Summary of Guidelines for Patients With Diabetes: Checklist for Your Doctor Visits
- Chris Woolston, M.S.
- Posted March 11, 2013
Every person with diabetes should visit a doctor at least every three months. Regular checkups allow your doctor to track your condition and, if necessary, make changes in your treatment plan.
But what should happen during those checkups? Do you wonder why your doctor orders certain tests? Or what the numbers mean? The American Diabetes Associations guidelines cover all aspects of diabetes care, including doctors' visits. This summary of the ADA's recommendations will help you know what to expect from your next visit. If you still wonder why your doctor has ordered a test -- or not ordered a test -- be sure to ask the doctor directly.
When tests should be done
The ADA has different guidelines for what should happen on diagnosis, at each visit, every three months, and once a year.
1. When you are diagnosed with diabetes, your doctor should provide a pneumococcal vaccine for protection against pneumonia, unless you have already been vaccinated. This vaccination does not have to be renewed each year. When you turn 65, however, you should receive another vaccine if you haven't had one in the last five years.
2. At each visit, a doctor should do the following:
- Ask about your self-monitoring of blood sugar.
- Ask about frequency and severity of episodes of hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar).
- Check your weight.
- Measure your blood pressure.
- Carefully inspect your legs and feet (including between the toes) for sores.
- Ask about your medication use.
- Answer questions about the disease and educate you about self-care.
- Check on any diabetic complications, including symptoms of nerve damage such as numbness.
- Ask about your use of tobacco and/or alcohol.
- Ask you about any lifestyle changes and discuss the consequences.
- Talk to you about possible stress, depression, or other psychological issues.
- Ask you about your exercise and eating habits.
- Follow up on anything suspicious from previous physical exams.
3. Every three months, a doctor should collect a blood sample from you to measure the percentage of blood cells that are attached to molecules of sugar. (If your blood sugar is under control, your doctor may perform this test only two times a year.) This measurement, called hemoglobin A1c, gives a clear picture of your blood sugar control over the previous months. The A1c reading for a person without diabetes is usually below 6 percent. A person who has poor control of blood sugar will typically have an A1c over 7 percent.
4. At least once a year, a doctor should take these steps:
- Conduct a general physical exam
- Conduct a comprehensive exam of the feet
- Conduct a comprehensive exam of the eyes (including a dilated retina exam) to check for any signs of damage to blood vessels. After one or more normal eye exams, a doctor may consider exams every 2 to 3 years or exams more frequently if eye disease is progressive.
- Check the urine for protein, a sign of kidney damage
- Record patient's height as well as weight
- Measure levels of cholesterol and other fats in the blood
- Provide an influenza vaccine
What do the tests show?
1. Hemoglobin (HbA1c) Measurement
Ideally, your A1c should be less than 7 percent. Patients who achieve this sort of control are at lower risk for heart disease, blindness, kidney damage, and nerve damage. However, this goal doesn't apply to everyone. If you have severe complications, talk with your doctor about the best options for you.
In most cases, an A1c reading over 7 percent is a call for action. It may be a sign that you need to change your medications or step up your self-care. Your doctor may also want to refer you to an endocrinologist (a specialist in diabetes and other metabolic disorders).
2. Eye Examinations
Doctors who find anything suspicious should refer patients to an ophthalmologist experienced in treating diabetic retinopathy (damage to blood vessels in the eyes). In addition, adults and teens with type 1 diabetes should see an ophthalmologist or optometrist for a comprehensive eye exam within 5 years of being diagnosed with diabetes. People with type 2 diabetes should have a thorough eye exam by an ophthalmologist or optometrist shortly after being diagnosed. An annual eye exam for both type 1 and type 2 patients is a good idea, though your eye doctor may suggest getting an exam less frequently if you don't have any problems with your eyes.
Any woman with diabetes who becomes pregnant should have a comprehensive eye exam promptly, as pregnancy increases the risk of eye trouble. Even better, women who are planning ahead should have an eye exam before getting pregnant.
3. Blood Pressure
Your goal is a pressure less than 130/80 mmHg. Patients who manage to keep their pressure under control are less likely to suffer heart attacks, blindness, or kidney damage.
Before starting any treatment to lower blood pressure, a doctor should check the pressure on two occasions within one month. If blood pressure is 130-139/80-89, lifestyle therapy alone may lower it to an acceptable level. Treatment with medicine should start immediately, however, if the diastolic pressure (the bottom number in a reading) is over 90 mmHg or the systolic blood pressure (the top number in a reading) is over 140 mmHg.
Ideally, the level of LDL ("bad") cholesterol should be below 100 milligrams per deciliter of blood (mg/dL). Many patients with diabetes far exceed this limit, putting them at increased risk for atherosclerosis (a type of hardening of the arteries) and heart disease. If your cholesterol tests don't raise any alarms, your doctor may wait two years before checking again.
Children over two years of age should have their cholesterol measured as soon their blood sugar is under control. If the readings are normal and there is no family history of high cholesterol, a doctor can wait until the child turns 10, then screen every five years thereafter.
American Diabetes Association. Standards of Medical Care in Diabetes - 2012. http://care.diabetesjournals.org/content/35/Supplement_1/S11.full
Mayo Clinic. Type 2 diabetes: When to seek medical advice. November 2005. http://www.mayoclinic.com/health/type-2-diabetes/DS00585/DSECTION=5
Standards of Medical Care in Diabetes - 2007. American Diabetes Association. Diabetes Care, Volume 30, Supplement 1, January 2007.
American Diabetes Association. Clinical Practice Recommendatiosns 2008. January 2008. http://care.diabetesjournals.org/content/vol31/suppl_1/
American Diabetes Association. Standards of Medical Care in Diabetes - 2009. Diabetes Care 2009 Jan; 32 (Supp. 1): S13-61.