Follow-up of diabetic patients: Importance, methods and key recommendations
Introduction
Diabetes is a chronic and progressive disease that requires continuous management and regular follow-up (follow-up). Careful care and monitoring of diabetic patients helps reduce the complications of the disease, improve the quality of life and prevent serious problems such as heart, kidney, nerve and eye diseases.
Follow-up of diabetic patients includes follow-up tests, assessment of the patient’s general condition, adjustment of medications, nutritional counseling and lifestyle modification. Below, we will review the most important aspects of follow-up of diabetic patients.
1. Regular blood sugar monitoring
a) Fasting blood sugar test (FBS) and random blood sugar
. Should be measured at least once every 3 to 6 months.
. Purpose: To assess the level of blood sugar control and adjust medications accordingly.
b) HbA1c test (glycosylated hemoglobin)
. Indicates the average blood sugar level over the past 2 to 3 months.
. The normal value of HbA1c is less than 7% in diabetic patients.
. If HbA1c is higher than the desired level, there is a need to modify the diet, change the medication or increase physical activity.
c) Home blood sugar test
. The patient should regularly check their blood sugar levels at home.
. Type 1 diabetic patients and those taking insulin should measure their blood sugar more often.
. Large fluctuations in measurements should be reported to the doctor.
2. Checking the condition of the kidneys and blood pressure
a) Kidney function test (BUN, creatinine, microalbuminuria)
. Diabetic patients are at risk of kidney damage (diabetic nephropathy).
. Kidney function should be checked every 6 to 12 months.
b) Blood pressure measurement
. Diabetes with high blood pressure increases the risk of heart and kidney diseases.
. The ideal blood pressure for diabetic patients is usually less than 130/80 mm Hg.
. If your blood pressure is high, you may need blood pressure medication and lifestyle changes.
3. Cardiovascular health check
. Diabetics are at higher risk of heart disease and stroke.
. Annual cholesterol tests (LDL, HDL, triglycerides) and an electrocardiogram (ECG) are recommended.
. Following a healthy diet, quitting smoking, exercising regularly, and controlling your blood pressure and cholesterol can reduce your risk of heart problems.
4. Eye health check (diabetic ophthalmology)
. Diabetes can cause diabetic retinopathy, cataracts, and glaucoma.
. Annual eye exams by a qualified ophthalmologist are essential.
. If you have blurred vision, floating spots in your field of vision, or sudden vision loss, you should see a doctor immediately.
5. Foot health check (diabetic foot care)
. Diabetics are at risk of diabetic ulcers, infection, and amputation.
. They should check their feet every day to be aware of wounds, cracks, redness or discoloration of the nails.
. Every 6 to 12 months, a doctor should evaluate the state of nerve sensitivity and blood flow in the feet.
. Wearing appropriate shoes, keeping the skin moisturized and preventing injury to the feet are very important.
6. Nutrition and weight management
. Losing weight (if overweight) helps improve blood sugar control and reduce insulin resistance.
. The diet should include foods with a low glycemic index, high fiber and healthy fats.
. Reducing sugar, salt and saturated fat intake is recommended.
. Patients should benefit from nutritional counseling by a dietitian or doctor.
7. Physical activity and healthy lifestyle
. Regular exercise improves insulin sensitivity and blood sugar control.
. Daily walking for 30 minutes or doing sports activities such as cycling and swimming is recommended.
. Patients should avoid excessive stress and anxiety, because stress increases blood sugar.
. Quitting smoking and reducing alcohol consumption are essential for diabetic patients.
8. Adjusting medications and insulin
. The doctor should periodically review the patient’s medications to determine the appropriate dosage and effectiveness of the medications.
. Patients should carefully follow the medication and insulin schedule and, if they forget to take medication, follow the doctor’s instructions.
. Drug interactions should be investigated, especially in patients who are also taking other medications.
9. Psychological counseling and emotional support
. Depression and anxiety are common in diabetic patients, so psychological counseling or participating in support groups can be helpful.
. Family and friends should support the patient in maintaining a healthy lifestyle and managing the disease.
Conclusion
Follow-up of diabetic patients is a multifaceted and continuous process that includes regular blood sugar control, monitoring of kidney, heart, eye, and foot health, adjusting medications, and maintaining a healthy diet and active lifestyle.
Regular follow-up and patient collaboration with the doctor are the keys to successful diabetes management and prevention of its complications.
10. The patient’s role in diabetes follow-up and management
Diabetic patients have a very important role in controlling and managing their disease. They should constantly monitor their condition and work closely with their doctor, dietitian, and other members of the treatment team. Some of the key actions that patients can take include:
a) Recording information and monitoring the course of the disease
. Keeping a blood sugar diary to record daily blood sugar levels, HbA1c levels, blood pressure, and abnormal symptoms.
. Using diabetes management apps to accurately track their health status.
b) Having sufficient awareness and knowledge about diabetes
. Recognizing the symptoms of severe high or low blood sugar (hyperglycemia and hypoglycemia).
. Learning how to deal with sudden drops in blood sugar, for example, consuming appropriate sugary foods in urgent situations.
. Understanding the effects of food, exercise, stress, and medications on blood sugar levels.
c) Staying motivated and committed to the treatment plan
. Understanding the importance of sticking to your diet, taking your medications regularly, and doing physical activity.
. Interact with support groups or other diabetic patients to exchange experiences and provide motivation.
11. The importance of regular visits to the doctor
To more accurately monitor the condition of the disease and modify the treatment plan, regular visits to the doctor are recommended. The recommended schedule for medical visits is:
. Every 3 to 6 months: HbA1c test and check for changes in blood sugar.
. Every 6 to 12 months: Kidney tests, blood lipids, blood pressure and foot health check.
. Annually: Retinal examination to check for diabetic retinopathy.
. In case of new symptoms: see a doctor immediately to prevent dangerous complications.
12. Managing emergency conditions in diabetic patients
Diabetes can sometimes cause emergency conditions that require quick action. Some of these include the following:
a) Severe drop in blood sugar (hypoglycemia)
Symptoms: excessive sweating, body tremors, headache, extreme hunger, dizziness, confusion, lethargy, and in severe cases, unconsciousness.
Solutions:
. Consume a fast-acting sugary substance such as fruit juice, sugar, or glucose tablets.
. In case of unconsciousness, bystanders should immediately inject glucagon and take the patient to the emergency room.
b) Severely high blood sugar (hyperglycemia)
Symptoms: Excessive thirst, frequent urination, fatigue, nausea, blurred vision, and rapid breathing.
Solutions:
. Drink plenty of water and inject the required dose of insulin as directed by your doctor.
. If your blood sugar level is more than 300 mg/dL and you have severe symptoms, you should go to the hospital immediately.
c) Diabetic ketoacidosis (DKA) – a dangerous condition
This condition occurs when the body burns fats instead of sugar and produces acidic substances (ketones).
Symptoms: Nausea, vomiting, abdominal pain, dry mouth, acetone breath, and confusion.
Solution: Immediate hospitalization and intravenous fluids and insulin are required.
13. Diabetes and pregnancy
. Women with diabetes (or those who develop gestational diabetes during pregnancy) need careful blood sugar control.
. Regular tests, diet modification, and adjustment of insulin or oral medication doses are essential to maintain the health of the mother and fetus.
. Blood pressure, fasting blood sugar, and HbA1c levels should be closely monitored.
. Regular visits to a gynecologist and endocrinologist are recommended.
14. Overall conclusion
. Regular follow-up and careful management of diabetes are key to preventing dangerous complications and improving the patient’s quality of life.
. Diabetic patients should follow a healthy lifestyle, proper nutrition, regular exercise, and careful medication use.
. Close cooperation with the doctor and treatment team, along with periodic testing, helps to better control the disease.
. Patient awareness and education about their disease play a key role in the success of diabetes management.
By following these principles, diabetic patients can live healthier and more productive lives and prevent complications of the disease.
Duration of follow-up for diabetic patients
The duration and intervals of follow-up for diabetic patients vary depending on the type of diabetes, severity of the disease, presence of complications, and the patient’s individual circumstances. However, general guidelines for follow-up for diabetic patients are as follows:
1. Follow-up for patients with type 1 diabetes
. Every 3 to 4 months: Check HbA1c, adjust insulin dosage, and check daily blood sugar.
. Annually: Check kidney function, eye examination, check foot health, and test blood lipids.
. If you notice severe fluctuations in blood sugar, unusual symptoms, or persistently high blood sugar, it is necessary to see a doctor immediately.
2. Follow-up for patients with type 2 diabetes
. Every 3 to 6 months: Measure HbA1c to assess blood sugar control.
. Every 6 to 12 months: Check blood pressure, check blood lipids, check kidneys, and assess foot health.
. Annually: Eye examination to check for diabetic retinopathy.
. If the patient has complications or comorbidities such as high blood pressure, heart disease, or kidney failure, follow-up intervals may be shorter.
3. Follow-up of pregnant women with diabetes or gestational diabetes
. Weekly or biweekly: Close blood sugar control and adjustment of diet and medications.
. Monthly: Check weight, blood pressure, and necessary tests to monitor the health of the mother and fetus.
. After delivery: Women with gestational diabetes should have a blood sugar test again 6 weeks after delivery to determine whether diabetes has resolved or has turned into type 2 diabetes.
4. Follow-up of elderly diabetic patients
. Elderly people need more frequent check-ups due to a higher risk of diabetes complications (such as kidney, heart, and nerve damage).
. Every 3 to 6 months: Measure HbA1c, evaluate diet, and review medications.
. Annually: Check vision, foot health, and kidney and heart function.
. In the presence of diabetic foot ulcers or severe fluctuations in blood sugar, follow-up should be performed more urgently.
5. Follow-up in patients with uncontrolled diabetes or complications
. If the patient’s blood sugar is not well controlled or complications such as nephropathy, neuropathy, or eye problems develop, follow-up should be performed every 1 to 3 months.
. In the event of hospitalization or sudden changes in blood sugar levels, earlier follow-up and more detailed examinations are needed.
Conclusion
. Diabetic patients should be regularly and continuously monitored by a doctor to prevent complications.
. The duration of follow-up depends on the state of blood sugar control, type of diabetes, patient age, and comorbidities.
. In stable conditions, follow-ups are usually performed every 3 to 6 months, but in high-risk patients, this period is reduced and may be monthly or even weekly.
When to start follow-up for diabetic patients
1. When to start follow-up after diabetes diagnosis
After diabetes is diagnosed, follow-up should begin immediately to monitor the patient’s blood sugar level and prevent complications. The time to start follow-up varies depending on the type of diabetes and the patient’s condition:
. Type 1 diabetes:
Initial follow-up: In the first weeks after diagnosis, the patient should be checked by a doctor and nutritionist weekly or every two weeks.
After blood sugar stabilizes: Follow-up is usually done every 3 months.
. Type 2 diabetes:
Initial follow-up: Immediately after diagnosis, the patient should see a doctor for initial assessments, medication adjustments, and necessary education in the first weeks.
After adjusting the treatment regimen: Follow-up usually continues every 3 to 6 months.
. Gestational diabetes:
Follow-up should begin immediately after diagnosis and, depending on the mother’s condition, is usually done weekly or every two weeks.
After delivery: Blood sugar recheck is done 6 weeks after delivery.
2. When to start follow-up after treatment change
. If medications are started or changed (for example, insulin or metformin), the doctor may monitor the patient for 1 to 2 weeks after the treatment change to check for complications and adjust the dose of the drug.
. If the patient does not respond well to the new treatment or has side effects, follow-up should be done earlier.
3. When to start follow-up after hospitalization
. If the patient is hospitalized due to complications of diabetes (such as ketoacidosis, severe hypoglycemia, kidney or heart problems), follow-up should be done immediately after discharge.
. The first follow-up should be done in the first week after discharge, then subsequent intervals are determined depending on the patient’s condition.
4. When to start follow-up to prevent complications
. Patients who are at risk of complications of diabetes (such as those with a family history of heart disease, high blood pressure, or obesity) should have careful and regular follow-up from the moment of diagnosis.
. If early signs of complications (such as numbness in the legs, vision problems, or kidney failure) are observed, follow-up should begin more immediately and may be every 1 to 3 months.
Summary
. Diabetes follow-up should begin immediately after diagnosis to prevent the development of complications.
. The first follow-up after starting treatment is usually done in the first weeks to check the effectiveness of the medications.
. After discharge from the hospital, the first follow-up should be done in the first week.
. Patients who are at high risk of complications should have careful and regular follow-up from the beginning.