Raising Your Standards: What to Expect From Your Doctor

How often should I see my doctor?

People with diabetes who are treated with insulin should generally see their doctor at least every three to four months. People with diabetes who are treated with oral medications or who are managing diabetes through diet should be seen at least every four to six months. More frequent visits may be necessary if the patient's glucose (blood sugar) is not controlled or if complications of diabetes are progressing.

What information should I give my doctor?

Generally, your doctor needs to know how well your diabetes is controlled and whether diabetic complications are developing or progressing. Therefore, at each visit, provide your doctor with your home glucose monitoring record and report any symptoms of hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar). Your doctor also should be informed of any changes in your diet, exercise or medications and of any new illnesses that may have developed. Tell your doctor if you have experienced any symptoms of eye, nerve, kidney or cardiovascular complications such as:

• Blurred vision
• Numbness or tingling in your feet
• Persistent leg swelling
• Chest pain
• Shortness of breath
• Numbness or weakness on one side of your body

At each visit, your weight and blood pressure should be measured. Your eyes, feet and insulin injection sites should also be examined at each visit.

What lab tests should I have done and how often?

Hemoglobin A1c

The hemoglobin A1c is an important blood test to determine control of your diabetes. It provides an average blood sugar measurement over the past six to twelve weeks and is used in conjunction with home glucose monitoring to make treatment adjustments. People with diabetes who are treated with insulin should have this test two to four times a year, depending upon whether those patients are meeting therapy goals.

People with diabetes may need to have the hemoglobin A1c test more frequently when their diabetes is not controlled. However, the test should be performed no sooner than every six weeks.

Urinalysis

To screen for diabetic kidney complications, a urine test for protein (urinalysis) should be done yearly beginning at diagnosis in people with Type 2 diabetes and after five years in people with Type 1 diabetes. If the results of a urinalysis are negative for people with Type 1 diabetes, microalbumin (which detects very small amounts of protein) should be checked yearly.

Cholesterol

People with diabetes should have their cholesterol level (including HDL, LDL and triglyceride levels) checked annually if their cholesterol level is abnormal or every two years if their cholesterol level is normal.

How can I monitor the development and progression of diabetic complications?

Eye disease (Retinopathy)

All patients with diabetes should see an ophthalmologist yearly for a dilated eye examination - beginning at diagnosis in people with Type 2 diabetes and within three to five years in people with Type I diabetes. Patients with known eye disease, symptoms of blurred vision in one eye or blind spots may need to see their ophthalmologist more frequently.

Kidney disease (Nephropathy)

Urine testing should be performed yearly as described in the section Urinalysis. Regular blood pressure checks are important since control of hypertension (high blood pressure) is essential in slowing kidney disease. Generally, blood pressure should be maintained less than 130/80 in adults. Persistent leg or feet swelling may be a symptom of kidney disease and should be reported to your doctor.

Nerve disease (Neuropathy)

Numbness or tingling in your feet should be reported to your doctor at your regular visits. You should check your feet daily for redness, calluses, cracks or skin breakdown. If you notice these symptoms before your scheduled visit, notify your doctor immediately.