Summary of American Diabetes Association recommendations
Feel free to print out this checklist and take it with you when you see your doctor. It's a summary of recommendations that the American Diabetes Association has made to physicians regarding their patients with diabetes. The organization calls for:
- A referral to a diabetes educator on your first visit. He or she can help you set up a program to manage your diabetes and avoid complications; an annual follow-up will help you gauge your progress.
- Quarterly checkups if you take insulin, have trouble controlling your glucose levels, or even if your blood sugar is under control. The ADA recommends four visits a year to evaluate your lifestyle changes and check on your progress with the disease. This means you should see your physician at least every three months.
- A foot inspection every time you visit your physician, so he or she can check your feet for nerve damage, foot ulcers, and sores. (You should have a foot and leg inspection quarterly. To help remind yourself, take off your shoes and socks each time you visit your physician.) The ADA also recommends an annual comprehensive exam of the feet which includes nerve testing.
- Every three months, a hemoglobin A1C blood test to monitor long-term glucose control for patients not meeting blood sugar goals. For patients meeting treatment goals, an A1C blood test should be performed at least two times a year.
- Once a year, a urine test to check for small amounts of protein -- an early sign of kidney damage.
- Once a year, an eye exam to inspect for cataracts or deterioration of the retina.
- Once a year, a cardiovascular exam, including your cholesterol and triglyceride profile.
- Once a year, a vaccine for influenza.
On each visit, your doctor should check on:
- your weight
- medications
- your blood pressure
- your blood glucose self-monitoring
- tobacco or alcohol use
- lifestyle issues
- diabetes complications such as eye or kidney problems
- psychological or social issues such as depression
- previous abnormalities on your physical exam
- episodes of high or low blood sugar -- how often they've occurred, their severity, and your plan on dealing with them.
Advice for smokers
If you smoke, the ADA recommends that you talk with your health care provider about ways to quit. You can work together to find the best method for you, whether it's cold turkey or a more gradual approach.
Before you visit the doctor
If your clinic doesn't mention it, ask what lab work you need done before the visit. Your doctor may want you to get tests for Hemoglobin A1C, BUN/Creatinine, urine albumin/creatinine, lipids (which require fasting), or others. That way, the test results will be available at the time of your visit.
Think about what you want to cover in the visit. Print out the above checklist and bring it as a reminder, if necessary.
Make a list of the medications and supplements you take and bring it with you. If this is difficult, take all the medicines, herbs, and supplements with you to the clinic to show the doctor.
Further Resources
American Diabetes Association, http://www.diabetes.org
Joslin Diabetes Center, http://www.joslin.org
The Unofficial Guide to Living with Diabetes, Maria Thomas, Loren Green, M.D. Macmillan Publishers
References
Clinical Practice Recommendations, American Diabetes Association Provider Recognition Program Measures, ADA, "Making Diabetes Checkups More Fruitful," Family Practice Management.
American Diabetes Association. Standards of Medical Care in Diabetes. http://care.diabetesjournals.org/cgi/content/full/30/suppl_1/S4
