Complication Related to Diabetes | Section | Diabetes Information Kiosk

12.

Aspirin/Anti-platelet Therapy Type 1 or 2
> age 30 years of age

Every visit

Date:
Result:

13.

HgbA1C Target: < 7%

Every 3-6 months

Date:
Result:

14.

Kidney Evaluation
Microalbumin test
24 hour urine testIf significant proteinuria, monitor serum creatinine every 3-6 months

Type 1: begin 5 years from diagnosisType 2: First visit, then annually

Date:
Result:

15.

Dilated eye exam

Annually

Date:
Result:

16.

Oral/Dental Exam

Every 6 months

Date:
Result:

17.

Foot exam
(Complete foot exam and
neurological evaluation)

At home: Check daily!
(Doctor’s office: Annually or as needed)

Date:
Result:

18.

Lipid Profile

Annually if at goal
Otherwise: every 3-6 months

Date:
Result:

19.

Flu vaccine

Annually

Date:

20.

Td vaccine

Every 10 years

Date:

21.

Pneumonia vaccine

Initial visit and repeat as directed

Date:

1.	Complete History and Physical	First visit and annually	Date: Result:
2.	Diabetes Education	Schedule with your doctor	Date: Result:
3.	Medical Nutrition Therapy	Schedule with your doctor	Date: Result:
4.	Exercise Counseling	Schedule with your doctor	Date: Result:
5.	Psychosocial Counseling	Schedule with your doctor	Date: Result:
6.	Lifestyle Changes	Talk to your doctor 1. Smoking cessation 2. Alcohol reduction	Date: Result:
7.	Weight	Every visit	Date: Result:
8.	Height	Every visit	Date: Result:
9.	Blood pressure	Every visit	Date: Result:
10.	Foot Inspection	Every visit	Date: Result:
11.	Growth and Development if suspected in children	Every visit	Date: Result: