Good continuing care is an essential part of diabetes management. This means regularly scheduled doctor’s visits and sometimes additional contact. ADA notes in its Standards of Care that in some situations, such as when a person first starts to inject insulin, daily contact may be needed until the patient’s glucose control improves. With a change in diet or oral medication, weekly contact is usually enough.
How Often to Visit
If you are treated with insulin, ADA suggests at least four visits a year to your health care provider. If you do not use insulin, two to four visits are recommended, depending on how you are doing with your treatment goals. More frequent contact may be needed if you aren’t meeting your blood glucose or if you have symptoms of diabetes-related complications.
Reviewing Your Program
Review blood glucose control
At each visit to the doctor, you will repeat some of the things you did at the first appointment. This includes discussing any hypoglycemia you’ve had, including frequency, cause, and severity. You should also discuss in detail your blood glucose test results and look for patterns of highs and lows.
Changes in Treatment
At each visit, you should discuss any changes to make in your diabetes care plan. It is difficult to stick to a treatment plan, for a variety of reasons. Depression, tension at work, or problems at home can all affect your treatment, so it’s important to mention them to your doctor.
Discuss any Symptoms
Discuss any symptoms that suggest you are developing complications of diabetes. These could include:
- A change in vision - possible retinopathy or cataracts
- Swelling of the ankles or painful feet - possible nephropathy
- Chest pain - possible heart disease
Other Health Concerns
If you have health problems other than diabetes, you and your doctor should talk about them, too. If you have more than one doctor, it’s important that everyone is clear about which doctor does what. This is critical, because all too often, more than one doctor is prescribing different medications for the same problem. Or one doctor may prescribe a medicine that should not be taken with one prescribed by a second doctor.
Physical Exam
At every visit, weight and blood pressure should be measured. Anything that was abnormal on previous visits needs to be checked.
Feet
Your feet should be examined at every visit.
Eyes
Your doctor should check your retinas for retinopathy. ADA recommends that a dilated eye exam be done annually for:
- All people aged 12 and older who have had diabetes for 5 years
- Everyone over the age of 30
- Any patient with visual symptoms and/or abnormalities
Management Plan
At each visit, review your management plan to find problems and check your progress in meeting your goals. For most people with diabetes, this will include a review of:
- Diabetes control (including exercise)
- Complications
- Blood pressure control
- Lipid levels
- Frequency of hypoglycemia
