Your Diabetes Annual Review
You should be seen by your diabetes care team or GP at
least every year for an annual check-up or “Annual
Review”. In New Zealand the components of this thorough
check-up are generally free to all people with diabetes,
although services vary by District Health Board (DHB)
In 2014, the Government intorduced the “Diabetes
Care Improvement Package (DCIP)” which enables
DHBs to formulate local diabetes services according to
need. This replaced what we previously knew as the “Get
What’s covered on this page
- Legs and feet
- Listening to your heart sounds
- Measuring your blood pressure
- Injection sites
Why do people with diabetes need to Get Checked?
The main aim of the Annual Review is to detect long-term complications early, so that they can be treated in order to minimise the risks of severe ill health, poor quality of life, and an early death, as a result of the effects of diabetes.
The development and progression of diabetes-related complications can be minimised by good blood glucose and blood pressure control. In addition, there are many other things that can be done to reduce the impact of complications.
So there is nothing to be lost – and everything to be gained – by learning how (if) diabetes is affecting your body, and staying on top of the situation.
What should you expect of an ‘Annual Review‘?
The Annual Review should include the following:
1. At some stage before the appointment, blood tests and urine tests* should be performed for
- blood glucose control
- kidney function
- liver function
- cholesterol and lipid profile
*Other tests may be requested at the discretion of your doctor; see “Laboratory Tests” for more information.
2. During the appointment, you should have a physical examination (see below), in particular, checking of
- your legs and feet
- blood pressure
- heart sounds and rhythm
- injection sites (if you use insulin)
3. During the appointment, you should have the opportunity to discuss
- your general health and well-being
- your diabetes management plan
- your weight
- blood glucose readings and HbA1c result
- other blood and urine test results
- any problems or concerns that you may have
4. At some stage you should also have a dilated eye examination:
In New Zealand official screening recommendations are for screening every two years (in the UK and the US screening is currently recommended on an annual basis). This will be performed either during the appointment, or at some other agreed place/time, depending on the screening programme in operation in your area, and whether you already have existing retinopathy.
The eye examination is a very important part of the Annual Review. Make sure you get one! See the sections, “Eye Examinations“, and “Diabetes and Your Eyes” for more on the detection and treatment of diabetes-related eye problems.
The Physical Examination
Legs and feet
Your feet and legs will be examined for signs of diabetic nerve damage (neuropathy) and circulation problems caused by large blood vessel disease (macrovascular disease).
As a person with diabetes your feet are very vulnerable to potentially serious problems. If the nerves in your feet are damaged you may not feel pain caused by blisters, callus or infection. If the blood supply to your legs and feet is reduced then you will have a reduced ability to fight infection. For these reasons many people with diabetes have a ‘high risk’ or ‘at risk’ feet.
Ankle and foot pulses will be felt to check the blood supply to your legs and feet.
Your reflexes and sensitivity to vibration and pin-prick will be tested to check your sensory nerves.
The doctor will inspect your feet for any signs of deformity or potential joint problems and look for dry or cracked skin and any areas of callous or ulceration.
Look after your feet!
You may not be aware that you have reduced feeling in your feet. For this reason you should inspect your feet every day. If you cannot see or reach your feet then enlist the help of a relative or friend to look at your feet.
|Daily Foot Care CHECK YOUR FEET DAILY AND WATCH OUT FOR: Redness Swelling Cracks in the skin Injuries, embedded foreign objects, cuts or scratches Blisters Corns or callouses Hot or cold spots NAILS Keep your toe nails short – trim around the edge as per the shape of your toes where possible; Use an emery board to smooth round rough or sharp edges; Thickened or white/yellow nails may indicate a fungal infection in the nail bed. HARD SKIN Avoid significant removal of hard skin e.g. on the heels, or big toes; Rub gently with a pumice stone, or use pumice-containing cream. USE A GOOD QUALITY MOISTURISER EVERY DAY IMPORTANT! If you cannot reach your feet easily, or cannot see well, then you will need to enlist the help of someone else in order to care for your feet on a regular basis.|
For more information on complications relating to the legs and feet, see the page “Legs and Feet“, in the complications section of the Website.
Listening to your heart sounds
Through the stethoscope the doctor can hear two distinct types of sound, caused by the opening and closing of the various valves controlling blood flow inside the heart. A normal heart rhythm would sound something like:
A normal adult HEART RATE is about 70 beats per minute. It is variable, but normally under tight control; for example it should be automatically increased during exercise, in order to provide exercising muscles with more oxygen as reequired. Damage to the nerves controlling automatic body functions, such as heart rate, can occur in people with diabetes and is referred to as autonomic neuropathy (also “Measuring your blood pressure”, below).
Measuring your blood pressure
The doctor will want to take your blood pressure, and will also listen to your heart. You may be asked to breathe in deeply, then out again whilst the doctor listens to your heart and your blood pressure may be taken lying down or sitting, and then standing up. These checks give an indication of the automatic control of your heart rate. Damage to the nerves controlling automatic body functions, such as heart rate, can occur in people with diabetes and is referred to as autonomic neuropathy.
If you use insulin then your doctor or nurse may ask to
check your injection sites (or infusion sites if you use a
pump). This is to ensure that you are not over-using one
particular site, which can lead to problems with
absorption of insulin, and erratic blood glucose levels.
You should be rotating your injection sites regularly.
Lumps or bumps are not a good sign!
A series of blood and urine tests should carried out at
every annual review. It is preferable if these tests are
carried out before you visit your doctor or nurse so that
the results of the tests can be discussed at the
appointment. Often you will be asked to fast before having
the blood taken.
The section on Lab Tests deals with the tests in greater detail.
Talking to your health professional
Good patient-provider communication is vital for a successful working relationship between you and the other members of your health care team. You should feel comfortable discussing issues relating to diabetes management in the context of your daily life; this is an important aspect of your diabetes care.
Collecting information on diabetes and related complications in New Zealand
An additional feature of the Government’s DCIP is that it facilitates the collection of data on people with diabetes across New Zealand. For privacy protection, personal details are ommitted, but collectively the other information can be used to generate national statistics, which in turn can be used to inform health policy.