Standards of Medical Care for Diabetes Mellitus
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).
- A nurse practitioner or physician assistant.
- Nurses.
- A diet and nutrition specialist (registered dietitian).
- A certified diabetes educator (CDE).
- An exercise specialist.
- A pharmacist.
- An eye doctor.
- A foot specialist (podiatrist).
- A dentist.
- A primary care provider.
- A mental health provider.
Your health care providers follow guidelines to help you get the best quality of care. The following schedule is a general guideline for your diabetes management plan. Your health care providers may give you more specific instructions.
Physical exams
Upon being diagnosed with diabetes mellitus, and each year after that, your health care provider will ask about your medical and family history. He or she will also do a physical exam. Your exam 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.
- Thyroid gland exam.
- Skin exam.
- Screening for damage to your nerves (peripheral neuropathy). This may include checking the pulse in your legs and feet and checking the level of sensation in your hands and feet.
- A complete 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, which 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 done:
- HbA1c
(hemoglobin A1c). 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 treatment goals have changed.
- Lipid
testing, including total, 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 3–5 years after you are diagnosed, and then once a year after your
first exam.
- For children with type 1 diabetes, a health care provider may recommend an eye exam when your child is age 10 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 once a year after your first exam.
Immunizations
- The yearly flu (influenza) vaccine is recommended for everyone 6 months or older who has diabetes.
- The pneumonia (pneumococcal) vaccine is recommended for everyone 2 years or older who has diabetes. If you are 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 afterward as needed. If your screening shows that you have symptoms (positive screening result), you may need more evaluation and you may work with a mental health care provider.
Treatment plan
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 are experiencing.
- Your blood glucose target goals.
- The frequency of your blood glucose monitoring.
- Lifestyle habits, such as activity level as well as tobacco, alcohol, and substance use.
Diabetes self-management education
Your health care provider will assess how well you are monitoring your blood glucose levels and whether you are taking your insulin correctly. He or she may refer you to:
- A certified diabetes educator to manage your diabetes throughout your life, starting at diagnosis.
- A registered dietitian who can create or review your personal nutrition plan.
- An exercise specialist who can discuss your activity level and exercise plan.
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 in order to help you get the best quality of care.
- Standards of care including having regular physical exams, blood tests, blood pressure monitoring, immunizations, screening tests, and education about how to manage your diabetes.
- Your health care providers may also give you more specific instructions based on your individual health.
