THE NUMBERS YOU SHOULD KNOW
If you have diabetes, there’s one number you probably know pretty well:
Your blood sugar.
Maybe you check it with a glucose meter. Maybe you wear a continuous glucose monitor. And every few months, your doctor probably checks your A1C.
Those numbers matter.
But after nearly four decades of practicing internal medicine, I can tell you something important: Good diabetes care is about much more than blood sugar.
The larger goal is protecting your heart, kidneys, eyes, nerves, feet, and ability to remain active and independent.
That means there are several numbers—and several routine tests—you should know.
Let’s walk through them.
1. A1C: Your Blood Sugar Report Card
Your A1C is a blood test that gives us an estimate of your average blood sugar over roughly the previous two to three months.
Unlike checking your glucose at one moment in time, A1C gives us a much bigger picture.
For many adults with diabetes, an A1C goal of less than 7% is commonly used. But this is not a one-size-fits-all number.
A healthy 55-year-old with newly diagnosed diabetes may have a different goal from an 85-year-old with multiple medical problems and a history of dangerously low blood sugars.
As we get older, avoiding hypoglycemia—blood sugar that drops too low—can become especially important. Severe hypoglycemia can lead to falls, confusion, loss of consciousness, and other serious problems.
Dr. Mike’s Take: Don’t just ask, “What’s my A1C?”
Ask, “What’s the right A1C goal for me?”
2. Blood Pressure: Protecting More Than Your Heart
High blood pressure and diabetes are a dangerous combination. Over time, both can damage blood vessels throughout your body. That increases the risk of heart attack and stroke, but it can also contribute to kidney and eye disease.
For many people with diabetes, a blood pressure goal of less than 130/80 mm Hg may be appropriate when it can be achieved safely.
But once again, the target should be individualized. Your age, medications, kidney function, heart disease risk, dizziness, and tendency to fall all matter.
And don’t rely only on the occasional reading in your doctor’s office. A home blood pressure monitor can give you and your healthcare professional a much better picture of what your blood pressure is doing during everyday life.
3. Cholesterol: Pay Attention to LDL
People sometimes think: “My cholesterol isn’t that high, so why is my doctor talking about a statin?”
The answer is that diabetes itself can increase cardiovascular risk.
That’s why cholesterol management in someone with diabetes isn’t based only on whether the total cholesterol number looks “normal.”
One of the most important numbers is LDL cholesterol, sometimes called the “bad” cholesterol.
The appropriate LDL goal depends on your overall cardiovascular risk.
Someone who has diabetes but no known cardiovascular disease may have a different target from someone who has already had a heart attack, stroke, or another form of atherosclerotic cardiovascular disease.
For some higher-risk patients, doctors may recommend substantially lower LDL levels.
The important question isn’t simply: “Is my cholesterol normal?”
It’s: “What should my LDL be based on my cardiovascular risk?”
4. Your Kidneys: Two Tests Matter
Diabetes can damage the kidneys quietly. You may feel perfectly well while kidney damage is developing. That’s why regular kidney testing is so important.
There are two major tests to know.
The first is eGFR, or estimated glomerular filtration rate. This blood-test calculation helps estimate how well your kidneys are filtering your blood.
The second is the urine albumin-to-creatinine ratio, often shortened to UACR. This urine test looks for small amounts of the protein albumin leaking into the urine. That leakage can be an early sign of kidney damage.
Generally, a UACR below 30 mg/g is considered normal or mildly increased, although your healthcare professional should interpret the result in context.
Here’s the important part:
You need both tests. A blood test alone doesn’t tell the entire story.
Finding kidney disease early gives you and your healthcare team an opportunity to take steps that may slow its progression.
5. Your Eyes: Don’t Wait Until Your Vision Changes
Diabetes can damage the tiny blood vessels in the retina at the back of your eye. This is called diabetic retinopathy.
Here’s what makes it tricky: You may have early diabetic eye disease without noticing any change in your vision. That’s why regular comprehensive eye examinations are important.
Depending on the type of diabetes, previous eye findings, pregnancy status, and how well your diabetes is controlled, the recommended timing of eye exams may vary.
The important message is simple: Don’t wait for blurry vision to have your eyes checked.
Early detection and treatment can help protect your sight.
And if you suddenly develop major vision changes, new floaters, flashes of light, or loss of vision, seek prompt medical attention rather than waiting for your next routine appointment.
6. Your Feet: Look at Them
This one doesn’t require a laboratory test. It requires your eyes.
Diabetes can damage nerves, particularly in the feet. This is called peripheral neuropathy.
If sensation decreases, you may not notice a blister, cut, or pressure sore.
Diabetes can also affect circulation, which may make wounds harder to heal.
That’s why I recommend getting into the habit of looking at your feet regularly.
Check for:
- Cuts or blisters
- Redness or swelling
- Cracks in the skin
- Calluses
- Sores
- Changes in color
- Nail problems
Your healthcare professional should also periodically examine your feet and assess sensation and circulation.
If you find a wound that isn’t healing, don’t ignore it.
Diabetes Care Is Really Organ Protection
This is the bigger message I want you to remember. We don’t treat diabetes simply because we want a prettier glucose number on a laboratory report. We’re trying to protect you. We want to protect your heart from heart attack. Your brain from stroke. Your kidneys from kidney failure. Your eyes from vision loss. Your nerves and feet from complications.
And ultimately, we want to help you remain active, capable, and independent for as long as possible.
That is why modern diabetes care looks beyond glucose.
Nutrition and exercise matter. Blood pressure matters. Cholesterol matters. Kidney health matters. Not smoking matters.
And for some people, certain diabetes medications may provide cardiovascular or kidney benefits beyond simply lowering glucose.
Diabetes management works best when we look at the entire person—not one laboratory value.
Dr. Mike’s Take
If you have diabetes, I want you to know more than your A1C.
At your next appointment, ask:
What’s my A1C?
What’s my blood pressure?
What’s my LDL cholesterol?
What’s my eGFR?
Have I had a urine albumin test?
Am I up to date on my eye exam and foot exam?
And don’t be afraid to ask why your doctor recommends a particular goal.
After decades of taking care of people with diabetes, one thing became very clear to me: The best diabetes care isn’t about chasing a perfect number. It’s about using those numbers to help protect the person.
Bottom Line
If you have diabetes after 50, blood sugar is only part of the picture.
Know your A1C, blood pressure, LDL cholesterol, kidney numbers, and whether you’re up to date on eye and foot care.
Your personal targets may differ depending on your age, health, medications, and medical history.
The goal isn’t perfection.
The goal is protecting your heart, kidneys, eyes, nerves, feet—and your independence.
That’s what good diabetes care is really about.