Time Wisely Spent

by gary scheiner, MS, CDE

If you’ve ever left your diabetes doctor/educator’s office thinking, “That’s an hour of my life I’d like to have back,” this article is for you.

I’m lucky enough to see diabetes care from both sides of the desk: as a patient and as a healthcare provider. And you know what? The two parties have a lot in common. Both have serious time constraints. Both bring something valuable to the table. And (hopefully) both contribute to improved diabetes management.

a little prep goes a long way

There are several things that you can do prior to your office visit to make it as productive as possible. If you are due for lab work (A1c, cholesterol, thyroid studies, blood panel, urinalysis, etc.), complete it at least a week ahead of time so that you and your healthcare provider have the results ready for discussion. As a provider, it is very frustrating when patients show up with no recent lab work. And to make the next visit productive, make sure your provider supplies you with lab order for the next go-round.

We all have massive piles of diabetes supplies somewhere in our home. TAKE INVENTORY before you see your provider. Are you running low on insulin? Test strips? Pens? Pump supplies? Did your glucagon expire in 1983? Some items, such as prescription medications, require new prescriptions every year. Bring a list of prescriptions you need to your appointment.

If there is something new that you are interested in trying or obtaining, be prepared to discuss it. Perhaps you are eligible for a new pump, or want to try a continuous glucose monitor. Or maybe you read about a new treatment option that might benefit you. Your appointment is a golden opportunity to ask questions and obtain letters of medical necessity that your insurance may require. But do some of your own research first so that you can speak intelligently and have legitimate questions on the subject.

For me, nothing kills more time during an office visit than having to break down pages of blood-smeared glucose records. Do yourself and your provider a favor: Review your own records before your appointment. Summarize the results (either statistically or in paragraph form) and present them as a basis for discussion. Do you tend to wake up high in the morning? Are you rebounding after your lows? Are there too many lows after exercise? Evaluating your own records allows you to determine your areas of strength and weakness, and lets you work with your provider to find practical solutions.

If possible, download your blood glucose meter, pump, and/or continuous glucose monitor to a computer and print out the past several weeks of data. Personally, I like to see a “modal day” or “standard day” report, which displays information according to time of day. Statistical summaries and logbook printouts can also be useful – particularly for comparing your progress from one visit to another. If your clinician is the type that likes to download your devices when you come in, remember to bring them! And check to make sure the time is correct on whatever devices you are using.

If your visit includes some time with a CDE (Certified Diabetes Educator), it’s a good idea to focus on one area of need. Perhaps you want to sharpen your carb counting skills. Or maybe you want to prevent or manage illness for the upcoming cold season. If you’re thinking about resuming or starting a new form of exercise, it’s a great time to discuss your blood sugar management strategies. Just don’t go into the visit without a plan. Have a specific question or topic ready for discussion.

No office visit is complete without a PLAN OF ACTION. Ask your doctor and educator to give you written instructions on whatever was discussed. Talk about the best course of follow-up between visits: Should you be faxing, e-mailing or downloading records at certain intervals? Should a call be placed after trying something that was discussed? Is there another specialist that you should see?

The plan of action should include specific, measurable goals for you to try to achieve. Sometimes goals are outcome-oriented, such as getting to a certain A1c level, cutting down on lows, or losing a few pounds. Other times they are behavioral, such as checking your blood sugar a certain number of times daily, exercising x-number of times per week, or cutting out late night snacks. Regardless, having a specific goal (or goals) gives you a measuring stick for gauging your performance. And don’t forget to bring the goals you set at this visit to your next appointment. A little accountability can go a long way!

gary’s sure-fire 10-point productive appointment checklist

• Have lab work done ahead of time

• Know what you need prescriptions for

• Analyze and summarize your own records

• Bring your records (or devices to download)

• Discuss something new that interests you

• Pick a pertinent educational topic

• Ask for written instructions

• Devise a follow-up plan

• Set specific, measurable goals

• Obtain a lab order for the next visit

Gary Scheiner MS, CDE is a diabetes educator with a private practice (Integrated Diabetes Services) near Philadelphia, and author of Think Like A Pancreas: A Practical Guide to Managing Diabetes With Insulin. He has had type 1 diabetes for 25 years, and offers diabetes education & management consultations via phone, fax and e-mail to patients throughout the world. Submit inquiries to gary@integrateddiabetes.com, or call (877) SELF-MGT.