Print out this information to be sure you are following up on your diabetes care.

DIABETES MANAGEMENT SCHEDULE

Take a copy of the Physicians Pocket Card to your doctor and ask your doctor to review your diabetes care and treatment plan.

Diabetes Management:

At Every Visit

  • Weight and blood pressure
  • Foot exam
  • Discuss self monitoring blood glucose records
  • Discuss ALL medications
  • Discuss self-management skills
  • Discuss dietary needs
  • Discuss physical activity
  • Discuss smoking cessation

TWICE A YEAR or MORE:

 

Check your A1c ___________ ___________
Date Date

 

 

 

 

ANNUALLY (have a):

 

Dialated Eye Exam ___________
Date
Dental Exam ___________
Date
Flu Shot ___________
Date
Diabetes Education Review ___________
Date
Peripheral nerve test ___________
Date
Treadmill test or EKG ___________
Date

 

 

 

 

ASK YOUR PHYSICIAN TO CHECK:

 

Protein and fat in your blood ___________
Date
Protein in your urine ___________
Date