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What information should I bring to my doctor to help him or her manage my diabetes with me?

The most important pieces of information that you can bring to your doctor are the results of your home glucose testing (and preferably your glucose monitor, also) and an updated list of the medications you are currently taking, not only for diabetes, but for other medical problems as well. The glucose testing results are important because they reflect the most current state of control of your blood sugar. Also, if you are taking your glucose tests at various times of day, your log will show where you are best controlled and where you are not so well controlled, which allows your doctor to recommend the most effective adjustment to your treatment, or to suggest factors that might be influencing your sugar levels. Generally speaking, the more complex your therapy and the longer you have had diabetes, the more important the home glucose test results become. For example, if you have developed diabetes relatively recently, are on one medication only, and your periodic HbAlc tests show that you are generally well controlled, the home glucose results are less critical than if you have had diabetes for several years, are on multiple pills and/or insulin, and have complications of your diabetes (see Part 4). The reason that it helps to bring your monitor is that the results may suggest a problem with it and it can be examined when you are seen. Also, the information in it can often be downloaded into the clinic computer and analyzed in a number of ways to show trends and patterns that can be very helpful. When you keep a record of your readings, it is much better to enter them into one of the commercially available logbooks designed for the purpose than to write them down one after the other on a sheet of paper, which often makes them quite hard to follow and understand.

Table 9 The Relationship Between HbAlc and Estimated Average Glucose Level (eAG)

HbAlc (%)

eAG (mg/dl)

5

97

6

126

6.5

140

7

154

7.5

169

8

183

8.5

197

9

212

9.5

226

10

240

11

269

12

298

Formula used to calculate mean blood glucose (eAG) from A1c: eAG(mg/dl) = (28.7 X HbAlc) - 46.7.

Source: Data from American Diabetes Association (ADA).

If you are taking your glucose tests at various times of day, your log will show where you are best controlled and where you are not so well controlled.

The importance of the list of your current medications and dosages is that your doctor can only safely make adjustments to your medicines (for diabetes and other related conditions) in light of accurate knowledge of what you are presently taking. This includes herbs, supplements, and alternative medicines. This leads to one final important point, which is to remind you never to be hesitant to reveal to your doctor whether you are, or are not, taking your prescribed medicines correctly. Your doctor's aim is to serve your healthcare needs and to advise and assist you. He or she does not wish to judge or blame you. You have ownership and control of your medical problems and are free to make your own decisions as to whether to follow medical advice or not to do so. The only time a responsible physician will not agree to partner with you in such a decision is if it would be unethical or dangerous and his or her primary obligation not to harm you would be violated.

What tests should my doctor be doing on a regular basis to monitor my diabetes?

Some of the tests that your doctor will perform to monitor your diabetes and the status of any of its chronic complications are shown in Table 10. The main things that interest your doctor are monitoring the control of your blood sugar, the control of your cholesterol and blood pressure, and the presence or progress of any long-term complications of your diabetes (see Part 4 for discussion of these), and to check for the presence or absence of other related conditions. Tests in this context can refer to clinical examination, such as checking the condition of your feet and testing the sensation, laboratory blood tests, and special tests, as indicated, such as scans or other images. Many of these your doctor can do himself and others may require referral to another specialist. A detailed eye examination is an example of the latter.

Table 10 Items That May Be Checked Regularly in Persons with Diabetes

Item

Monitoring Tool

Glucose control

HbAlc, fructosamine, CBGs, eAG

Lipids

Fasting lipid panel ± special lipid tests

Blood pressure

BP cult measurements

Large vessel health

EKG, carotid IMT

Small vessel health Feet

Inspection, microfilament, capillary refill,

Kidneys

Allis

Serum creatinine, estimated CCr, MACR

Eyes

Retinal imaging, dilated eye exam

Peripheral nerves

Monofilament, NCV testing, touch and

Autonomic nerves

vibration perception, proprioception* Postural BP, pulse, RR variation

Abbreviations: HbAlc: hemoglobin A1c; CBGs: capillary (fingerstick) blood glucoses; eAG: estimated average glucose; BP: blood pressure; EKG (ECG): electrocardiogram; IMT: intimal-medial thickness by ultrasound; ABIs: ankle- brachial indices; CCr: creatinine clearance; MACR: microalbumen-to-creati- nine ratio; NCV: nerve conduction velocity; RR: R-wave to R-wave (on EKG). *Position sense .

 
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