What to expect during MD visits
You really should see your friendly doctor
So you think you are at risk of diabetes or may have its signs and symptoms – and decided: you really should see your friendly doctor. Know what to expect from this important first visit.
There are a number of ways to diagnose diabetes – all of them would require a sample of your blood. These tests include: (1) fasting blood sugar (FBS); (2) oral glucose tolerance test (OGTT); and/or (3) HbA1c.
• When measuring FBS, you should have fasted (not eaten or drank anything other than water) for at least 8 hours. This evaluates your blood sugar levels over a short period of time.
• Measuring OGTT requires testing for FBS first. After blood is drawn for your FBS, you will drink a sugary liquid given to you by the laboratory staff. Your blood sugar levels will then be tested again 2 hours after drinking.
• HbA1c measures the level of hemoglobin in the blood that has attached sugar molecules. You do not need to fast for this test but the blood used to test for FBS can also be tested for HbA1c. This test evaluates your blood sugar levels over a longer period (i.e., over the last 3 months).
The table below shows the meaning of the results of these three tests:1
*Prediabetes is a state where your blood sugar level is above normal but is not high enough to be considered diabetes. People with prediabetes have a higher risk of getting diabetes and should take measures to lower this risk.
Aside from tests, a dialogue with your doctor is an important part of your first few visits. During this dialogue, it is important to tell your doctor the following:
• Your symptoms. These may include hunger, tiredness, increased urination, increased thirst, weight loss/gain, dry mouth, dry/itchy skin, yeast infections, slow-healing wounds, numbness or pain, blurring of vision, nausea and vomiting
• Any family member who has diabetes or heart disease
• Your lifestyle habits, such as your eating habits, exercise habits, smoking, and alcohol drinking
• Any abnormal blood sugar tests in the past
• Any abnormal blood cholesterol/lipid tests in the past
• Any other diseases you had in the past, including heart disease
• Medicines you suspect may have increased your blood sugar or your body weight (e.g., some anti-allergy medications or other medications that may contain steroids, or treatments for asthma, arthritis or other inflammatory diseases)
• Medications for other diseases you may have
• For women, the history of your childbirth, or any conditions/symptoms concerning the reproductive tract
After this dialogue, your doctor would also examine you for signs of diabetes. This examination may include:
• Checking of your blood pressure, height, weight, waistline, and hipline
• Vision test
• Inspection of the skin
• Examination of the chest, heart, and lungs
• Examination of the abdomen
• Examination of the arms and legs
Based on the information from your history, examination and blood tests, your doctor will make a decision on whether you have diabetes or not. If he/she diagnosed you with diabetes, this means he/she will make recommendations to:
• Lower your blood sugar
• Keep them within a controlled range over a prolonged period of time to prevent complications
• Monitor your blood sugar levels regularly
• Monitor the development of complications to be able to address any of these complications early.
This would usually mean:
• Making lifestyle changes (diet, exercise, smoking, alcohol, and stress)
• If needed, taking medicines to control your blood sugar
• If needed, taking medicines to lower your risk of heart disease
• Schedule for regular blood sugar testing and follow-up visits
• If needed, seeing other medical specialists that may assist in treating your diabetes
There are several types of medications for diabetes. Most of these are taken by mouth but some need to be injected. Always remember to follow the exact instructions of your doctor on how to take your medications. In addition, inform your doctor if you experience any side effects that you think could be due to any of your medications. More importantly, do not hesitate to ask your doctor about anything that is unclear about your disease or treatment.
In conclusion, make your doctor your partner in managing diabetes. Keeping the diabetes dialogue with your doctor ongoing from the first visit to the succeeding ones is the best way to keep diabetes under control.
1American Diabetes Association. Diabetes Care 2004 Jan; 27(suppl 1): s5-s10.