When Should Someone Be Screened for Diabetes?

Certified diabetes educator Becky Wells recently retired from working with a diabetes self-management education program at Hendrick Medical Center in Abilene, Texas. She has shared her “Ask the Diabetes Educator” advice columns from that program with Insulin Nation.

Question: I have diabetes and I understand it can run in the family. I suspect I have several family members who may also have diabetes. Can you tell me when someone should be screened for Type 1 or Type 2 diabetes?

Answer: Testing for Type 1 diabetes is indicated when the patient exhibits classic signs and symptoms of the condition. These can include excessive thirst, excessive urination, weight loss, and blurry vision. If a medical care provider diagnoses someone with Type 1 diabetes, it’s vital that treatment begins right away, as the body can quickly exhaust its internal insulin supply. This could lead to dire health complications or death if not treated.

Testing adults for Type 2 diabetes usually follows established guidelines. Adults over 45 years of age often are screened every three years by using a fasting blood sugar test, glucose tolerance test, or Hemoglobin A1C test. More frequent screening may be prescribed if an individual is overweight or is showing other signs of insulin resistance.

Type 2 diabetes screening may start at a younger age if someone has a family history of diabetes, is physically inactive, has severe obesity, high blood pressure, or cholesterol problems, or has a skin condition called acanthosis nigricans (patches of brown velvety skin found on the back of the neck, in the armpits, or in other creases of the body). Some women who have had gestational diabetes, given birth to a baby weighing over nine pounds, or been diagnosed with a condition called PCOS may also be screened earlier than the average population.

Screening for Type 2 diabetes in children is a new phenomenon. Screening might occur after age 10, or at the onset of puberty. Children screened for Type 2 diabetes likely will be overweight and have a family history of Type 2 diabetes with first-degree or second-degree relatives. These children may also belong to certain racial groups with a genetic predisposition to Type 2 diabetes including Native Americans, African Americans, Hispanic Americans, or Asian/South Pacific Islanders. Like adults, these children will be deemed to be at higher risk for Type 2 diabetes if they have acanthosis nigricans, high blood pressure, cholesterol problems, or PCOS. They may also be at higher risk with a mother who had gestational diabetes.

The golden rule of diabetes screening is this: when in doubt, test. Unfortunately, many cases of Type 1 diabetes are initially overlooked or misdiagnosed, especially in adults, and such a delay in treatment can be deadly. Also, untreated Type 2 diabetes can lead to long-term and potentially fatal complications. If you suspect a loved one has diabetes and a medical care provider doesn’t take your concerns as seriously, you may want to insist on a test to rule diabetes out.
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Becky Wells is a recently retired registered nurse with 22 years of hospital bedside nursing experience in a pediatric setting, 15 years experience teaching hospital nurses and working with adult patients, and more than a decade of experience as a Certified Diabetes Educator. She has Type 2 diabetes and her sister has Type 1 diabetes.

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