metabolic on a 3-month basis then, I think per year, Lipid (aka fat intake), TSH (aka Thyroid) and Creatine (aka Kidney). The latter three may just be ad hoc.
I’ve not had a CBC since 2022 and that was requested by my GP, not my endo.
Cardiac calcium scoring isn’t covered by a lot of insurance, but I had it done on my cardiologist’s advice, since I’m on a statin and we needed to decide whether to be more aggressive with it or not. The cost wasn’t prohibitive ($95 or so) relative to the projected benefit of having the information.
CBC/differential has never been part of my twice-a-year bloodwork ordered by either my current nor my previous endo (both chiefs of the department, so I’d assume they were up-to-date on these things). Do you need a history of something (besides diabetes) for this to be routine?
TSH and creatine kinase are always added under “Other tests.” Otherwise it’s the standard diab blood/urine list keeping an eye on lipids, kidneys and liver.
I’ve also been trying to get this testing, based on a friend of mine who had the test and scored terribly despite none of the usual risk factors. My endo referred me and the test is scheduled for Monday. Initially, she said that I (T1, low cholesterol, non smoker, age 68, close to ideal weight) did not have the risk factors that Medicare wants to see to cover the test. But when I gave her a bit more family history of heart attacks she got it through for coverage.
It’s bone marrow; that’s what produces the cells. I guess other things kill them; for example for dogs onions kill red blood cells, but CHD is nothing to do with blood cell count.
The reason for not doing “tests” is that the results are mostly meaningless without a question. Diagnostic tests, like HbA1c, are useful because they suggest possible problems, e.g. high HbA1c may be indicative of pregnancy.
The reason qualified docs don’t do them is because they have lots of sick people to help already. There’s no point doing one of the non-standard tests unless they have a reason to suspect that it might tell them something.
The non-so-qualified docs are maybe not so focused. I was recently persuaded to do a PSA, but why? Unless my prostate is significantly enlarged why on earth would I care? Why pay for an expensive test when a doc can do a simple physical examination every few years?
One of my good friends, a very healthy, fit, active 45 yo man was just diagnosed with terminal level prostate cancer that had spread throughout his body. He has 3 young children. They told him there’s zero chance of him making it to fifty. The docs only feedback was “if we’d done psa screening we’d have caught it sooner”
@jbowler
About the PSA and prostate cancer. I received annual PSA tests from the age of 40. It was alway in the normal until I was 60 when it doubled. The digital prostate exam was normal, but the PSA continued to climb over the next 6 months.
I underwent a biopsy which out of 12 cores show a small amount of cancer in one.
While I was debating on the options I was at a get together with fellow deacons. John, a physician assistant and I had lunch together.I told him about my diagnosis. He said, and I quote, “When I get prostate cancer (he went on to explain that if a man lives long enough prostate cancer is almost inevitable,) When I get prostate cancer I will have it removed surgically.”
Radiation he went on to explain will cook the tissues into something like baked clay making any surgical intervention impossible. If after surgery there are indications of spread usually to bone then radiation can be used to treat that spot.
My son would never get an exam, his philosophy was, “I feel fine, why do I need to see a doctor.” Fortunately he married a nurse and she had more weight than his mom and me. His PSA was 29. This is very high. The cancer had spread to the pelvic area and was not operable. He is currently being treated with testosterone blocker and his PSA is ver low, but he will likely need this for the rest of his life.
If I understand Joe Biden’s prostate cancer, Kenneth’s is much the same.
A PSA without insurance is around $100. That is well worth the cost,
I always get my electrolytes checked every three months or so - had problems with low salt due to my blood pressure pill that had a diuretic. Also get my lipids checked too - am a bit worried as I’ve been eating lots of cheese and sausage stuff as snacks! Bad idea I know!