What You Should Expect From Your Doctors
| When you have diabetes, it is important that you get good medical care. Now that it's clear that high glucose levels play a role in many complications, your doctor's skill is more vital than ever. Good care helps you live a full life and have as few complications as possible.
The Team Approach You should be receiving your diabetes care from a team put together by your doctor. Diabetes is complicated. Your doctor alone cannot be an expert in every area. For this reason, your diabetes care team probably includes an eye doctor, nurses, and a dietician. Depending on what complications you have, your doctor may send you to other specialists as well, such as a foot doctor. The Goal Too-high levels of glucose in the blood are a feature of all forms of diabetes. The main goal of diabetes treatment is to bring glucose levels down as close to normal as is safely possible. How far down? Suggested goals are under 7.8 millimoles per litre (mmol/L) before meals and under 9 mmol/L at bedtime. Your doctor may set different targets for you, depending on other factors, such as how often you have low blood glucose reactions. Most aspects of your treatment plan -- measuring your glucose levels, taking diabetes pills or insulin shots, exercising, losing weight, eating a planned diet -- are aimed at helping you achieve your target glucose level. High glucose levels can affect many parts of the body. They can lead to diabetic eye disease, nerve disease, and kidney disease. High glucose levels also make it easier to get infections. They can blur your vision or make you feel tired or thirsty all the time. People with diabetes also are more likely to get other health problems, including high blood pressure, high cholesterol levels, and heart disease. As you can see, keeping your glucose levels under control is vital to your future health and happiness. Your doctor can advise you on ways to reach this goal. But much rests on your shoulders. For this reason, your treatment team should spend a lot of time teaching you about diabetes and how to make diabetes care part of your life. The First Visit Your first visit to a new doctor who will treat your diabetes should have four parts. First, the doctor should take a medical history (ask questions about your life, complications, and previous diabetes treatment plan). Second, the doctor should also give you a complete physical exam. Third, the doctor should run tests on your blood and urine to find out your blood glucose level, your glycohemoglobin 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 lab tests your doctor does. Fourth, 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 does a complete job at your first visit. Did your health-care team: Putting together a diabetes care plan is an important part of your first visit. 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 account of your work or school schedule, how active you are, what and when you like to eat, your cultural background, and what other medical problems you have. You need to be involved in devising your diabetes care plan. Otherwise, it's unlikely that the plan will fit into your life or that you will understand what you need to do. Is your diabetes care plan complete? If so, it should include: A birth-control and pre pregnancy plan. Future Visits How often you should return to your diabetes doctor depends on many things. If you take insulin for your diabetes or if you're having trouble controlling your glucose levels, you should see your doctor at least four times a year. Otherwise, you should see your doctor two or three times a year. You may need to visit your doctor more often if you have complications or if you are starting a new medicine or insulin program. Your doctor will advise you about when to return. Your doctor should also tell you other times to call or come back. For example, your doctor may want you to call if you've had nausea or vomiting so that you can't eat, or if you've had a fever for more than a day. You will need to stay in touch with your doctor by phone every week or even every day if you are making big changes in your diabetes care plan. When you return, expect the doctor and other members of your health-care team to give you an exam, take a medical history, run lab tests, and fine-tune your treatment program. These later visits are not as in-depth as your first visit, although you should get a complete physical exam once a year. Also, your doctor may order new tests, do other exams, or refer you to a specialist depending on test results and your needs. This checklist will help you make sure your health-care team does a good job at your follow-up visits. Did your health-care team: Children and Teenagers Standards of care for children are somewhat different. Children whose diabetes is not well controlled sometimes are slow to grow and mature. So the doctor should measure height at every visit, not just the first. And the doctor should check the progress of sexual maturation. The types of lab tests the doctor does also can differ because children are not at risk for certain complications. The diabetes care plan must take children's needs into account. Children need enough nourishment to grow properly. It's important to prevent low blood glucose reactions, which can easily happen to children when they are too young to know the warning signs of a reaction. The dietician may recommend more snacks and different foods than for adults to help with these special needs. Also, children tend to get more illnesses than adults. Parents need instructions about treating them and when to call the doctor. Treatment plans need to be adapted for teens as well. The busy schedules of many teenagers can make it hard for them to stick to their diabetes meal plan. So can spending time with friends who are eating junk food. For these reasons, children with their parents and teenagers should meet with a dietician each year to review their meal plans and work out problems. |
