DIABETES MANAGEMENT SCHEDULE
( Print out and take this information to your doctor to review your diabetes care)

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:
* Dilated 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