Screening, targets and the five levers
The Canadian screening schedule for type 1, what guideline-level success really looks like, and the five risk factors that shape long-term outcomes.
This is the practical page: the checks to book, the targets that define success, and the five things that together shape long-term risk. If you leave having booked one overdue appointment, this page has done its job.
The Canadian schedule: the actual to-do list
| What | When it starts | How often | What it involves |
|---|---|---|---|
| Eyes | 5 years after diagnosis, age 15+ | Annually | An optometrist or ophthalmologist looks at the retina |
| Kidneys | After 5 years' duration | Annually | A urine sample and a blood test |
| Nerves | 5 years after puberty ends | Annually | A nylon filament and a tuning fork on the feet |
| Feet | From diagnosis | At least annually | Someone looks at them properly, shoes and socks off |
| Cholesterol | At diagnosis | Annually if untreated | A blood test, fasting or not |
| Blood pressure | From diagnosis | Every visit | Target below 130 over 80 |
Notice that every screen for the small blood vessels (eyes, kidneys, nerves) begins at five years. Canadian guidelines do not expect a newly diagnosed person to have anything to find.
What success actually looks like, and it is not 100%
These are the time-in-range targets from the 2019 international consensus, plus Diabetes Canada's A1C target. They apply to most non-pregnant adults; children, older adults and pregnancy have their own targets, so check yours with your team.
- >70% time in range, 3.9 to 10.0 mmol/L: about 17 hours of the day
- <4% below 3.9 mmol/L: about an hour a day, and under 1% below 3.0
- <25% above 10.0 mmol/L: roughly six hours, and under 5% above 13.9
- ≤7.0% A1C, for most adults: Diabetes Canada's target
Read the first two together. Success, as the guidelines define it, includes roughly seven hours a day outside range and about an hour low. If every high reading feels like a failure, the target itself says otherwise. Perfectionism drives burnout, and the guideline is the best argument against it.
Glucose is the biggest lever. It is one of five.
Swedish registry research models outcomes by how many of five risk factors are on target, and risk rises step by step for each one that is not. This is genuinely good news that is rarely told: four of the five are handled at an appointment, not at every meal.
Glucose. A1C at or under 7.0%, time in range over 70%. This is the one that takes constant attention.
Blood pressure. Under 130 over 80. Usually one tablet, checked at every visit.
Cholesterol. LDL under 2.0 mmol/L, or halved. A statin is indicated from age 40, or from age 30 with 15 years' duration of diabetes.
Kidney protection. An ACE inhibitor or ARB where indicated. It is the strongest kidney intervention there is, and it works independently of glucose.
Not smoking, and moving regularly. Both sit in the same model as the other four.
There is an honest limit here: even with all five on target, kidney risk in type 1 stays above that of the general population. Managing these risk factors roughly halves the extra risk rather than erasing it. That is still a very large effect, and most of it does not depend on moment-to-moment effort.