Diabetes Management Schedule

( Print out this information to be sure you are following up on your diabetes care. Click here for a printer-friendly version of this form.)

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: Know Your ABCDE's

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):

Dialated 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
Our Mission
To improve the lives of children and adults affected by diabetes through prevention, education and service.
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© 2011 Nevada Diabetes Association. All Rights Reserved. Reno: (775) 856-3839 Las Vegas: (702) 364-5604