Diabetes checkups: Seeing your doctor regularly is key to blood sugar management

Regular medical checkups are vital to your diabetes care. Your doctor examines your entire body to look for warning signs of diabetes complications and tests your blood and urine to help monitor your condition.

Know how often you need to check in with your doctor and what to expect during your checkup. Preparing yourself for the checkup can help you take a more active role in preventing diabetes complications.

When to see your doctor

How often you visit or contact your doctor or other members of your health care team depends on the type of diabetes you have as well as on your overall health.

• New diagnosis of diabetes and starting an insulin injection regimen? If you've just been told you have diabetes and you're starting an insulin injection program, your doctor may recommend that you stop in daily until your blood sugar and insulin levels stabilize.
• Blood sugar levels within target range and you're in good health? You may need to see your doctor only twice each year.
• Take insulin or have trouble managing your blood sugar? The American Diabetes Association (ADA) recommends that you see your doctor at least four times each year.
• Starting a new medication or insulin injection regimen? See your doctor frequently so that he or she can gauge how you're responding to changes in your treatment plan. Your doctor will tell you how often you need to schedule your appointments.
• Blood sugar or blood pressure unstable? You may need frequent contact with your doctor if your diabetes management is hitting some stumbling blocks. If your blood sugar or blood pressure isn't well controlled, for instance, you may need frequent monitoring — perhaps weekly visits. If you have diabetes-related complications, you might also need frequent contact. Your doctor will tell you how often to schedule your appointments.

How to prepare for your checkup

Take an active role on your health care team by preparing for your checkup. Be sure to take your blood sugar record with you. Look through the record for patterns and trends your doctor needs to know about.

Some people become anxious during their checkups and have difficulty remembering everything that was discussed. Consider taking a family member or trusted friend with you if you'd like someone else to listen in on what your doctor tells you.

Making a list of questions before your checkup can help you remember to get answers to all your questions. Some questions you might want to ask your doctor include:

• What lab tests are you getting, and when will you learn the results?
• Do you have early signs or symptoms of diabetes complications?
• Is any complication you've developed improving or becoming worse?
• Are there new techniques or devices for injecting insulin or monitoring blood sugar?
• Do you need to lose weight?
• Is the cost of the diabetes medication(s) you take covered by any special programs?
• What blood sugar level indicates that you need to immediately call your doctor or seek emergency care?
• Who should you call if you have a question during the week, at night or on weekends?

If you don't have someone to go with you to your appointment, consider writing down the answers your doctor gives you.

Diabetes checkups: The purpose of the exam

Regular diabetes checkups give your doctor an opportunity to evaluate how well you're doing. During your checkup your doctor:

• Looks for early signs and symptoms of diabetes complications, such as kidney, eye or nerve damage
• Performs blood and urine tests to monitor how well your treatment plan is working
• Reviews your blood sugar record with you, looking for patterns that warrant changes in your treatment plan
• Reviews and adjusts your medication, diet and other parts of your treatment plan

Before or after you see your doctor, you might have an appointment with a dietitian to go over your diabetes meal plan. Your doctor may also ask you to meet with a diabetes nurse educator — a registered nurse with special certification in diabetes care — to discuss blood sugar monitoring or your medication regimen.

What you can expect

Each visit to your doctor includes some of the following procedures, questions and tests.

Questions about how you're doing
Your doctor may ask you questions about your:

• Treatment. At each visit, talk to your doctor about any adjustments you have made or want to make to your diabetes care program. Be sure to discuss changes in medication or abnormal blood sugar readings, for instance.
• Symptoms. Diabetes can cause a variety of complications, especially if your blood sugar isn't well controlled. Discuss any signs or symptoms you've had, such as vision problems or chest pain, which might signal new or progressing complications.
• Psychological health. Chronic illness can take an emotional toll. Talk to your doctor about your mood and coping abilities. Your doctor may suggest counseling.
• Other health issues. Discuss any medical problems you may have, as well as your visits to other health care professionals and any medications you take.
• Lifestyle changes. Let your doctor know if you've made changes in your health habits, such as tobacco or alcohol use, that could affect your diabetes care. Review your exercise and activity levels and meal planning.
• Goals. You may find it hard to stick to your treatment plan, especially over the long term. Talk to your doctor if you're having trouble following medication regimens or eating plans. Your doctor may refer you to a dietitian or social worker.

A physical exam
During your checkup, your doctor checks your temperature, weight, pulse and respiratory rate, and does a physical exam. Your doctor focuses on your:

• Eyes. Your doctor looks for damage to the retina (retinopathy). Ask your doctor how often you should visit an eye specialist (ophthalmologist or optometrist).
• Blood pressure. Like diabetes, high blood pressure can damage your blood vessels. Diabetes and high blood pressure frequently occur hand in hand, and together, they can increase your risk of a heart attack or stroke. Have your blood pressure checked at each office visit.
• Heart and lungs. Your doctor listens to your heart and lungs with a stethoscope. Based on the sound of your heart, you may also need an electrocardiogram (ECG) or chest X-ray.

A thorough look at your feet
Your doctor examines your feet briefly for signs of problems, such as cuts or blisters. At least once a year, you need a thorough foot exam focusing on:

• Skin. Breaks, ulcerations or blisters can lead to infection.
• Foot pulses. These indicate if you have good blood circulation in your feet.
• Sense of touch. This indicates if sensory nerves in your feet are working properly.
• Deformities. Bony deformities or evidence of increased pressure, such as calluses, may suggest you're at risk of more serious complications.

If your feet require treatment, such as treatment for a fungal infection or wound care for an ulcer, your doctor may refer you to a foot specialist (podiatrist). Another reason to see a foot specialist is to have your toenails carefully trimmed to minimize the risk of infection around the nails.

Blood and urine tests
As part of your ongoing diabetes care, you need regular blood and urine tests. These tests help show if your treatment is working and can alert you and your doctor to early signs of diabetes complications, such as kidney disease.

Be an active member of your health care team

Knowing what to expect at your diabetes checkup can help ensure that you're an active part of your health care team. Prepare yourself for the checkup by knowing what lab tests you need and what's normal. And don't forget to take your blood sugar record with you. Empower yourself to take a leading role in preventing diabetes complications.

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