How often should your parent with type 2 diabetes see her diabetes doctor? The ADA recommends quarterly appointments for people who take insulin or who have trouble controlling their glucose levels, and two or three annual visits for others with diabetes. At these visits your parent's physician will review her blood glucose numbers to see if she's in her target range, since managing blood sugar is the most important way for her to feel her best and prevent long-term complications. Make sure your parent brings her logbook to these appointments.
During these checkups, your parent's healthcare provider should also review your parent's plan to address high or low blood sugar episodes, discuss any lifestyle changes and medication goals, and check on her medication usage and treatment plan. If your parent smokes, her doctor should immediately refer her to a counselor to help her quit, and he should follow up at subsequent checkups to see if she's broken the habit.
Also on her initial visit, your parent's physician should refer her to a diabetes educator, a health care professional who can teach your parent how to manage the disease and avoid complications.
Also at these appointments your parent's physician will want to assess whether social, mental, or emotional conditions, such as isolation, cognitive impairment, depression, or denial, have an impact on her ability to manage her own diabetes care.
Quarterly foot checks
People with diabetes can develop a variety of foot problems. Since even routine ailments can lead to serious trouble if left unchecked, your parent's doctor should examine her feet at routine checkups for any sores, ulcers, blisters, or calluses that may require treatment.
Quarterly infection checks
High blood sugar impairs your parent's immune system, limiting her ability to fight off bacteria and viruses that cause infection. That's why people with diabetes are more prone to bacterial and fungal skin infections. Any breaks in the skin, redness, or wounds that won't heal should be examined by your parent's doctor, who should also conduct a routine skin check, especially at insulin injection sites. People with diabetes are also more prone to vaginal and bladder infections, and the doctor should ask about such concerns at regular visits as well.
Your parent should also get a yearly flu shot and a pneumonia vaccine to help prevent these common illnesses. Check with your parent's physician to see if she needs a booster shot against pneumonia.
Quarterly blood pressure and weight checks
Your parent's doctor will want to keep close tabs on her blood pressure and weight, both of which will be measured at routine visits. Here's why:
If your parent has high blood pressure, also called hypertension, her heart has to work much harder to pump blood, and her doctor will advise her about lifestyle changes and drug therapy that can help with this condition. Hypertension is also a contributor to kidney and eye diseases associated with diabetes.
Carrying excess pounds in any amount can also complicate diabetes management and puts your parent at greater risk for other related health ailments, including hypertension, heart attack, and stroke. Even modest weight loss of just 5 to 10 pounds can improve blood sugar levels and reduce cardiovascular risks. In addition to her weight, your parent's body mass index, or BMI (which measures her weight in relation to her height to assess her amount of body fat), should be regularly checked.
Biannual A1c test
The A1C test, also known as the HbA1c test, is a blood analysis that determines glucose control over the previous two to three months. It does so by measuring the amount of the protein hemoglobin found in red blood cells. The ADA recommends this test at least twice a year for people whose diabetes is under control; people who have changed therapies or who aren't meeting blood glucose goals should be tested quarterly. The test results give a good indication about how the treatment plan is working. It's a bit like a batting average in baseball, because it gives an overall assessment of success, not just a look at how things are going on a day-to-day basis.
More Diabetes Health Checks
Twice-yearly dental checks
Gum disease is common in people with diabetes because their bodies have a tough time keeping bacteria in check. Your parent needs regular dental checkups and cleaning to keep this condition at bay.
Annual cardiovascular exam
Cardiovascular disease is a major cause of mortality for people with diabetes. Your parent's doctor should conduct an annual cardiovascular exam, including tests for the blood lipids (fats) cholesterol and triglycerides. Low-density lipoproteins (LDLs), also called "bad" cholesterol, and triglycerides can build up and clog your parent's blood vessels, leading to a heart attack or stroke. On the other hand, high-density lipoproteins (HDLs), or "good" cholesterol, help remove cholesterol from blood vessels.
As a general guide, your parent should aim for total cholesterol count below 200, with an LDL under 100, an HDL of 50 in women (40 in men), and triglycerides at less than 150. If your parent's numbers aren't satisfactory, her doctor will likely recommend lifestyle modifications that focus on lowering trans and saturated fat and cholesterol intake, weight loss (if applicable), and increased physical activity. Medications are also available to treat these conditions if behavioral changes don't do the job. In addition, her doctor may recommend that your parent take an aspirin a day as a preventive strategy to ward off cardiovascular complications.
Annual urine test
Diabetes can damage the kidneys, a common complication known as nephropathy. Small amounts of protein in the urine are an early warning sign of this disorder. A urine test will measure the amount of the protein microalbumin to determine how well your parent's kidneys are working.
Annual comprehensive foot exam
Diabetes can reduce blood supply to the legs and cause numbness in the feet. In addition to the quarterly foot checks recommended above, your parent's doctor should screen annually for loss of sensation and pulses in the feet, a sign of nerve damage called neuropathy. A foot and lower leg inspection should also include a check for any infections. People with diabetes often have reduced blood flow to the feet, coupled with a loss of sensation, and together these problems make it easier for ulcers and sores to develop. Left untreated, such problems can eventually lead to amputation.
Annual eye exam
Diabetes is a leading cause of blindness. Your parent should have a thorough eye exam every year to check for problems common to people with diabetes, such as deterioration of the retina (damage to the small blood vessels in the eye), glaucoma (an increase in fluid pressure in the eye), or cataracts (clouding of the lens of the eye). Finding and treating eye conditions early can help stave off serious vision loss later on.