Test Your Knowledge

Choosing the right physician may be the most important decision a person with diabetes makes in establishing an effective care program. Patients should choose a physician who is knowledgeable and flexible. Endocrinologists specialize in diabetes and other disorders of the endocrine system (glands).

Some patients may prefer to select a primary care physician who is also a certified diabetes educator (CDE). Certified diabetes educators are licensed multidisciplinary health professionals who teach people with diabetes. To gain this accreditation, a provider must pass a test and earn recertification every five years.  Most CDEs are nurses who have acquired the additional appropriate training. Many endocrinologists work together with CDEs associated with their practice, forming a comprehensive diabetes healthcare team.

Above all, patients should feel comfortable with their physician, especially in asking questions and expressing concerns about their care.

When selecting a physician, patients should ask the following questions:

• Does the physician have special training in diabetes?
  
  
• Does the physician treat many patients with diabetes?
  
  
• Is the physician available every day of the week? If not, who covers for the physician in cases of emergency?
  
  
• Does the physician accept the patient’s insurance coverage? Are there any additional fees associated with visits and tests?
  
  
• Is the physician part of a team of experts (including registered dietitians, educators, therapists and others) who can provide comprehensive diabetes care?
  
  
• Will the physician create a sick-day plan for the patient and give specific instructions about how and when to address problems such as hypoglycemia with treatments such as sugar consumption or a glucagon injection?

People with diabetes should take time before the initial visit (and subsequent appointments) to think about questions they would like to ask their physician. They should also bring along any records that may be helpful to the physician, such as a chart of glucose (blood sugar) readings or a food diary. A list of current and past medications with the specific dosages is also valuable. A valuable tool can be a daily diabetes log, covering matters such as symptoms and questions, that a patient can maintain and bring to medical appointments. It might help to call ahead and ask the physician about which things to bring to the visit.

Topics that a physician is likely to address during an initial visit include:

• Family and personal medical history. A physician is particularly likely to be interested in any family history of diabetes. Patients should assemble a family medical history chart that provides a history of illnesses in their family (parents, grandparents, aunts, uncles, siblings), as well as dates of birth, death and ages when a particular illness or injury has occurred.
  
  
• Use of drugs and supplements. Patients should tell their physician about prescription and over–the–counter medications and supplements they are taking. It may be helpful to collect all pill bottles in a plastic bag to bring to the appointment.

Once an initial relationship is established, patients should be sure to take an active role in subsequent visits by closely monitoring their examinations and asking relevant questions. Potential issues to be addressed include those surrounding the following topics:

• Glycohemoglobin test (HbA1C). Measures a patient’s glucose control over the previous three months. When was the last time the test was performed? What were the results, and what do they indicate? How often does the physician plan to perform it in the future?
  
  
• Lipid profile. Measures the level of cholesterol and other fats in a patient’s bloodstream. When was the last time the test was performed? What were the results, and what do they indicate? How often does the physician plan to perform it in the future?
  
  
• Home glucose monitoring (self–testing). Patients should discuss how often to use their glucose meter and should know their target blood glucose levels.
  
  
• Dietary guidelines. Patients should have a clear, detailed meal plan that tells them how much food they can consume, in what categories (carbohydrate, protein, fat) and other specifics, such as whether alcohol is allowed. It may be appropriate to request a physician’s referral to a dietitian for nutrition counseling. 
  
  
• Foot examinations. Foot problems are a common and potentially serious complication for patients with diabetes. People with diabetes should have their feet examined during every visit to a physician. A comprehensive foot exam, including assessment of sensation and circulation, should be performed every year, or more frequently if there are any risk factors. In addition, physicians should show diabetic patients how to care for their feet. For more information, see Foot Care & Diabetes.
  
  
• Eye examinations. People with diabetes should be sure to have dilated pupil examinations at least once a year. Dilation allows an ophthalmologist to detect damage that has resulted from diabetes. Patients with conditions such as diabetic retinopathy, glaucoma or cataracts may need to see an ophthalmologist more often.
  
  
• Blood pressure. High blood pressure increases the risk of heart disease and stroke, primary causes of death in people with diabetes. Elevated blood pressure can also lead to or worsen other disorders, such as kidney disease and glaucoma. It is vital that patients consult with physicians about appropriate blood pressure readings and treatments that can control blood pressure.

• Microalbuminuria testing. This urine test can detect small amounts of protein in urine (proteinuria), an early sign of diabetic nephropathy (kidney damage). When was the last time the test was performed? What were the results, and what do they indicate? How often does the physician plan to perform it?
  
  
• Ketone tests. Samples of urine or blood can reveal levels of a waste product called ketones that are dangerous if they build up. Home urine tests and certain glucose meters can assess these levels. How often and under what circumstances should the patient perform ketone testing?
  
  
• Other endocrine diseases and autoimmune disorders. Some diabetic patients may be prone to other endocrine or autoimmune conditions. For example, people with type 1 diabetes are at increased risk for Hashimoto’s thyroiditis and Graves’ disease. Should the patient have a thyroid blood test?
  
  
• Musculoskeletal disorders. Diabetes increases the risk of a wide range of rheumatic and orthopedic problems from gout to osteoporosis. Should the patient have a waste product test, bone density test or other screening test for such conditions?
  
  
• Cardiac stress test. Some experts are now recommending that diabetic individuals, especially elders, have comprehensive stress testing to detect silent forms of heart disease.  Is this recommended for the individual?

The American Diabetes Association recommends that various tests be performed with the following frequency:

• Each visit
  
  
• Weight
• Blood pressure
• Foot examination
  
  
• Every three months
  
  
• Glycohemoglobin test
  
  
• Annually
  
  
• Lipid profile
• Dilated pupil exam
• Dental exam
• Microalbuminuria/proteinuria test
• Complete foot examination

Patients with certain risk factors may be advised by their physicians to have such tests performed more often.