Making the Most of Your Diabetes Visit
What to bring a primary care provider, what to ask, and how to follow through
You know the drill: Set an appointment, spend 40 minutes reading outdated magazines, sit in a cold exam room for 20 more minutes, then speed through your health concerns in 10 minutes. The routine is similar whether you’re visiting a specialist or primary care doctor. And the reality is, most people see a primary care provider for their diabetes care.
Primary care providers include general practitioners, family physicians, internists (who treat only adults), and nurse practitioners. Consider them the jacks-of-all-trades of the medical profession who have a broad understanding of a number of diseases and conditions. Primary care providers (PCPs) are usually competent in helping you manage diabetes.
Seeing a PCP may be your only option, depending on where you live. Many communities aren’t within close enough driving distance of an endocrinologist’s office, so PCPs serve as people’s sole diabetes doctors—and not only for those with type 2. “In rural areas, there are not a lot of endocrinologists, and a lot of type 1s are taken care of by their primary care physicians,” says diabetologist Andrew Rhinehart, MD, FACP, CDE, BC-ADM, program director of the Johnson Memorial Hospital Diabetes Care Center in Abingdon, Va., and chair of the American Diabetes Association’s primary care advisory group.
But no doctor should be the sole member of your health care team. That’s especially important if your PCP handles all of your diabetes care. “Because office visits seem to be so short, it’s important to have the whole team,” says Jay Shubrook, DO, FACOFP, FAAFP, associate professor of family medicine at Ohio University’s Heritage College of Osteopathic Medicine. (For a list of health care team members, see “Team Roster,” below.)
Your biggest challenge may be finding the right PCP for your needs. Aside from location, consider whether the provider has additional training in diabetes. Some PCPs, such as Rhinehart, call themselves diabetologists, and while there’s no certification for the title, doctors who say they’re diabetologists may have more training in the disease than others.
Don’t be afraid to interview potential providers, especially if you have type 1 diabetes. “You need to ask them how many patients with diabetes they have. How many patients on [insulin] pumps they have,” says Rhinehart. “If you’re the only one, that’s a problem. That’s a big problem.”
While just about all PCPs are familiar with type 2 diabetes, many may not be knowledgeable about or comfortable with devices commonly used by people with type 1, such as insulin pumps and continuous glucose monitors (CGMs). Part of the PCP’s job, says Rhinehart, is knowing when to refer you to a specialist. If you use the technology but aren’t getting help from your PCP, you may want to consider seeing an endocrinologist who has more experience with the devices. Or, if that’s not an option, talk to a certified diabetes educator, who may have more training with insulin pumps and CGMs than your physician.
Because diabetes educators, nurses, and dietitians often work closely with people with diabetes, they may know which doctors are most familiar with the disease. Not sure where to find a good PCP with plenty of diabetes know-how? Ask a diabetes educator, dietitian, or nurse at a regional diabetes care center for recommendations. \
Cue Your Questions
The smartest thing you can do before a doctor’s appointment is prepare. Start with a list of questions or discussion points you want to talk about with the doctor. “Write it down,” says Charles Cutler, MD, an internist in Norristown, Pa., and chair of the board of regents at the American College of Physicians. “It’s impossible to remember it all, and something gets forgotten.”
Your list may include health concerns, such as knee pain and insomnia, or medication worries, including side effects you may be experiencing. If you have financial worries related to your medical care, add it to the list. It may seem as if you’re “bothering” the PCP, but he or she will want to know of anything that would keep you from following your treatment plan. For instance, Shubrook says it’s better to tell your provider early on that you’ll be hitting Medicare’s “donut hole”—when you reach a certain drug-spending cutoff and have to pay full price for prescription drugs until your plan begins paying for them again. Your provider, anticipating your lack of coverage, may suggest cheaper medication or may provide medication samples to help you along.
You may not get to all of your worries in one visit, but a list of three or four items is a good place to start. Order the questions from most to least important so you’re guaranteed to cover your top priority first.
If you’re concerned about hitting all of your questions while covering your many diabetes care needs, consider scheduling a diabetes-specific appointment. “We can’t squeeze diabetes along with those other four questions and complaints into this visit,” says Rhinehart. He suggests setting one appointment every three to four months with the sole goal of talking about your diabetes. Yes, that may mean extra co-pays, but being able to touch on your blood glucose trends, medications, and complication prevention without the distraction of other health worries will go a long way toward keeping you in tip-top condition.
At the Ready
1. Blood Glucose Log. If you use a blood glucose meter, it’s important to bring a detailed blood glucose log to the appointment. “If I can’t see it, I don’t know how to make [treatment] adjustments,” says Shubrook. If you can, download your glucose data straight from your meter (remember to bring your meter to the appointment!), but if not, a paper log will do.
Being able to see patterns in your blood glucose readings can help your doctor determine whether your medication is working and how your food choices and exercise affect your diabetes management. It may influence your medication dose and the time of day you take your meds. “I live and die by logbooks,” says Rhinehart. “There’s great information there.”
2. Medications List. Another must for appointment prep: a list of your medications. “Many people don’t know the medications they’re taking,” says Shubrook. Or, if they do, they don’t know the specific dose. Make sure you and your doctor are on the same page by bringing a list of your medications, the dosages, and how often you take them. Or just bring all of the medication bottles with you. “I had a lady two days ago who had a bag full of medications, and it was incredibly helpful,” Rhinehart says.
3. Health Documents. Remember to pack any other health forms and documents. “Bring in any information that may have a health impact, even something remote,” says Cutler. For example, if you visited an urgent care clinic for a sprained ankle, bring the discharge forms with you to your primary care appointment. Your physician will also want to see the result of any blood work you had between appointments.
The Doctor Will See You Now
The first order of business when you enter the exam room is to remove your socks and shoes. Even if you remove no other clothing for the exam, ditch the footwear. Rhinehart says it’s the best way to ensure both you and your doctor remember the foot exam.
Next, pull out your list of questions. “Make it clear to the doctor why you’re there,” says Cutler, who recommends showing the provider your full list before you launch into your first point. “It may be that a thing a patient thinks is rather unimportant is a really important medical issue.” That is, if you listed knee pain, numbness in the toes, and chest discomfort in descending order of importance, your doctor may decide the chest pain deserves attention first. It could, after all, be a symptom of dangerous heart disease.
You’ll also want to give your doctor your list of medications (or the bottles themselves), any medical documents you’ve collected since your last visit, and your blood glucose log. With all of that information on hand, you and your provider will be on the same page.
How thoroughly you discuss those details depends on your other health concerns as well as the type of appointment you’ve made. Diabetes-only appointments free up a lot more time to speak about diabetes-care essentials, such as the blood glucose trends apparent from your log, your eating plan and fitness, how often you test your blood glucose, how often you have low blood glucose, and whether your medication is working properly. Other common elements are the foot exam as well as A1C, blood pressure, and cholesterol tests.
During general appointments, touching on all of those diabetes-care needs can be difficult. That’s especially true if your other questions involve painful or otherwise bothersome health issues. But a good PCP won’t allow diabetes to take a backseat, and that’s because the disease, if not properly cared for, can silently wreak havoc on your body. Chronic illnesses may not be painful, but you’re rusting from the inside out, Rhinehart says. Continuous, dedicated care can help you head off diabetes-related damage.
Though it’s your doctor’s job to keep current on your diabetes management, you shoulder as much, if not more, of the responsibility. “You are your own best advocate,” says Rhinehart. “If you want to get good health care—you’re paying for it—you should demand it.” So even if you have no diabetes concerns to discuss, make sure general diabetes management is on your agenda.
Your other responsibility: portraying your health honestly. Fibbing about your eating plan, exercise habits, the number of times you test during a day—it’s only going to hinder your health care. “You’re not doing yourself any favors,” says Rhinehart. “How does that help me take care of you? You want to provide accurate information so [your doctor] can make good decisions.”
And then ask plenty of questions. Why is the doctor suggesting a certain treatment? What are the side effects of that medication? How will it all affect your blood glucose? What blood sugar and A1C targets should you meet? It’s important to fully understand your diagnoses and treatment plans, including any medications you’re taking.
That’s a lot of information to take in, so consider taking notes. Or bring a friend, family member, or caregiver with you to bring up issues you may have forgotten and take notes while you speak with the doctor. “That’s another way to make sure what you thought you heard is what the doctor said,” says Cutler.
Your primary care doctor may refer you to specialists, such as a neurologist for nerve pain or a cardiologist for heart problems, or other health care providers who handle specific areas of diabetes care. Certified diabetes educators can help you master the basics—blood glucose testing, insulin injections, hypoglycemia treatment—as well as how to operate technology such as blood glucose meters, insulin pumps, and CGMs. Educators can also help you adjust to new regimens or health changes. Registered dietitians are particularly helpful. “Not all of us are incredibly comfortable with the dietary aspects of things,” says Rhinehart, who notes that only a small portion of the medical curriculum handles diet. “That’s why having that dietitian on the team is so important.”
There are times when you might need the doctor’s help outside of an appointment. Discussing protocol with your doctor ahead of time is critical. “Ask your doctor, ‘At what point do I need to call you?’ ” says Rhinehart. For example, he talks to patients about calling him if they experience a pattern of low blood glucose levels. Your doctor can advise you on the type of health problems that count as emergencies and require a 911 call, those worth a call or e-mail to the doctor’s office, and those problems that can wait for an office visit.
The goal is for you to leave the appointment with a firm grasp on the state of your health, your goals, the medications you’re taking, the health care providers you should see soon, and whether you should contact your doctor between visits. Then, before you leave, schedule your next appointment.
Your most important role in your health care begins when you walk out of the exam room. You’ll be charged with any tasks your physician has set before you—say, having lab work done, setting up appointments with a dietitian, starting a new medication, or beginning an exercise program. During the interim, keep a detailed blood glucose log, a food log if necessary, and a running list of questions to bring up with your PCP on your next visit.
If you get sick or injured or have any other health worries in the meantime, don’t be afraid to contact your provider. “Depending on the situation, I’ll say, ‘Give me a number and I’ll call you back,’ or ‘I’ll respond to your e-mail,’ ” says Cutler. Communicating with your PCP about big issues can make your next appointment more productive because you discussed major problems between visits instead of taking time out of your appointment. (But keep in mind: PCPs are busy people, and they might not have time to answer all of your concerns over the phone or by e-mail.)
In the end, the work you put into your health between visits will yield more productive appointments. And that, in turn, will yield a healthier you.
A primary care provider (PCP) is just one member of your health care team. Here are a few more people you might turn to for medical care*:
- Endocrinologist (MD or DO): all aspects of diabetes care. Diagnosis and treatment of endocrine diseases, medication prescription, blood tests, and device know-how.
- Registered nurse (RN): blood tests, care for illnesses (the flu) and injuries (sprains)
- Physician assistant (PA): diagnosis and treatment of illnesses, exams, blood tests, medication prescription, and some medical procedures. Physician assistants work in collaboration with a primary care physician.
- Certified diabetes educator (CDE): diabetes information, diabetes management, lifestyle changes, and device know-how. Various health care providers, including nurses, dietitians, and pharmacists, can earn this certification.
- Registered dietitian (RD): nutrition
- Pharmacist (RPh or PharmD): medication information
- Dentist (DDS or DMD): oral health
- Eye doctor (MD, DO, or OD): vision correction and eye disease prevention and treatment
- Podiatrist (DPM): foot care
- Psychiatrist (MD or DO), psychologist (PsyD or PhD), mental health counselor (CCMHC or MHC), social worker (LCSW-C): mental health care
- Specialists (such as cardiologists, neurologists, and nephrologists): heart disease, nerve damage, kidney disease, and more
*Other credentials than those listed may apply.