Diabetes Management Schedule

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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):

Dilated 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