Diabetes care works when the routine checks happen on time. None of them are dramatic, most take minutes, and together they are the difference between diabetes that stays quietly managed and diabetes that causes problems years down the track.
The blood test that guides everything
HbA1c is the number your GP will refer to most. It reflects your average blood glucose over roughly the previous three months, which makes it far more useful than a single finger-prick reading. It does not care what you ate this morning.
How often it is checked depends on how things are going. When your diabetes is stable and at target, a check every six months is common. When something has changed — a new medicine, a rising trend, a target not yet reached — every three months is more usual.
What matters more than any single reading is the direction of travel. Your GP is watching the trend, and so should you. Ask for the number at your appointment, and ask what it was last time.
Bloods are collected on site through 4Cyte Pathology, so the test can usually be done straight after your appointment. See pathology and blood tests.
The annual checks worth booking in advance
Diabetes affects small blood vessels and nerves, which is why the annual checks focus on eyes, feet and kidneys. All three problems are far easier to prevent than to reverse, and all three are silent in the early stages.
Once a year, at least
- Eyes — a retinal examination by an optometrist or ophthalmologist. The recommended interval is every one to two years if there is no or minimal retinopathy, and yearly if you are at higher risk, if you are Aboriginal or Torres Strait Islander, or if any retinopathy has been found. Diabetic retinopathy causes no symptoms until it is advanced, and it is treatable when found early.
- Feet — checking sensation, circulation, skin and nails. Loss of sensation is the reason a small injury can become a serious one without being noticed.
- Kidneys — a blood test for kidney function and a urine test for protein. Early kidney changes are picked up on a test long before they cause symptoms.
- Blood pressure and cholesterol — because the biggest risk that comes with diabetes is cardiovascular, not the glucose itself.
- A review of your medicines, including whether the doses still fit and whether anything can be simplified.
If you are not sure when your last eye or foot check was, or you know it is overdue, that alone is worth an appointment. See diabetes care.
Blood pressure, cholesterol and the cardiovascular picture
People with diabetes are at higher cardiovascular risk, and managing blood pressure and cholesterol does at least as much good as managing glucose. That is not a reason to ignore glucose — it is a reason not to focus on it exclusively.
Your GP will assess your overall cardiovascular risk rather than treating each number in isolation, and will talk through whether medicines are worth adding. An ECG can be done at the clinic if it is useful. See ECG.
Smoking is the single biggest modifiable risk on top of diabetes. If you smoke and have diabetes, stopping does more for your long-term health than any other change available to you. Support is available and it works better than willpower alone — ask at your next appointment.
Your care plan and the allied health that comes with it
Diabetes is the textbook case for a GP Chronic Condition Management Plan. With one in place you can access up to five individual Medicare-subsidised allied health services per calendar year — which for diabetes usually means a podiatrist, a dietitian, a diabetes educator or an exercise physiologist.
Patients with type 2 diabetes can also access up to eight group services per calendar year on top of that individual allowance, after a suitability assessment. Group diabetes education is genuinely useful and consistently underused.
The allowance resets each calendar year. If it is spring and you have not used any of it, that is worth raising. More on how care plans work.
The everyday things that move the numbers
None of this is news, and all of it works.
- Movement after meals. A ten-minute walk after eating has a measurable effect on post-meal glucose. It is the highest-return change most people are not making.
- Consistency beats perfection. Three reasonable meals a day at roughly the same times does more than an ambitious plan you abandon in a fortnight.
- Sleep and stress affect glucose directly. If either is a mess, say so — it is part of the clinical picture, not an excuse.
- Take medicines as prescribed, and say if you are not. If a medicine makes you feel awful, there are usually alternatives. Silently stopping is the worst of the options.
- Check your feet. Once a week, including between the toes and the soles. A mirror on the floor makes it easier.
And book the next appointment before you leave. Diabetes care slips when appointments are made reactively rather than scheduled.
This article is general information for people in the Gosford and Central Coast area. It is not advice about your situation and it does not replace a consultation with your own doctor. If you are worried about a symptom, book an appointment or call us on (02) 4311 3800. In an emergency, call 000.
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