Diabetes Mellitus and Standards of Medical Care
Living with and managing diabetes (
diabetes mellitus) can be complicated. Your diabetes treatment may be managed by a team of health care providers, including:
A physician who specializes in diabetes (endocrinologist). You might also have visits with a nurse practitioner or physician assistant.
Nurses.
A registered dietitian.
A certified diabetes care and education specialist.
An exercise specialist.
A pharmacist.
An eye doctor.
A foot specialist (podiatrist).
A dental care provider.
A primary care provider.
A mental health care provider.
How to manage your diabetes
You can do many things to successfully manage your diabetes. Your health care providers will follow guidelines to help you get the best quality of care. Here are general guidelines for your diabetes management plan. Your health care providers may give you more specific instructions.
Physical exams
When you are diagnosed with diabetes, and each year after that, your health care provider will ask about your medical and family history. You will have a physical exam, which may include:
Measuring your height, weight, and body mass index (BMI).
Checking your blood pressure. This will be done at every routine medical visit. Your target blood pressure may vary depending on your medical conditions, your age, and other factors.
A thyroid exam.
A skin exam.
Screening for nerve damage (peripheral neuropathy). This may include checking the pulse in your legs and feet and the level of sensation in your hands and feet.
A foot exam to inspect the structure and skin of your feet, including checking for cuts, bruises, redness, blisters, sores, or other problems.
Screening for blood vessel (vascular) problems. This may include checking the pulse in your legs and feet and checking your temperature.
Blood tests
Depending on your treatment plan and your personal needs, you may have the following tests:
- Hemoglobin A1C (HbA1C). This test provides information about blood sugar (glucose) control over the previous 2–3 months. It is used to adjust your treatment plan, if needed. This test will be done:
At least 2 times a year, if you are meeting your treatment goals.
4 times a year, if you are not meeting your treatment goals or if your goals have changed.
- Lipid testing, including total cholesterol, LDL and HDL cholesterol, and triglyceride levels.
The goal for LDL is less than 100 mg/dL (5.5 mmol/L). If you are at high risk for complications, the goal is less than 70 mg/dL (3.9 mmol/L).
The goal for HDL is 40 mg/dL (2.2 mmol/L) or higher for men, and 50 mg/dL (2.8 mmol/L) or higher for women. An HDL cholesterol of 60 mg/dL (3.3 mmol/L) or higher gives some protection against heart disease.
The goal for triglycerides is less than 150 mg/dL (8.3 mmol/L).
Liver function tests.
Kidney function tests.
Thyroid function tests.
Dental and eye exams
Visit your dentist two times a year.
- If you have type 1 diabetes, your health care provider may recommend an eye exam within 5 years after you are diagnosed, and then once a year after your first exam.
For children with type 1 diabetes, the health care provider may recommend an eye exam when your child is age 11 or older and has had diabetes for 3–5 years. After the first exam, your child should get an eye exam once a year.
If you have type 2 diabetes, your health care provider may recommend an eye exam as soon as you are diagnosed, and then every 1–2 years after your first exam.
Immunizations
A yearly flu (influenza) vaccine is recommended annually for everyone 6 months or older. This is especially important if you have diabetes.
The pneumonia (pneumococcal) vaccine is recommended for everyone 2 years or older who has diabetes. If you are age 65 or older, you may get the pneumonia vaccine as a series of two separate shots.
The hepatitis B vaccine is recommended for adults shortly after being diagnosed with diabetes.
Adults and children with diabetes should receive all other vaccines according to age-specific recommendations from the Centers for Disease Control and Prevention (CDC).
Mental and emotional health
Screening for symptoms of eating disorders, anxiety, and depression is recommended at the time of diagnosis and after as needed. If your screening shows that you have symptoms, you may need more evaluation. You may work with a mental health care provider.
Follow these instructions at home:
Treatment plan
You will monitor your blood glucose levels and may give yourself insulin. Your treatment plan will be reviewed at every medical visit. You and your health care provider will discuss:
How you are taking your medicines, including insulin.
Any side effects you have.
Your blood glucose level target goals.
How often you monitor your blood glucose level.
Lifestyle habits, such as activity level and tobacco, alcohol, and substance use.
Education
Your health care provider will assess how well you are monitoring your blood glucose levels and whether you are taking your insulin and medicines correctly. He or she may refer you to:
A certified diabetes care and education specialist to manage your diabetes throughout your life, starting at diagnosis.
A registered dietitian who can create and review your personal nutrition plan.
An exercise specialist who can discuss your activity level and exercise plan.
General instructions
Where to find support
There are many diabetes support networks, including:
-
-
-
International Diabetes Federation (IDF):
idf.org
Summary
-
Managing diabetes (diabetes mellitus) can be complicated. Your diabetes treatment may be managed by a team of health care providers.
-
Your health care providers follow guidelines to help you get the best quality care.
-
You should have physical exams, blood tests, blood pressure monitoring, immunizations, and screening tests regularly. Stay updated on how to manage your diabetes.
-
Your health care providers may also give you more specific instructions based on your individual health.
This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.
