Type 1 (Insulin Dependent Diabetes Mellitus)

Type 2 (Non-Insulin Dependent Diabetes Mellitus)

Back to Diabetes Tests

Diabetes Control Monitoring

Short term monitoring of diabetes is achieved by regular testing of blood glucose. This is usually performed by the patients themselves using a finger prick drop of blood placed onto a small pad contained on a strip and placed into a hand held glucometer instrument. Patients usually perform this test many times during the day to establish their blood glucose levels. These levels are known to fluctuate during the day according to diet, insulin intake and exercise.

Long term monitoring is achieved by testing for glycated haemoglobin (HbA1c). Haemoglobin is the protein contained within the red blood cells that gives blood its characteristic red colour. A particular part of the haemoglobin molecule reacts with glucose to form glycated haemoglobin. The amount of glycated haemoglobin is proportional to the concentration of glucose in the blood and the glycation process (once the stable product is formed) is irreversible. Therefore high levels of blood glucose at any one time leads to a high level of glycated haemoglobin.

As the average life span of the red blood cell is approximately 120 days, measurement of glycated haemoglobin has been shown to indicate the average level of blood glucose concentration over a 2-3 month period.

Back to Diabetes Tests

Kidney Damage

One of the complications of diabetes is susceptibility to kidney damage (diabetic nephropathy). Regular monitoring of the kidneys for signs of damage allows steps to be taken to prevent or delay complications.

One way to check for damage is the urine microalbumin test. A urine microalbumin test measures the amount of albumin in the urine. The presence of albumin is often the first sign of early kidney damage. Albumin is a type of protein that is normally present in high amounts in the bloodstream. Blood proteins help protect against infection, aid in blood clotting and keep the right amount of fluid circulating in the body.

Kidneys that function properly filter out waste products from the blood through a vast network of tiny blood vessels (capillaries). The waste products are then excreted in the urine. Beneficial proteins like albumin, on the other hand, are not filtered out and instead remain in the blood.

However, when the kidneys become damaged, the opposite occurs: Waste products remain in the blood and protein leaks into the urine. At first, when the damage is just beginning, only very small amounts of albumin escape into the urine, a condition known as microalbuminuria. Microalbuminuria (persistent albuminuria in the range of 30–299 mg/24 hours) has been shown to be the earliest stage of diabetic nephropathy in type 1 diabetes and a marker for development of nephropathy in type 2 diabetes. In later stages of kidney disease, large amounts of protein leak into the urine, a condition called macroalbuminuria, also known as proteinuria.

How the microalbumin test helps you

Large amounts of leaking protein may cause the urine to look foamy and the body to retain fluid, resulting in swelling in the hands, feet, abdomen or face. However, these symptoms of kidney disease may not manifest for many years.

Screening with specialised tests — a routine urinalysis by a "dipstix" cannot detect microalbuminuria — offers a good way to spot kidney disease early. Detection at a very early stage – and the appropriate clinical treatment - can prevent kidney disease from progressing. Untreated, kidney disease can ultimately result in complete kidney failure (end-stage renal disease, or ESRD), which requires dialysis or transplant.

Controlling blood sugar and blood pressure can help prevent further kidney damage. Certain blood pressure medications that can help protect kidney function may need to be taken, such as angiotensin-converting enzyme (ACE) inhibitors.

There may also be a need to make dietary changes. Some people, for instance, benefit from diets that reduce protein, sodium or phosphate. However, because of potential nutritional deficiencies, consult with a registered dietician or a health care team, rather than designing a meal plan on your own.

How the microalbumin test is done

Various methods are used to screen for microalbuminuria. Normal albumin values vary depending on the testing method.

The more convenient is a random urine for Microalbumin/Creatinine ratio. The usual urine “dipstix” screening method is unsuitable to detect microalbumin as it is only sensitive to levels of albumin >300mg/L (by then it may be too late to recover full kidney function). Therefore Mullhaven Medical Laboratory uses a sensitive “immunoturbimetric” assay to detect albumin levels as low as 2mg/L (well within normal ranges).

An early morning urine is adequate; both microalbumin and creatinine are measured and a ratio is calculated. The normal ratio is <2.5 for males, <3.5 for females. Should a result show higher than these, then 24-hour urine collections are arranged to measure the rate of albumin excretion over a 24 hour period (normal range <30mg/day). Confirmation of microalbuminuria is made when at least two 24-hour urine collections show albumin >30mg/day over a 6 month period.

How often to have the microalbumin test

The frequency of urine microalbumin testing depends on your individual situation. In general, the test is performed:

As an initial screening at the time of diagnosis of type 2 diabetes

As an initial screening five years after diagnosis of type 1 diabetes

At least annually after initial screening, but more often if microalbuminuria is present, or if blood vessel damage to other areas of the body, such as your heart, eyes or lower extremities, is noted; this could indicate impending damage to your kidneys

Back to Diabetes Tests