Five secrets for a good diabetes check-up

A man arrives at his local car workshop and asks to speak to the mechanic. He enquires whether the mechanic can help fix his car. “No problem,” replies the friendly mechanic. “Let me take a look.” The man answers quickly, “Oh, I haven’t brought it, but I can tell you what is wrong.”

Sometimes healthcare professionals (HCP) in the field of diabetes feel like that mechanic. We are so often asked, even expected to ‘fix’ the diabetes but we are not given the opportunity to see the glucose control or other health issues (the car). This simple analogy alludes to a diabetes check-up as perceived by an HCP.

On the other hand, the patient may perceive the diabetes check-up totally differently. More like a trip to the principals’ office, a nerve-wracking, dreaded experience.

These situations for both the patient and HCP can be avoided by following these tips.

1. Bring the “goods”

Bring along a list of all the medications, prescribed and others you are taking, including the dosage. You can bring in the actual medication or a photo of the box or container (anything that will identify the medication). Unfortunately, HCP do not know what all tablets look like and there are at least 100 “little orange tablets” on the market. No treatment changes can be made without this information.

Your glucometer, diabetes diary or CGM are vital for all appointments. These should not be a cause for anxiety. Many patients do not test their blood glucose levels because they fear seeing high readings or are afraid of what the HCP may say. Analysing these readings together, high or not, will allow for better outcomes. An HCP will focus on fasting and post meal readings as well as any hypoglycaemic events (readings below 3,9mmol/L), trends and patterns. It is important to see if your readings are in keeping with your HbA1c.

A food diary is a good accompaniment to a glucometer. It allows you to realise the effects of certain foods on your blood glucose readings. This will enable you and the HCP to work on possible food alternatives or quantity changes. You can discuss any observations you have noted or concerns about these readings.

If your HCP has requested any blood or other tests be done, please ensure that they are done at least three days prior to the diabetes check-up. Bring any recent sonars, X-rays or specialist reports along.

2. Be prepared

For your first appointment with your HCP, you will be asked about your family’s health history – is there a history of diabetes, strokes or heart attacks? If you have any disabilities of any kind, inform the practice so that steps can be taken to accommodate these. This may sound odd, but I have had a patient with hearing difficulties politely nod at me until we established that they couldn’t hear me. This is particularly important during this pandemic when masks are being worn.

A lot of information will be exchanged during the consultation. Bring along a friend or second set of ears as many things may be forgotten after the appointment. A notebook to write down instructions is also a good idea. Clarify any instructions by repeating them back to the HCP. Most HCP will take notes throughout a consultation.

Many patients, in my experience, are nervous or anxious during appointments. Having a list of questions and concerns you’d like to address with your HCP will prevent you from forgetting anything.

3. Be honest

It bears repeating that it’s of vital importance that you are honest with your HCP. Remember, these diabetes check-ups are confidential. If you feel that you’re unable to be completely honest with your HCP, it may be worth considering changing your HCP.

Patients often feel, a natural urge, to tell their HCP what the patient thinks their HCP wants to hear. This is not in anyone’s best interest. The best outcomes are based on complete honesty. Don’t be shy about discussing problems with the HCP, there are probably many people with diabetes who have the same problem. Keep an open mind and give input on your treatment plan. Your HCP will be honest with you. This may mean that they are not able to answer 100% of your questions and may need to refer you to someone who can answer a specific question.

This honesty will range from the medication that you are taking and the doses you are omitting, food and exercise as well as your blood glucose readings. There are various reasons that patients omit medication doses, from side effects of the medication, cost, painful injections and genuinely forgetting to take it. These can all be dealt with if the HCP is aware.

Carbohydrates need not be lied about either; they are an important part of a healthy diet and need to be eaten. Let us know what you are eating/drinking and together we can plan the best way to incorporate these foods.

Elevated blood glucose levels do not always indicate a lack of effort or interest in ones’ own diabetes management. Multiple factors affect readings and these need to be discussed honestly and openly. Sometimes that elevated Hba1c may be due to the natural progression of diabetes and not that full slab of chocolate you plundered.

4. Be consistent

Attending regular follow-up appointments with your HCP is important. It allows for timeous interventions when necessary. It forms the basis of managing a chronic condition, such as diabetes. If any change or intensification of treatment is required, early implementation can delay the onset of diabetes complications. On this note, staying in contact with your HCP between appointments is beneficial and can lead to better outcomes. Confirm what forms of communication the practice uses be it email, phone calls or WhatsApp. Ask about emergency contact details or hotline numbers.

5. Relax

These appointments are for your benefit. Arriving anxious at your appointment can influence your vital signs, increasing your blood pressure to levels that you would not have in other settings. This is known as white coat syndrome/hypertension. Try to arrive at your appointment a few minutes early to enable you to wind down from any traffic stress. This appointment is yours, embrace it and make it meaningful.