Improving Your Diabetes Care Visits

If you haven’t had a visit to an eye specialist, ask your diabetes care provider for a recommendation or a referral to one, if necessary.

Are my kidneys OK?

Your diabetes care provider should order a yearly microalbuminuria test to assess your kidney health. This test measures even tiny amounts of the protein albumin in your urine, and it’s the best way to catch diabetes-related kidney problems early. A normal microalbumin test result (meaning there is no kidney damage) is below 30 mg/g. A diagnosis of microalbuminuria is given when the test result is between 30 mg/g and 300 mg/g, and a diagnosis of macroalbuminuria is given when the level is over 300 mg/g.

Because albumin excretion may be affected by such factors as strenuous physical activity, an infection, high blood glucose, or high blood pressure on the day of the urine test, a test result showing micro- or macroalbuminuria should be confirmed in two or preferably three separate tests done over a 3- to 6-month period before a diagnosis is made.

Early treatment is the most successful in preventing further damage to the kidneys, so be sure your doctor tells you not just how your kidneys are doing, but also what you should be doing to keep them as healthy as possible.

Do I need a flu shot?

Just about everyone who has diabetes is advised to get a flu shot once a year, usually in the early fall. People with diabetes may or may not be at higher risk of catching the flu, but they are at higher risk of developing potentially dangerous complications of the flu, such as pneumonia. Your health-care provider may give you a flu shot at one of your routine appointments, or some providers set up drop-in hours in the fall, when established patients can stop in without an appointment or schedule an appointment with a nurse just for a flu shot. If you don’t have a routine diabetes appointment set up in the early fall, ask your provider how best to get your flu shot in a timely manner.

Also ask your provider about the pneumonia (or pneumococcal) vaccine, which prevents against pneumonia caused by pneumococcus bacteria. (It does not prevent against pneumonia caused by other microbes or substances.) This vaccine is recommended for all adults age 65 or older and for all persons with diabetes between the ages of 2 and 65. Generally, only one dose is required. People who were vaccinated before age 65 should be vaccinated again at age 65 if five or more years have passed since the first dose.

Discussing your diabetes medication plan
The majority of diabetes treatment plans include one or more diabetes medicines to help lower blood glucose levels. Many plans also include medicines taken for other reasons, such as a daily aspirin to lower heart disease risk. Over time, as a person’s body and lifestyle change, his medication plan will likely need to change, as well. Taking a few minutes to review your plan with your health-care provider and to ask questions will help you stay up to date on your medication regimen and informed about how, when, and why to take the medicines you take.

It is important to recognize that no medicine is completely safe; all have potential side effects. So any time you and your doctor are considering adding to or changing your diabetes medication treatment plan, you should discuss both the benefits of taking a particular medicine, as well as any risks associated with it.

The U.S. Food and Drug Administration (FDA), the organization responsible for protecting the public’s health by assuring the safety and efficacy of drugs sold in the United States, advises using the acronym “SAFER” to guide discussions of medicine use with your doctor. SAFER stands for Speak up, Ask questions, Find the facts, Evaluate choices, and Read the label and follow directions.

Speak up. To prescribe the medicines that will work best for you, your diabetes care team needs certain types of information about you. This includes your health history (health problems you’ve had in the past) as well as any current physical or mental problems you may have. Your team also needs a comprehensive list of all the medicines you currently use, including prescription medicines, over-the-counter (OTC) medicines, vitamins, and other dietary supplements. They additionally need to know about any allergies or sensitivities you may have to certain drugs or drug ingredients. And they need to know about any personal characteristics that may affect medicine use, such as a history of confusion, failing memory, trouble remembering or swallowing, pregnancy, or breast-feeding. Your team will be relying primarily on you to supply this information.