Clinic visits are a time to take stock of how well the home management plan is working, how the diabetes is affecting your child’s and family’s life, and how life is affecting the diabetes. Visits will focus on diabetes-specific and general health issues, including:
- insulin requirements: frequency, injection sites, timing of injections, types of insulin, doses
- meal planning, including eating attitudes and behaviour, particularly in adolescents
- results of self-monitoring of blood glucose levels
- symptoms, frequency, and treatment of hypoglycemia and hyperglycemia
- physical and other activities that affect blood glucose control
- sick days
- growth and physical development, including progression of puberty
- psychosocial adjustment, including family stress, school attendance and performance, and behavioural issues
- for teens, issues such as smoking, alcohol and drug use, sexuality and sexual exploration, career planning and, eventually, transition to adult care
The physical checkup generally includes height and weight measurements to make sure that your child is growing well. The doctor or nurse will also measure blood pressure, feel the thyroid gland (in the neck) and the liver for any enlargement, look at the back of the eye with an ophthalmoscope, and look at insulin injections sites for bumps and lumps.
The regular visits also provide you and your child with the opportunity to learn more about diabetes and become more confident in your ability to make your own routine adjustments. The diabetes team can also help identify any potential personal issues that may affect diabetes management, or vice versa, and begin to deal with them.
The needs of children with diabetes change as they age. This is why it helps if you and your child can continue to meet diabetes team members from time to time. Many centres offer group meetings for parents to meet each other and ask experts questions, while children meet each other in a friendly environment. However, group sessions should not replace individual family counselling, which helps to nurture the relationship between the team and the growing child or teen. These sessions are important for children who are having a hard time achieving blood glucose targets. They are also a valuable support for those with excellent or good control.
Getting the most out of the visit with your health care team
Over the years, the family dealing with diabetes will become quite familiar with the health care system. Some people take a while to become comfortable working with health care professionals. Remember that the diabetes team is there for the family. Here are some tips on how to get the most from your health care team.
Before the visit
- Write out questions and concerns so you won’t forget things.
- Write down any recent symptoms.
- Keep self-monitoring records current.
- Know and follow the standards of care.
- Know what the previous HbA1c was.
- Rehearse the main points you want to cover.
During the visit
- Always remember to bring the blood glucose record book and the glucose meter.
- Request time to ask questions.
- Write down the answers.
- Repeat answers back to the health care provider to make sure you understand.
- Make a specific plan of action for any changes to the diabetes routine.
- Make an appointment for the next visit.
- Ask if thyroid and blood fat tests should be done. If your child is over 15 years of age and has had diabetes for 3 to 5 years, ask if it is time to begin screening for eye and kidney changes.
After the visit
- List the recommendations given.
- Decide how to implement them.
- Tell the rest of the family.
- Encourage the child to keep a diary to help keep track of the routine.
- Phone to get the HbA1c result from the previous visit if it was not available before you left the clinic.
- Phone to get results from any other screening tests.