Author's Perspective: During my recovery,I looked forward to my doctor appointments with my primary care physician because he was very supportive. However, I didn't like my appointments with my endocrinologist because he was not as supportive.
However, I realized that I had to see him on a regular basis because it was very important to get my hemoglobin A1C and blood glucose tested.
Not only is it important to schedule these appointments, but, you must take an active role in your appointments. For example, you should prepare a set of questions and notes before your appointment.
Make sure that you come prepared to your appointments and ask specific questions to get the most out of your appointments and to avoid any medical mistakes.
In this way, you'll get a lot more out of your appointments; and, if your doctor sees that you're actively involved he/she will usually take more time with you and be more patient in answering your questions.
Another way to become actively involved is to not blindly accept drugs from your doctor as the primary solution to your diabetes. Instead, ask for non-drug solutions first and explain that you would prefer not to take any drugs, if possible.
By being prepared and organized, you can actually reap the benefits of Western Medicine.
Concerning when to schedule your appointments, you should ensure that you set up the necessary doctor appointments during the calendar year as specified by your primary care physician (see chart below). If possible, try to schedule your appointments during the same time period each year.
Doctor Visits Annual Schedule
The following is a list of the key doctor visits that you should complete during the year:
- Primary Care Physician
- Dietitian/Health Coach
You should visit your primary care physician and/or endocrinologist on a regular basis to review your progress, your blood glucose readings, corrective actions, and other notes – at least until you have your blood glucose level under control.
Depending on your health needs and your health goals, you should get a complete physical and set of blood work every 6 to 12 months to identify any trends that may be getting overlooked, especially if you’re not making any significant improvements.
Concerning your feet, you should always clean and inspect them daily. Record any abnormalities to discuss with your physician at your next visit. Keep your feet clean and moist; and wear cotton socks for better absorbency.
Concerning your teeth/gums, you should always check them for any bleeding that doesn’t stop, and, notify your dentist and primary care physician immediately. Gum disease can increase internal inflammation and increase the risk of cardiovascular disease.
Depending on your health needs and your health goals, other members of your diabetes care team may include one or more of the following: cardiologist, neurologist, nephrologist, physiotherapist, naturopathic doctor, or psychiatrist.
Other members may include a health coach, diabetes educator, pharmacist, community health nurse, or social worker.
The 7 Keys to Working With Your Doctor | Doctor Appointments
As previously mentioned, besides your primary care physician, your other doctors should (minimally) include an ophthalmologist (eyes) and a dentist (teeth).
In addition, depending on your health issues, you may need to visit an endocrinologist (diabetes specialist), a podiatrist (feet), a nephrologist (kidneys), a neurologist (nerves), a cardiologist (heart), a psychiatrist/ psychologist (mind), etc.
Given all of these doctors that you may need to see, one of the best ways to manage your diabetes is to develop an effective working partnership with your primary care physician and the other doctors.
Your primary care physician’s role in this partnership is to provide medical advice, offer treatment options and recommend resources. Your role is to monitor your symptoms and blood glucose readings, report them accurately and do what you can to manage your disease on a day-to-day basis.
1a. Get prepared before your appointment. Start thinking ahead of time about what you want to ask or talk about at your appointment. A lot can go on between visits, and it can be difficult to remember everything you want to bring up.
So keep a small notebook handy, and write down your questions and concerns as they come up. Plan on telling your doctor about any major changes in your life or your daily schedule, such as starting a new job or traveling more than usual. Changes such as these — and even more minor changes — can affect your blood glucose levels.
Review your notebook one month, one week, and again one day before your appointment to make sure you haven’t forgotten anything important. At your appointment, keep your notebook out so you can refer to it, and use it to take notes on your doctor’s or other caregiver’s instructions.
1b. Come prepared. Doctor appointments are very important, but most people come ill-prepared to take full advantage of the time with their doctor. Then, they complain about the doctor not taking enough time with them. Or, they don’t ask the doctor any pertinent questions; or, they don’t bother to take any notes and forget what the doctor told them.
Bring your notes,your top 3 questions/concerns, your blood glucose readings, your meal plan, exercise activities, problems you encountered since your last appointment, etc. Prioritize your questions since you'll probably run out of time.
The doctor could spend more time with you, but you must first take full advantage of the time that you do have with your doctor. And, then, you will be pleasantly surprised how well your doctor responds when you take a more active role in your health.
2. Bring both your blood glucose meter and logbook to your appointment. Make sure that your meter is well charged or has fresh batteries so your physician or the office staff can review your meter memory and/or upload it to a computer. Check with the office before your appointment to ask if they have the capability to upload data from your specific meter.
The numbers recorded in your logbook help your doctor see trends, or patterns, in your blood glucose levels. Seeing a pattern of highs or lows enables your doctor to recommend medication changes or changes in other parts of your diabetes regimen. Having actual numbers is much more useful than telling your physician, “My sugars are all over the place.” However, only accurate records are useful: Filling in your logbook the night before your appointment will be obvious to your doctor and won’t be helpful in improving your blood glucose control.
If your provider has not already specified what glucose ranges you should be aiming for before breakfast, lunch, and dinner and before bedtime, ask — and make sure to write it down in your notebook.
3a. Get the necessary tests. Usually your doctor will determine which blood tests you need. However, make sure that you get the following tests:
- Fasting blood glucose
- Fasting insulin
- Hemoglobin A1c
- Blood pressure
- Urine Tests
- Filament test (bottom of each foot)
- Cholesterol (lipid profile)
- Cardiac risk factors (as required)
Note: For a complete list of the key blood tests, visit our Critical Blood Tests web page.
3b. Get your feet examined. For the filament test, your doctor will brush a soft nylon fiber (monofilament) under each foot to test your sensitivity to touch and check for possible neuropathy.
Depending on your symptoms and how long you've been diabetic, your doctor may perform other tests to help diagnose diabetic neuropathy.
Tell your doctor about any foot-related concerns you may have, such as any tenderness, redness, irritation, changes in sensation, or slow-healing wounds you have observed in your daily foot exams.
If you’re having trouble trimming your toenails or finding shoes that fit, ask about a referral to a podiatrist. Even if you have no specific concerns about your feet, it’s important for your provider to check them for the presence of neuropathy, which can cause you to lose feeling in your feet and to not notice small or even large injuries.
4a. Empower Yourself. Don't be intimidated by your doctor. Don't take what your doctor says at face value. Your doctor doesn't know everything, in fact he/she is only making an educated guess as to what is wrong with you.
Use his services as a tool but don't base your life on what your doctor says or think that a few little pills he/she prescribes will fix the problem... it won't. You'll only require more pills to counteract the side effects that the first pills gave you and that will escalate with each new prescription you are given.
So, make sure that you learn the truth about the drugs you're taking so that you have some possible insight into your doctor and some of his motives.
4b. Don't take the easy way out. Question and research everything. The body can and does heal itself if given the right tools. Your health is the most important thing you will ever have and once it is lost, the biggest loser is you.
Don't assume that your doctor has all the answers! Do your own homework; and, find someone in Alternative Medicine that you trust; is not trying to sell you a bunch of supplements; and, more importantly, has credibility and experience about diabetes pathology.
5. Discuss your medications. Bring a current list of all of the medicines and the doses you are taking; or, bring the bottles of medicines themselves if that’s easier.
Go over the list with your doctor to make sure he/she is aware of what you’re taking. Identify before your appointment whether you will need to get new prescriptions from your doctor for any of your drugs or diabetes supplies.
Include any over-the-counter (OTC) or herbal products on your list, and mention if you have started taking any new products since your last appointment. Ask whether these new products might interact with anything else you’re taking.
If you are not taking your prescribed medicines, tell your doctor, and say why. It is better to be candid about what’s going on than to have your provider prescribe more medicines.
If your medicines too costly, ask your provider if there are lower-cost alternatives. If there has been a recent change in your financial situation, the doctor’s office staff can provide you with information about pharmaceutical assistance programs that may help to cover the cost of your medicines and diabetes supplies. The Partnership for Prescription Assistance Program, which can be found online at www.pparx.org has the application forms for many pharmaceutical assistance programs.
Money is not the only reason people don’t take their prescribed medicines. Perhaps you are not taking them because the medications aren't working. Verbalizing how you feel can open an important dialog with your doctor about your emotional well-being. In addition to offering a supportive ear, he may be able to suggest other resources, such as a therapist or diabetes support group. Similarly, if side effects or forgetfulness are causing you to stop taking your medicines or to skip doses, your doctor may be able to help you work out solutions to these problems.
6. Make sure that you understand the treatment options. Your doctor should tell you what treatments are standard for your illness. Your doctor will not always share the option of palliative care or hospice without being asked directly. If you are interested in finding out how palliative care or hospice can help you, be sure to ask.
Review each drug that you're taking and the purpose of that drug with your doctor. Also, discuss any side effects or other concerns you may have, including non-drug alternatives.
Unfortunately, when most patients mention that they did their own research and found something on the Internet, the doctor usually frowns or laughs instead of applauding you for doing your own research. Why is that? Maybe it's because some of the information on the Internet is not true, but, more than likely, it's because your doctor wants to control you by keeping you in the dark.
Author's Note: When I told my endocrinologist that I had found some information on the Internet, he laughed and said: "You can't believe anything you read on the Internet."
And, I said: "What if the information came from PubMed or some other medical research database?" My endocrinologist just frowned and left the room.
7. Keep a notebook. Sometimes we become flustered or intimidated during our doctor appointments, so we forget to ask certain questions. So, keep a journal or a notebook of some kind; or, use your smartphone to keep notes or record your appointment (with your doctor's approval).
Note: If you are helping a loved one and need some guidance, we recommend that you get the author's DTD Caregiver's Guide.
Diabetes Care Team | Key Members
People with diabetes work with an extensive diabetes care team, which may include a primary doctor, dietitian, diabetes educator, diabetes health coach, eye doctor, foot doctor, dentist, and possibly an exercise trainer.
But remember, you are the most important member of your diabetes care team. Your health care team is available to help you manage your diabetes and maintain your good health.
Your diabetes care team may include most or all of the following, depending on your specific health needs:
You: You are the most important member of your diabetes care team. Only you know how you feel. Your diabetes care team will depend on you to talk to them honestly and supply information about your body. Monitoring your blood sugar is an important part of effective therapy. It tells your doctors whether your current treatment is effective. Your participation in monitoring your blood sugar levels will also help prevent or reduce the episodes of hypoglycemia (low blood sugar).
Primary care physician (PCP): Your PCP is the doctor you see for general checkups and when you get sick. This person is usually an internist or family medicine doctor who has experience treating people with diabetes. Because your primary care doctor is your main source of care, he or she will most likely head up your diabetes care team.
Endocrinologist: An endocrinologist/diabetologist should also be seen regularly. An endocrinologist is a doctor who has special training and experience in treating people with diabetes.
Certified diabetes educator: A CDE is a health professional who has been certified to help those living with diabetes understand and manage their blood sugar including how to inject with insulin and how to use a blood glucose monitor. A CDE is a good person to go to with questions you have about living with diabetes.
Your PCP and endocrinologist, if you have one, can help with medical questions; a CDE is a great resource for questions about eating, exercise, and tips that may help with everyday situations.
Unfortunately, most CDEs are as drug-focused as your doctors, because they have been trained in a similar manner to believe and trust in the drugs. They tend to know very little, if anything, about real nutrition and nutritional science.
Dietitian: A registered dietitian (RD) or nutritionist is trained in the field of nutrition. Because food is a key part of your diabetes treatment, a dietitian is very important. Your dietitian helps you figure out your meal plan and your food needs based on your weight, lifestyle, medication, and other health goals (such as lowering blood fat levels or blood pressure).
Dietitians know a lot about food, calorie/carb counting, the glycemic index, etc.; but, they know very little about real nutrition and nutritional science.
Author's Observation: Doctors know a lot about science and dietitians know a lot about food; but, doctors know very little about food and dietitians know very little about science. As a diabetic, you would think that this covers your needs.
But, in actuality, it doesn't -- what you really need is a person who knows something about both science and food so that he/she can link the two areas to design an optimum nutritional program for you.
Diabetes health coach: a trained specialist in the fields of medical science, diabetes pathology, nutrition, meal planning, lifestyle, and spiritual health can help and guide you in many ways beyond what your doctor and dietitians can do for you. Just make sure that you know something about both the science of medicine and the science of food -- otherwise, they can't provide any added value beyond the dietitian or nutritionist.
Nurse educator: A nurse/diabetes educator or diabetes nurse practitioner is a registered nurse (RN) with special training and background in caring for and teaching people with diabetes. Nurse educators often help you learn the day-to-day aspects of diabetes self-care.
Eye Doctor (Ophthalmologist): This doctor is another key member of your diabetes care team because diabetes can affect the blood vessels in the eyes. The eye doctor is usually an ophthalmologist, a doctor who can treat eye problems both medically and surgically. You should see your eye doctor at least once a year.
Podiatrist: This health professional is trained to treat feet and problems of the lower legs. For anyone with diabetes, which can cause nerve damage in the extremities, foot care is important. Podiatrists have a Doctor of Podiatric Medicine (DPM) degree from a college of podiatry. They have also done a residency (hospital training) in podiatry.
Dentist: People with diabetes are at somewhat greater -- and earlier -- risk of gum disease. The excess blood sugar in your mouth makes it a nice home for bacteria, which can lead to infection. You should see your dentist every six months. Be sure to tell your dentist that you have diabetes.
Exercise trainer: Exercise plays a major role in your diabetes care, no matter what kind of diabetes you have. The best person to plan your fitness program -- along with your doctor -- is someone trained in the scientific basis of exercise and in safe conditioning methods.
Other Members: Depending on your specific health needs, you may have other members such as a cardiologist, neurologist, nephrologist, psychologist, etc.
Family & Friends: An ideal healthcare team includes the people who are closest to you, both emotionally and physically. Diabetes is 24-7, and so it is crucial that the people you spend your days with are on board with your diabetes management plan, and are receptive to being involved to the extent to which you want them involved in your diabetes.
Some people with diabetes want their loved ones to know all the details, and to actively participate in healthy meal planning, attending doctors’ visits, and so on. Others hate to be policed by family members and would prefer everyone stay out of it.
Whatever your personal preference, there are two guidelines for keeping loved ones on your healthcare team successfully:
- Communicate what you need to your loved ones. If you want involvement, tell them so. If you want space, tell them that. Be clear, and be understanding of their needs, as well.
- Have an emergency plan. Even if you don’t want daily input from your loved ones, it is important that they know what to do in the event of an emergency or natural disaster.
Note: Depending on your health needs, you may have some additional people on your healthcare team. Possible members may include one or more of the following: a naturopathic doctor, pharmacist, nephrologist, neurologist, cardiologist, social worker, physical therapist, psychologist, licensed herbalist, chiropractor, holistic practitioner, a person from your diabetic support group, etc.
Note: For information about emotional support and diabetic support groups, refer to the Emotional Support web page.
How Often Should I See My Doctor if I Have Diabetes?
People with diabetes who are treated with insulin shots generally should see their doctor at least every three to four months. Those who are treated with pills or who are managing diabetes through diet should be seen at least every four to six months.
More frequent visits may be necessary if your blood sugar is not controlled or if complications of diabetes are worsening.
What Information Does My Doctor Need About My Diabetes?
Generally, your doctor needs to know how well your diabetes is controlled and whether diabetic complications are starting or getting worse. Therefore, at each visit, provide your doctor with your home blood sugar monitoring record and report any symptoms of hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar).
Your doctor also should be informed of any changes in your diet, exercise, or medicines and of any new illnesses you may have developed. Tell your doctor if you have experienced any symptoms of eye, nerve, kidney, or cardiovascular problems such as:
- Blurred vision.
- Numbness or tingling in your feet.
- Persistent hand, feet, face, or leg swelling.
- Cramping or pain in the legs.
- Chest pain.
- Shortness of breath.
- Numbness or weakness on one side of your body.
- Unusual weight gain.
What Lab Tests Should I Have for My Diabetes?
If you have diabetes, the minimum set of lab tests should include:
- Blood glucose
- Fasting insulin
- Hemoglobin A1c
- Blood pressure
- Urine Tests
- Filament test (bottom of each foot)
- Cholesterol (lipid profile)
- Cardiac risk factors (as required)
- BMI, Weight
Note: For a complete list of the key blood tests, visit our Critical Blood Tests web page.
How Many Drugs Should I Be Taking for My Diabetes?
Ideally, you shouldn't be taking any drugs for a disease that is primarily due to poor eating habits and poor lifestyle choices!
Unfortunately, most diabetics start out with the drug metformin (Glucophage), and eventually transition to multiple drugs, until one day they have to go on insulin.
Most diabetics take other drugs besides the diabetic drugs. The most common drugs that diabetics are given are drugs for high blood pressure (i.e. Lisinopril, HTCZ) and high cholesterol (i.e. Lipitor, Zocor).
Unfortunately, the combination of these drugs tends to make your diabetes even worse in the long run.
Make sure that you educate yourself about drugs and their side effects. Also, although this may be uncomfortable, make sure that you understand the relationship between your doctor and the pharmaceutical companies that he/she may be working with.
For example, if your doctor recommends an expensive new drug, ask a lot of questions and make sure that the drug is the best option for you. In most cases, because there isn't a lot of available test data, new drugs are usually not a good choice for most patients.
Your Rights to Your Medical Records
It is very important to obtain and maintain copies of your personal medical records. You need your records especially when you decide to talk to another doctor or health coach, who may not have access to your records.
Your medical records are vitally important for a number of reasons. They obviously are the method by which your current doctors follow your health and your health care. They're also important to provide background if you need to see a specialist and to bring new doctors up-to-speed. Your medical records are the records of the people with whom you literally entrust your life. Let's explore some of the issues regarding medical records.
According to federal law, you have the right to get copies of most medical records, whether they are paper copies, or electronic health records. Doctors' notes, medical test results, lab reports and billing information must be supplied to you if you ask properly.
The federal law that addresses your medical records is called HIPAA (pronounced HIP-a), the Health Information Portability Accountability Act. These rules mostly address privacy issues, but they also address a patient's right for access to his/her medical records.
Once you've obtained copies of your records, be sure to review them carefully. If you find errors, you'll want to correct them immediately to be sure they cannot affect any future diagnoses or treatment you may receive.
How to Avoid Medical Mistakes and Stay Safe
The best way you can help to prevent errors is to be an active member of your diabetes care team. That means taking part in every decision about your health care. Research shows that patients who are more involved with their care tend to get better results.
1. Make sure that all of your doctors know about every medicine you are taking. This includes prescription and over-the-counter medicines and dietary supplements, such as vitamins and herbs.
2. Bring all of your medicines and supplements to your doctor visits. "Brown bagging" your medicines can help you and your doctor talk about them and find out if there are any problems. It can also help your doctor keep your records up to date and help you get better quality care.
3. Make sure your doctor knows about any allergies and adverse reactions you have had to medicines. This can help you to avoid getting a medicine that could harm you.
4. When your doctor writes a prescription for you, make sure you can read it. If you cannot read your doctor's handwriting, your pharmacist might not be able to either.
5. Ask for information about your medicines in terms you can understand—both when your medicines are prescribed and when you get them:
- What is the medicine for?
- How am I supposed to take it and for how long?
- What side effects are likely? What do I do if they occur?
- Is this medicine safe to take with other medicines or dietary supplements I am taking?
- What food, drink, or activities should I avoid while taking this medicine?
6. When you pick up your medicine from the pharmacy, ask: Is this the medicine that my doctor prescribed?
7. If you have any questions about the directions on your medicine labels, ask. Medicine labels can be hard to understand. For example, ask if "four times daily" means taking a dose every 6 hours around the clock or just during regular waking hours.
8. Ask your pharmacist for the best device to measure your liquid medicine. For example, many people use household teaspoons, which often do not hold a true teaspoon of liquid. Special devices, like marked syringes, help people measure the right dose.
9. Ask for written information about the side effects your medicine could cause. If you know what might happen, you will be better prepared if it does or if something unexpected happens.
10. If you are in a hospital, consider asking all health care workers who will touch you whether they have washed their hands. Hand-washing can prevent the spread of infections in hospitals.
11. When you are being discharged from the hospital, ask your doctor to explain the treatment plan you will follow at home. This includes learning about your new medicines, making sure you know when to schedule follow-up appointments, and finding out when you can get back to your regular activities.
It is important to know whether or not you should keep taking the medicines you were taking before your hospital stay. Getting clear instructions may help prevent an unexpected return trip to the hospital.
12. If you are having surgery, make sure that you, your doctor, and your surgeon all agree on exactly what will be done.
Having surgery at the wrong site (for example, operating on the left knee instead of the right) is rare. But even once is too often. The good news is that wrong-site surgery is 100 percent preventable. Surgeons are expected to sign their initials directly on the site to be operated on before the surgery.
13. If you have a choice, choose a hospital where many patients have had the procedure or surgery you need. Research shows that patients tend to have better results when they are treated in hospitals that have a great deal of experience with their condition.
14. Speak up if you have questions or concerns. You have a right to question anyone who is involved with your care.
15. Make sure that someone, such as your primary care doctor, coordinates your care. This is especially important if you have many health problems or are in the hospital.
16. Make sure that all your doctors have your important health information. Do not assume that everyone has all the information they need.
17. Ask a family member or friend to go to appointments with you. Even if you do not need help now, you might need it later.
18. Know that "more" is not always better. It is a good idea to find out why a test or treatment is needed and how it can help you. You could be better off without it.
19. If you have a test, do not assume that no news is good news. Ask how and when you will get the results.
20. Learn about your condition and treatment options by asking your doctor and nurse and by using other reliable sources.
For example, treatment options based on the latest scientific evidence are available from the Effective Health Care Web site at: http://www.effectivehealthcare.ahrq.gov/options
What to Eat Days Before a Colonoscopy
Always consult with your doctor. The following information are general guidelines only. You can help the cleansing process by eating light 3 or 4 days before the procedure. Doctors recommend low-fiber foods that are easy to digest and leave your system quickly.
You can have:
- White bread, pasta, and rice
- Well-cooked vegetables without skin
- Fruit without skin or seeds
- Lean meat, chicken, or fish
Please Note: If you're diabetic, you may want to avoid the "white" processed foods and somefruits -- unless you are following our program and have stabilized your blood sugar.
- Seeds, nuts, or popcorn
- Fatty foods
- Tough meat
- Whole grains
- Raw vegetables
- Fruit with seeds or peel
- Corn, broccoli, cabbage, beans, or peas
At this point you should stop taking vitamins or other supplements. Ask your doctor whether and when you should stop taking any prescription medicines you use regularly, and anyOTC anti-inflammatory or blood thinning meds you may use.
The day before your procedure you can’t eat anything solid -- you can only consume clear (see-through) liquids. It is important to stay hydrated by drinking lots of clear liquids, such as clear juice like apple and white grape, herbal tea (no caffeine), and clear broth. You can have gelatin and ice pops, but stay away from anything colored red, blue, or purple. The dyes can discolor the lining of the colon and make it harder for the doctor to see. Also avoid alcohol and drinks you can’t see through, like milk or orange juice.
Two to four hours before the procedure, be sure not to drink or eat anything (please consult your doctor on the exact time to stop consuming clear liquids).
Doctor Appointments General Summary
You should schedule appointments with your doctor, other doctors and other members of your diabetes care team on a regular basis.
Educate yourself about diabetes and drugs, and stop being a victim, and become a victor of wellness. Take back the power and take back your life.
Join a comprehensive diabetes wellness program such as the Death to Diabetes program. Such a program will educate you about diabetes and nutrition, and will improve your diabetes and overall health.
Make sure you have copies of your medical records. With today's technology, your doctor, hospital and insurance company can provide Internet access to your medical records and lab test results.
Find an alternative healthcare practitioner that has the proper background in science and nutrition. Use both your medical doctor and your alternative healthcare practitioner to optimize your health.
If you can't find an alternative healthcare practitioner in your area, contact our office to help you find someone local or set up an appointment with one of our diabetes educators.
Key Point: Don't assume that just because a healthcare professional is involved in alternative medicine that they can help you with your diabetes! Some of the following alternative healthcare professionals may be ill-equipped to help you with your diabetes: dietitians, nutritionists, diabetes educators, chiropractors, herbalists, wellness consultants, holistic practitioners, acupuncturists, etc.
Ensure that the person has the science background in diabetes pathology and nutrition by interviewing the person before you give him/her any of your money! Be wary if they offer a guarantee but require full payment up front!
For more details about doctor appointments, medical records, hospital practices, etc. refer to the Death to Diabetes Blog.
Disclaimer: This site does not provide medical advice, diagnosis or treatment.
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