First, it’s your responsibility to learn all about checking your blood sugars, eating correctly, taking the correct medications, exercising, understanding “sick day management,” stopping smoking and watching out for hypoglycemia, hyperglycemia and infections.  But even after you’re doing your part, it’s important to also pay attention to what your doctor is doing for your diabetes.

Many doctors are not treating their patients well enough to keep their numbers in the right control zones in order to shield their patients from the long-term consequences mentioned above (studies show that about 45 percent of the time, you’re not being treated adequately).  Thus, it’s ultimately up to you to make sure that you pay attention to the essentials of your diabetes care and “numbers.”

The best website that I’ve found for diabetes information is www.joslin.harvard.edu.  You can also find thousands of solid advice articles about diabetes on the Internet at other reputable websites like www.MayoClinic.com (an arm of MayoClinic.org), the American Diabetes Association at www.diabetes.org and www.WebMd.com.  But what I’ve found is that all of the information gets somewhat fragmented.  You may read 10 or 20 articles or even more, but still have not happened upon some of the most important information.  Or you’ve seen most of the important information, but no one has put it in a list for you, so you can keep track of what’s most important.

That is, until I came upon this list online from the Joslin Diabetes Center (Harvard University). Finally, in this hand-out (at http://www.joslin.org/docs/Joslin_sixtests.pdf), there is an up-to-date, comprehensive list of what your doctor should be checking, and when, and what your numbers should be, so that you can make sure that your busy doctor is not overlooking one or more of these crucial tests, and/or not getting your numbers into the right safety zones.

The six tests mentioned on the “Six Tests for Staying Healthy with Diabetes” handout are:

1.  A1C: Read the hand-out and follow these guidelines:

• My A1C should be drawn at least every six months!
• My A1C Goal is less than seven!

Your A1C, a blood test, tells how well your blood sugar has been under control for the last three months.  It is vitally important to get this checked by your doctor, and if not under seven, then to ask your doctor to alter your meds so you can get there. And although twice a year is the minimum requirement, you may need to be checked every three months if you are not under control and your A1C is not under seven.  Don’t accept an A1C higher than seven—ask for your medications to be altered.

2.  Blood Pressure (BP): Read the hand-out and follow this guideline:

• My BP Goal is less than 130/80!

Don’t accept 136/74 or 128/86! If your BP is not lower than 130/80 (and I mean under 130 for the first number and under 80 for the second), insist that you be given medicines that will get you there. (Your real BP is an average, so having a BP monitor at home can be really helpful to see what your average is.)

3.  LDL cholesterol:  Read the hand-out and follow this guideline:

• My LDL Goal is less than 100 or 70!

Your LDL (a part of your cholesterol that’s bad for your arteries) should be less than 100; but many experts say it should be less than 70 for a diabetes patient, so aim closer to 70.  If your LDL cholesterol is more than 100, ask your doctor to give you whatever meds you need to get it to less than 100 (or preferably, less than 70).  (And your LDL should be checked at least once a year.)

4. Microalbuminura: Read the hand-out and follow these guidelines:

• Make sure I get a urine test for kidney disease every year, and my goal is < 30!

If you get a positive test (greater than 30), visit WedMD.com’s Diabetes and Urine Test, for some advice on what your doctor should be doing about this.  (See section “What Happens If the Microalbuminuria Test is Positive?”)

On the “Six Tests …” handout, see under “Microalbuminuria - Action Steps”—“Ask [your doctor] about medicines called ACE inhibitors that help control blood pressure and also help control microalbumin.”  But here’s a tip on how to do this “asking”:

Most diabetes patients should be on an ACE inhibitor (a once daily pill), unless it is otherwise contraindicated—diabetes patients on this drug just have better outcomes.  So ask your doctor to place you on an ACE inhibitor unless he or she thinks it is otherwise contraindicated (and if so, ask him or her why), and make sure you stay on it.  (And if you have diabetes with kidney disease already, you absolutely must be on this.)

• I should be on an ACE inhibitor!

5. Eye Exam: Read the hand-out and follow this guideline:

• See an ophthalmologist every year for an eye exam!

6. Foot Exam: Read the hand-out and follow this guideline:

• Take off my shoes and ask the doctor to examine my feet at each visit!

Under the “Other tips for staying healthy” – these are the most important to follow:

• I must take aspirin every day to help my heart avoid injury!

“The probability of dying from heart disease is dramatically higher in a person with diabetes.”  http://diabetes.webmd.com/guide/complications

If you have no contraindication to aspirin, then, as a diabetes patient, it is crucial that you take 182 mg of aspirin a day.  (That’s half of a regular aspirin, or two baby or low-dose aspirins).

• Get a flu shot every year.

OK! Now print out THIS handout and look at each one of these stars before every doctor’s visit—in fact, take it with you so you can remember what you need to know.  Make sure that your doctor is giving you advice, examining you, referring you or testing you for all the critical components that involve keeping your diabetes under control and keeping your chance of the bitter complications of diabetes at the absolute minimum. (And feel free to write next to each of the above stars the dates and values numbers when they’re measured so that you have a place where you’re keeping track of them.)

You’ll find more about these important exams, tests and numbers below:

• A1C at http://www.joslin.harvard.edu/info/six_tests_for_staying_healthy_with_diabetes.html
• BP at http://www.joslin.harvard.edu/info/blood_pressure.html
• LDL cholesterol at http://www.joslin.harvard.edu/info/lipids.html
• Microalbuminuria at http://www.joslin.harvard.edu/info/know_your_gfr_to_stop_kidney_disease.html
• Eye Exam at http://www.joslin.harvard.edu/info/annual_eye_exam.html
• Foot Exam at http://www.joslin.harvard.edu/info/foot_exam.html

And if you have been newly diagnosed with diabetes, you need a lot of basic information.  Check with a local hospital as it often offers free diabetes education classes.

You might get a running start on information about your newly-diagnosed diabetes by using the free online courses at the Joslin Center. The first four only take 15 minutes each—so that’s a good start.

Then visit Joslin Diabetes Center and print out the checklist. This is a basic list of everything you should learn about your diabetes.  (Yes, diabetes is the disease where the patient has to learn the most information!)

Then visit Joslin Diabetes Center’s Newly Diagnosed section, and become acquainted with all the different aspects of diabetes you’ll find there.  You can also use the “search” box at the upper right-hand corner of the page to find specific articles on topics you need.  Look at your checklist and then search for articles on topics you need to know more about.