Routine Health Care with Diabetes

Diabetes provider vists

• If your A1C is less than 7 for 1-2 years-one diabetes care visit per year.
• If you are not on insulin-every 6 months
• If you are on insulin-every 3-4 months

Schedule and keep your follow-up appointment with your health care team.

After being discharged from the hospital, we recommend an appointment to assess your diabetes within one month, sooner if necessary.

Eyes-regular eye exams

• Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness.
• Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma.
• An eye exam is recommended every one to two years.
       

Foot exam

• Diabetes may cause you to have poor blood supply (circulation) to your legs and feet.
• Take care of your feet by wearing well-fitting shoes. Avoid wearingshoes that are too tight or rub.
• Keep your feet clean and dry.
• Inspect your feet daily for areas of rubbing or sores.
• A yearly foot exam with your diabetes provider is recommended.

Oral health

• Having diabetes contributes to the risk of developing gum disease or cavities.
• Brush and floss daily and see your dentist every six months.

Smoking cessation

• Persons with diabetes should not smoke or use tobacco in any form.
• Smoking contributes to the risk of a heart attack or stroke.
• Smoking affects the blood vessels of the body impacting the blood flow to the feet, eyes, heart and kidneys.
• Insulin is less effective when exposed to high levels of nicotine and people with diabetes may need higher doses of insulin to control blood sugar.
• Free help in quitting smoking at 1-800-QUIT-NOW and at smokefree.gov and cdc.gov/tips.

Coping

• Many people may feel stressed or sad when diagnosed with diabetes. Change in one’s health and lifestyle habits are hard. It is important to remember that these feelings are normal and there are methods for coping with change.
• Reach out to your support network such as friends and family.
• Learn about diabetes through group educational classes.
• Stay positive and exercise every day. Engage in hobbies you enjoy.
• If you should feel very down and lose interest in previous enjoyed activities, withdraw from your support system, or spend the day sleeping, these may be signs of depression. Please reach out to your provider, diabetes educator, family, or friends for support.

Lipids

• Lipids are fats (cholesterols, triglycerides) that circulate in the blood that come from the food you eat. A high level of fats in the blood adds to the risk of a heart attack or stroke.
• Your diabetes provider may order a lipid blood test at least once a year.
• Your diabetes provider may prescribe a medication to help control the lipids in your blood.

Vaccinations

• It is recommended that you receive a flu (influenza) vaccine every year.
• It is also recommended that you receive a pneumonia (pneumococcal) vaccine.
     

Know the signs of low blood sugar. You may feel nervous, sweaty, shaky, weak, and have blurred vision.

• If you feel you have low blood sugar, immediately check your blood sugar.
• If your blood sugar is low (less than 70), eat or drink 15 grams of sugar.
• On quarter cup of apple juice, a hard candy or a glucose tablet all contain 15 grams of sugar.
• Recheck your blood sugar after 15 minutes. If your blood sugar is still < 70 eat or drink an additional 15 grams of sugar and recheck your blood sugar in 15 minutes.`}
• If your blood sugar is low after 30 minutes, call 911.
• When your blood sugar is over 70mg/dL, eat a snack with carbohydrate and protein.
       

What your doctor will do

• Have the most up-to-date information on diabetes treatment.
• Know how to use that information to make recommendations for your diabetes treatment.
• Explain why a treatment for your diabetes is recommended.
• Explain the reason for lab tests and what the results mean.
• Review any changes to your care plan to make sure you understand.

How to get the most from your doctor visit

• Bring your blood sugar log or your glucometer to your visit.
• Bring your record of all medicines and supplements you take (prescription as well as over the counter). Let the team know if you need any refills of your prescription medications.
• Let the team know at the beginning of the visit about specific topics you need to talk about.
• Let the team know about any changes to your health since the last visit.

Possible topics for discussion with your doctor

• Your blood sugar tests results
• Any very high or very low blood sugar levels and what time of day the blood sugar levels occur. This includes understanding symptoms and what to do about them
• Your current medicines, when to take them, and how to adjust if needed.
• Your meal plan and what kinds of food you eat
• Anything that's getting in your way of your day-to-day diabetes management such as school, work or feelings; cost of medications or the ability to self-administer the medications.
      

Lifestyle choices such as food preferences and exercise habits affect blood sugar control and, over time, the potential for the long-term complications of diabetes. Changing lifelong ways is very hard! The good news is small changes in everyday living can lead to big improvement in diabetes management.

One strategy to consider that many people have found helpful is setting SMART goals. Using the SMART goal framework helps people focus on specific small achievable changes.

The SMART acronym stands for:

• S: Specific
• M: Measurable
• A: Achievable
• R: Realistic
• T: Timely

As an example, many people would like to exercise more. If a person has not exercised routinely for a while, walking is a good start. An example of setting SMART goals for daily walking may be:

• Specific: I will walk around the block every day when I get home from work. On the weekends, I will walk after my morning coffee.
• Measurable: I will set a reminder on my phone to ping me at the same time every day and I will check off completion of the walk on my calendar.
• Achievable: Before I start walking every day, I will choose sturdy footwear and rain gear so that I am ready to walk whatever the weather.
• Relevant: I would like to get back into shape so that I feel better and burn a few calories. My doctor told me that I need to lose some weight and improve my blood sugar numbers.
• Timely: I really want to live my best life possible and be here for my family.

People who report the best success using SMART goals is to write your goals down and share with family or friends. Remember start small and celebrate your wins!
     

• High blood sugar (hyperglycemia) occurs when there is too much sugar in the blood.
• When high blood sugar continues for a long period of time, lasting damage to the body can occur.
• Know the signs of high blood sugar. You may have an increased thirst, blurred vision, frequent urination, increased hunger and numbness or tingling of the feet.
• High blood sugar occurs when glucose lowering medications are skipped; eat too much food or the wrong food; change or lowered activity levels, and sickness.
• Check your blood sugar. If your blood sugar is greater than 300 persistently over 6 to 8 hours, call your diabetes provider’s office.
• If your blood sugar is over 400, strongly consider presenting to the Emergency Room or an Urgent Care facility.

• Blood sugar can be more difficult to control when you are sick.
• Colds, fever, flu, nausea, vomiting, and diarrhea are all examples of common illnesses that can cause problems for people with diabetes.
• Loss of body fluids (dehydration) from fever, vomiting, diarrhea, infection, and the stress of a sickness can all cause blood glucose levels to increase.
• Because of this, it is very important to take your diabetes medicines and to eat some form of carbohydrate food when you are sick.
• Liquid or soft foods are often tolerated, and they help to replace fluids.

These guidelines are intended for managing a short-term (48 hours or less) sickness:

• Take your usual dose of insulin or oral diabetes medicine, except for METFORMIN
• Continue to take your insulin even if you are unable to eat solid foods or are vomiting. Your insulin dose may need to be adjusted.
• Continue to take your insulin even if you are unable to eat solid foods or are vomiting. Your insulin dose may need to be adjusted.
• You will need to test your blood glucose more often, generally every 2-4 hours.
• Eat some form of food that contains carbohydrates. The carbohydrates can be in solid or liquid form. You should eat 45-50 grams of carbohydrates every 3-4 hours.
• Replace fluids if you have a fever, vomit, or have diarrhea.
• Call your diabetes provider for self-management support as needed.
• Be careful with over-the-counter medicines. They may contain sugar or types of sugars that can increase your blood glucose levels. Read the labels.

• You are unable to drink fluids, even small amounts
• You have nausea and vomiting for more than six hours
• Your blood glucose level is more than 300 mg/dL
• There is a change in mental status
• You have a fever above 101 F

• If you take medication for diabetes and need to undergo a medical procedure, your diabetes provider may need to adjust your regular medication schedule until the procedure is finished.
• For safety, discuss your diabetes medication regimen with the provider who will be performing the procedure, your anesthesia and diabetes care provider.
• Remember to bring your glucometer or blood glucose log to all provider appointments.

Mayo Clinic: Diabetes Medication Choice Decision Aid

American Diabetes Association - Standards of Medical Care in Diabetes - 2019 Abridged for Primary Care Providers

American Diabetes Association - Standards of Medical Care in Diabetes - 2018

The YMCA of Seattle offers a Diabetes Prevention Program - contact your local YMCA for more information about the program.