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Having type 2 diabetes can be overwhelming. Not only are you expected to make changes to your diet and lifestyle, but when you go to the doctor, talk with friends, and start doing a bit of research, conversation can start to sound like a foreign language.
Statements like “What’s your A1c?” or “Have you had any lows?” or What’s the difference between glucose and A1c?” sound like gibberish to the average person but these become increasingly important to someone living with diabetes.
There are a variety of tests that help you monitor the progression (or regression!) of your condition.
Here’s the rundown:
1. Hemoglobin A1c (HbA1c)
What it is: Think ‘bird’s eye’ view. The HbA1c measures the percentage of red blood cells that have sugar attached to them. The higher the percentage, the higher the sugar level. Since red blood cells have an average 90 day lifespan, this test gives you an idea of how your blood sugar levels have been averaging over the past 3 months. A1c has little day-to-day variation, as it’s an average over time.
When to do it: Every 3-6 months depending on how well controlled your diabetes is.
Targets: An initial target might be set to 7%, but over time, try to aim for normal A1c levels, 5.7% or below.
2. Self Monitoring Blood Glucose (or SMBG)
What it is: Your daily home testing can have day to day variation. Blood sugar fluctuations are normal because this value is continually changing based on what you eat, when you exercise, how well you’ve sleep, whether you’re stressed, etc – lots of things can influence a self-monitored test.
When to do it: Many people test fasting blood sugar levels, first thing in the morning. Another common time to test is two hours after meals.
Targets: Ideal fasting (morning) blood sugar is under 100 (6.0). Less than 140 (7.8) for after-meal blood sugar levels.
2.1 Continuous Glucose Monitoring (CGM)
What it is: A CGM system provides continuous, real-time tracking of blood glucose levels, which is particularly helpful for understanding fluctuations throughout the day.
When to do it: Continuous monitoring is generally recommended for people with more severe diabetes or for those struggling with blood sugar control. But, if you can afford one (they can be expensive), research indicates they can be beneficial at any stage of diabetes, and even in prediabetes.
Targets: A CGM can provide valuable trends, and optimal glucose levels depend on the system used and individual goals. The general aim is to keep glucose within a healthy range, with minimal highs and lows.
3. Fasting Insulin Test
What it is: The fasting insulin test measures the level of insulin circulating in your blood after not eating for at least 8 hours. Unlike glucose tests, which tell you how much sugar is in your blood, this test gives insight into how hard your pancreas is working to keep blood sugar in check. High fasting insulin is often one of the earliest signs of insulin resistance, long before blood sugar rises into prediabetic or diabetic ranges.
When to do it: This test isn’t usually ordered routinely, but it can be useful at diagnosis or if you want a clearer picture of your metabolic health beyond A1c levels and fasting glucose. Ask for it to assess your level of insulin resistance.
Targets: Optimal fasting insulin is below 10 μIU/mL, and closer to 2–6 μIU/mL is a sign of excellent insulin sensitivity. Higher levels may indicate insulin resistance, even if your blood sugar looks normal.
4. Blood Pressure
What it is: The amount of force required by your heart to pump blood through your arteries. Higher blood pressure indicates greater stress on the heart and increases risk for heart disease. Activities that constrict blood vessels (such as smoking) increase this as well.
When to do it: Every office visit and daily at home for some.
Targets: Less than 120/80
5. Lipid Panel
What it is: This is a group of blood tests revealing the body’s ability to metabolize lipids (or fat), or in other words, your cholesterol levels. Having values out of target can increase risk for heart disease.
When to do it: Every 1-2 years if controlled, every 6 months if high risk. Remember to be sure to FAST 12 hours prior to the test.
Ideal Targets: Cholesterol: <200; Triglycerides: <150; HDL: >60; LDL: <100
5.1 Extended Lipid Panel
What it is: An extended lipid panel goes beyond the standard cholesterol test. Instead of only looking at total cholesterol, HDL, LDL, and triglycerides, it measures advanced markers such as LDL particle size and number, ApoB (apolipoprotein B), Lp(a) [lipoprotein(a)], Cardiac Calcium Score (CAC), and sometimes remnant cholesterol.
These markers provide a clearer picture of cardiovascular risk because two people with the same LDL cholesterol number may have very different risks depending on their particle profile. For people with insulin resistance, type 2 diabetes or metabolic syndrome, these advanced markers are especially relevant since blood sugar problems often go hand in hand with abnormal lipid metabolism.
When to do it: If your lipid panel comes back and the only number that’s high is LDL cholesterol. If you want to avoid taking statin medications. And, consider requesting one every couple of years if you have a family history of heart disease, even if your standard lipid panel looks “normal.” This is particularly important if you’ve had unexplained changes in blood sugar or cholesterol, or if you want a deeper risk assessment.
Ideal Targets:
- ApoB: <90 mg/dL is optimal, <100 mg/dL is acceptable for lower risk, and >130 mg/dL is considered high risk.
- Lp(a): Ideally <30 mg/dL, though this is largely genetic.
- LDL particle size: Larger, “fluffier” particles (Pattern A) are considered less atherogenic than small, dense particles (Pattern B).
- Triglyceride-to-HDL ratio: Ideally <2 (in mg/dL units), as this is a strong marker of insulin resistance and cardiovascular risk.
6. Urine Microalbumin
What it is: This test detects early signs of kidney damage by measuring small amounts of protein (albumin) in the urine.
When to do it: Annually, especially for people who have had diabetes for several years or have high blood pressure.
Targets: Less than 30 mg/g of creatinine.
7. Comprehensive (dilated) eye exam:
What it is: High sugar in the blood can cause damage to tiny vessels in the eyes resulting in glaucoma, cataracts and other vision problems. Regular comprehensive exams will detect any actual or potential problems and allow for early treatment options.
When to do it: At diagnosis and every 1-2 years thereafter.
Targets: Normal healthy eyes.
8. Comprehensive Foot Exam
What it is: Neuropathy in type 2 diabetes is very common over time and loss of sensation may result in unnoticed infections and wounds. In prediabetes, people can get neuropathy symptoms such as tingling, numbness or pain, particularly in the legs. Getting feet checked with a monofilament at office visits as well as checking your feet daily with a mirror for any cuts, bruises, discoloration will help to prevent problems. See our foot care guide over here.
When to do it: Every office visit (at least once/year) and checking feet daily at home (very important).
Targets: Healthy circulation, no loss of sensation, no bruises, cuts, dry skin or abnormalities.
9. Dental Exam and Cleaning
What it is: People with diabetes are more prone to gum disease. This test helps detect early signs of infections or other oral issues.
When to do it: Twice aper year.
Targets: Healthy teeth and gums, free of plaque, cavitations, or infection, and no signs of periodontal disease.
Conclusion
Having regular health checks and diagnostic tests is very important and can help you avoid any complications associated with your type 2 diabetes.
And, if you’re being proactive and working on changing your nutrition and lifestyle, your tests provide a benchmark for what’s working and what’s not, helping you make the adjustments necessary as you continue your health journey.
Remember, denial is never a good choice. So whatever you do, don’t put your head in the sand. Get your tests and keep yourself if good health!
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