What is it about ?
Diabetes is characterized by having too much sugar (glucose) in the blood (blood sugar). Insulin plays an important role in the development of diabetes. Insulin is a hormone made by the pancreas, which causes sugar in the blood to be absorbed into cells.
In type 1 diabetes, the pancreas does not make enough insulin. To correct this lack, insulin is injected several times a day into the fat under the skin (subcutaneous injection). These injections make it possible to mimic the natural secretion of insulin.
Too high blood sugar (blood sugar) levels damage the blood vessels. If you have been diabetic for a while and are not treated properly, you may suffer from damage to all the small blood vessels in the body, with consequences for the cardiovascular system, eyes, kidneys, nervous system and feet.
What tests are needed after a diagnosis of type 1 diabetes?
The doctor will perform a general clinical examination. It will measure weight, height, body mass index (BMI) and blood pressure. He will examine the heart and blood vessels, the functioning of the nerves (reflexes and sensations) and the feet.
A blood test and urinalysis will also be done to assess the following:
- Fasting blood glucose: interpretation of the measured value should be done with caution, as it is only a snapshot. Blood sugar may be high during measurement, while the average value is good. Or, on the contrary, the blood sugar may be low at the time of the measurement, while the average value is too high. The advantage, however, is that the insulin dose can be adjusted immediately if necessary.
- Glycosylated or glued hemoglobin (HbA1c): this test gives a good representation of the average value of blood sugar over a longer period.
- Peptide C: This test assesses the ability of the pancreas to produce insulin.
- Function of the kidneys.
- Amount of cholesterol and fat in the blood.
- Function of the thyroid gland.
- Protein in the urine.
An eye specialist (ophthalmologist) will check your eyesight and examine the retina to see if the blood vessels are affected.
What follow-up exams are needed?
At each follow-up visit
The doctor asks about your condition and reviews the results of your home blood sugar checks. He checks the insulin doses used and asks if you have had any hypoglycaemia. It monitors your weight and measures your blood pressure. If you have (had) any problems with your feet, they will examine your feet carefully. Finally, he takes a blood test to determine the level of HbA1c.
Once a year
An eye exam is done to test the eyesight and examine the retina. The heart and large blood vessels are examined. The doctor checks the feet to see if there are any wounds that heal poorly. He also performs a brief neurological exam: he checks the knee and Achilles tendon reflexes, as well as the sensory nerves.
Insulin injection sites are also checked. If you give your injections too often in the same place, the skin may harden there, or an accumulation or loss of fat (lipodystrophy) may appear there. These phenomena influence the blood circulation, which slows down the absorption of the injected insulin.
The doctor takes a blood sample to determine the amount of cholesterol and fat in the blood and to check how well the kidneys are working. A urinalysis is scheduled to detect the presence of protein in the urine.
Finally, the doctor checks the accuracy of your blood glucose meter. A blood glucose meter is the device that monitors your blood sugar at home using a small drop of blood taken from your fingertip.
What can you do at home?
Monitor your weight regularly. Measure your blood sugar with a small drop of blood taken from your fingertip. These measurements that you take yourself (self-measurements) allow you to adjust the amount of insulin you need. It usually takes 2 to 3 measurements per day. It varies from person to person. In the event of illness, pregnancy or poor diabetes control, self-measurements usually need to be done more often.
What about reimbursement of expenses?
It is essential to ensure close monitoring of diabetic patients, but the costs associated with checks and treatments can quickly multiply. This is why the “diabetes convention” was established. It is a contract concluded between the diabetic person and the diabetology department of a hospital. By this contract, the diabetic person undertakes to go to the diabetology consultation at least once a year and to do a certain number of preventive examinations (eye exam, foot exams, blood test and analysis of the urine collected. for 24 hours).
You can sign a diabetes agreement if you need at least 2 insulin injections a day or if you are using an insulin pump. The doctor will complete the necessary forms.
In exchange, the diabetic person has certain advantages: free equipment (lancets and test strips), 2 free check-ups per year with a foot specialist (podiatrist) and 2 free consultations per year with a dietitian.
Want to know more?
- Type 1 diabetes – mongeneraliste.be – SSMG – Scientific Society of General Medicine
- Diabetes: mobile applications – mHealthBelgium
- Diabetes: intervention of mutuals for children and adolescents – INAMI – National Institute for Sickness and Invalidity Insurance
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