EACH CLINIC VISIT

BLOOD GLUCOSE - To assess your average blood sugar control for the past 2-3 months a hemoglobin A1C test is done at 3-4month intervals.  The results are discussed with patient at their clinic visit.  Acceptable A1C is <7.0%.  If patients are at an acceptable A1C level they should be tested every 6 months.

Self - monitoring Blood Glucose records are vital to diabetes management decisions.  Keeping a log of your results and bringing them to each visit is vital.  The provider will discuss the A1C results and blood glucose records with you at each visit.

FOOT CHECK - People with diabetes can develop many different foot problems and even ordinary problems can get worse and lead to serious complications. Foot problems most often happen when there is nerve damage in the feet or when blood flow is poor. At each visit the provider inspects the feet and nails. They check for ingrown toenails, calluses, deformities, pressure points, ulcers and cellulitis.

ANNUAL - According to the Indian Health Services National Diabetes Program, specific tests and exams are recommended annually to help provide consistent, quality care to diabetic patients.

LAB TESTS –

Creatinine - This is done to screen for kidney function.

Complete UA/Microalbuminuria - A test for urine protein is performed to assess kidney function.

Lipid Profile - A lipid panel should be done annually to assess cholesterol levels and risk of cardiovascular disease.

Immunizations - Influenza and pneumonia are common, preventable infectious diseases associated with high mortality and morbidity in the elderly and in people with chronic diseases. Some patients with diabetes are at higher risk for complications, hospitalizations, and death.

Flu vaccine - Given yearly before influenza season is the most effective measure.

Pneumovax - Given at time of diabetes diagnosis. Revaccination is recommended 5 years after first dose.

Hepatitis B - Vaccinate persons who are likely to be on kidney dialysis or transplantation.

TD - Tetanus injection is given every 10 years

PPD (TB skin test)- Once after diagnosis unless pt has had previous positive reaction.  PPD-positive people with diabetes have 5 times the risk of reactivating TB. If unable to take a PPD test then a chest x-ray is done.                                                  

EXAMS-taking good care of your body should be a priority. Eye, dental, and foot care could delay or prevent the onset of dangerous diabetes complications later in life.

EYE EXAM- People with diabetes are at a higher risk for blindness than general public. But most people with diabetes only have minor eye disorders and there are treatments that work well for major disorders if they are started right away. Individuals with type 1 diabetes should receive an initial exam within 3-5 years of diagnosis once they are 10 years of age or older.  People with type 2 diabetes should receive aninitial exam at the time they are diagnosed and yearly thereafter.

DENTAL EXAM - An Annual dental exam is recommended to check for gum disease and other mouth-related problems because of increase risk caused by diabetes.

FOOT EXAMS- Foot exams are done at least once a year and more often if you have foot problems, to check pulse and sensation, to identify foot deformities and document history of foot ulcers.  Nerve damage, which results in loss of feelings in your feet, and poor blood flow or changes in the shape of your feet or toes, may cause problems.

SCREEN FOR NEUROPATHY - This is done by history and physical. Neuropathy is the damage to the nerves that run throughout the body, connecting the spinal cord to muscles, skin, blood vessels, and other organs.  Diabetic neuropathy is a group of nerve diseases.  All these disorders affect the peripheral nerves, that is the nerves that are outside the brain and spinal cord.

SELF CARE EDUACTION - Meal planning, nutrition education and exercise are the primary treatment strategies for type 2 diabetes. By choosing foods wisely, exercising regularly, reducing your stress level, and making modest lifestyle changes you can positively influence your blood glucose and your overall health.

NUTRITION EDUCATION - nutrition is important for good diabetes control.  You can keep blood glucose levels as close to normal as possible by eating well-balanced meals in the correct amounts.  The Indian Health Service Diabetes Program supports the American Diabetes Association position that all persons with diabetes receive regular nutrition counseling and are seen by a registered dietician every 6 months to a year. Some people may require more frequent evaluation and counseling.

EXERCISE - Increasing physical activity and weight loss is one of the most important things you can do to keep blood glucose in good control. The two leading risk factors for type 2 diabetes are overweight or obesity and a sedentary lifestyle.  Exercise counseling should be individualized for each patient. Exercise education is provided annually by a certified diabetes educator at the Diabetes Wellness Center.

GENERAL - At the Diabetes Wellness Center certified diabetes educators provide diabetes education on various topics. They educate the diabetic patients about their medications, exercise, diet, disease process, lifestyle adaptations, complications, foot care, home management, and smuch more.