Your First Visit
Your first visit to a doctor who will treat your diabetes should have four parts:
- The doctor should take a medical history (ask questions about your life, complications, and previous diabetes treatment plan).
- The doctor should give you a complete physical examination.
- The doctor should run tests on your blood and urine to find out your blood glucose level, your glycated hemoglobin level (a measure of average blood glucose levels over the past two to three months), your cholesterol and fat levels, and your urine protein level. Your age, complications, and symptoms dictate which other laboratory tests your doctor does.
- Your health care team should work with you to make a plan for managing your diabetes.
This checklist will help you make sure your health care team is thorough at your first visit. They should:
- measure your height and weight
- measure your blood pressure, look in your eyes, ask you about any problems you have seeing, and refer you to an eye doctor for a dilated eye exam
- look in your mouth, and ask about your dental health
- feel your neck to check your thyroid gland, and do tests if necessary
- feel your abdomen to check your liver and other organs
- take your pulse
- look at your hands and fingers
- listen to your heart and lungs through a stethoscope
- look at your bare feet, and check the sensation and pulses in your feet
- check your skin, especially the places where you inject insulin
- test your reflexes
- take blood and urine samples for tests
- ask how and when you were diagnosed with diabetes
- ask for results of laboratory tests you had in the past
- ask about your eating habits and weight history
- ask about your current diabetes treatment plan
- ask how often and how hard you exercise
- ask about times you've had ketoacidosis as well as low blood glucose reactions
- ask about infections you've had
- ask what complications you've had and what treatments you've received for them
- ask what medicines you are taking
- ask about factors that make you more likely to get heart disease, such as smoking, high blood pressure, eating and exercise habits, cholesterol levels, and family history
- ask what other medical problems you've had
- ask who else in your family has diabetes
- ask about problems you may have had while pregnant
Making a Plan
Putting together a diabetes care plan is an important part of your first visit. It’s important to have a plan for how you’re going to take care of yourself until your next visit and what to do in case of an emergency. Your diabetes care plan will not be the same as everyone else's. To work well, the plan must be adapted to your own life. For example, it needs to take into account your work or school schedule, how active you are, what and when you like to eat, your cultural background, and other medical issues you have. The plan will change over time as you enter into various stages of life with diabetes and life in general.
You need to be involved in devising your diabetes care plan. Otherwise, it is unlikely that the plan will fit into your life or that you will understand what you need to do.
It is best to have a written plan. Is your diabetes care plan complete? If so, it should include:
- a list of goals (both short term and long term)
- a list of the medicines that you will use to control your diabetes
- contact information and instructions for getting prescriptions and prior authorizations for medications and diabetes devices. Be sure you know how much “lead time” is needed for prescriptions, especially if you use mail order
- advice from a dietitian on eating - diabetes requires a solid education in balancing carbs, insulin, and exercise. Ask for a referral to a diabetes educator and a dietitian. This is helpful at diagnosis and at intervals along the way. Never stop being a learner or asking for help.
- a list of changes you have agreed to make in your life, such as getting more exercise or stopping smoking
- teaching sessions for you and your family on how and when to measure your blood glucose levels and urine ketones, how to keep records of these, and how to treat low blood glucose reactions
- a complete list of your local resources
- contact information for your clinic
- instructions for how to get help after-hours
- a plan for seeing an eye doctor
- a plan for seeing a foot doctor, if you need to
- a plan for seeing other specialists, if you need to
- instructions on when to come back and when you should call
- a birth-control and prepregnancy plan
- a plan for caring for your teeth and seeing the dentist
- a plan for sick days
- a plan for exercise days and how that affects your diabetes
- contact information and instructions for getting paperwork completed for school/camp
It's always best to be prepared!