When to see a doctor

Nobody wants to call the doctor for every little thing—but we know that treatments for diabetes-related health problems are more effective if you start early. So when should you see your doctor? Here are a few guidelines:¹

• Pain, numbness, weakness or tingling — especially in the hands, feet, arms or legs: Even if it seems insignificant, these feelings can be a sign of early nerve damage. If that's the case, as nerves become more damaged, the symptoms can get worse.²
• Changes in your health: If you feel lightheaded after standing, experience constipation, bloating or nausea, have trouble seeing—even just at night or when the light changes, or if you have sexual problems, these can all be signs of issues with your nerves.²
• Skin problems or infections: A wound or cut that won't heal, an ongoing sinus, bladder or vaginal infection—diabetes can interfere with your body's ability to recover on your own.³
• Illness: If you're running a fever, are sweating or have the chills, or are experiencing nausea, vomiting or diarrhea, your doctor wants to know. Being sick can affect your blood sugar levels, and it may be a sign of an infection that needs care.³ If you can't keep food or fluids down, call for emergency assistance.⁴
• High blood sugar: If your blood glucose remains above 240 mg/dL, even after taking your medicine and/or increasing insulin and fluids, or you have trouble staying in range, make an appointment.
• Moderate to large ketones in your urine: Talk to your doctor if you are experiencing symptoms that might signal ketoacidosis or dehydration, such as worsening abdominal pain, trouble breathing or breath that smells fruity or like acetone.

Your doctor may be able to alleviate the symptoms you're experiencing, and even help slow the progression of the problem through better blood sugar control.²

Still not sure? Just call. Your doctor wants to know everything that's going on. If it's no big deal, they'll tell you. Pick up the phone and put your mind at ease.

How long do you spend with your doctor these days? 10 minutes? 15? Even though your time is crunched, there are things you can do to forge a more collaborative relationship, have more productive conversations and make every second count.

1. Plan a day or two ahead. Send your numbers in advance by email or the route your doctor prefers. Call out anything you notice that's out of the ordinary. Then bring a copy of everything you send with you, just in case. Your doctor may only take a glance before you meet, but you'll get the wheels turning for a more fruitful appointment.
2. Collect your questions. Something about a paper-thin gown can make anyone forget what they wanted to discuss. Whether it's in a notepad or on your phone, having a list to refer to—and take notes on—can help you cover everything you want to discuss and remember what to do next.
3. Give it to 'em straight. Don't sugar-coat (pun completely intended) your results or how things are going. Your doctor is there to help you navigate challenges and solve problems, not pat you on the back. Besides, no matter what problem you bring up or how embarrassing it might be to you, you're probably not the first person who's had to deal with it. Your doctor may have suggestions that have worked for others.
4. Participate in the decisions. Your doctor knows a lot, but nobody knows everything—and you're the expert on what works for you. The best patient-physician relationships are respectful and collaborative. You both should bring ideas to the table.
5. Don't commit to things you know you won’t do. It's okay to say, "That goal is a little out of my range. Maybe we can dial it back a bit and work up to that." Your doctor would rather have you leave with directions you'll actually follow than with lofty goals that will be forgotten by next week.
6. Do what you say you'll do. Think about it—if your doctor said they'd do something after the appointment, you'd expect them to follow through. They should be able to expect the same from you. If there's something stopping you, think about how to solve it and move forward. Testing pain getting in the way of checking your blood sugar? Get a less-painful lancing device. No time to exercise? Take the stairs at work. Start with the goal and brainstorm ideas to help you get there.
7. Create a sick day plan. Make sure you are prepared for days when you feel under the weather by creating an action plan with your care team.

When you're feeling ill, you'd like nothing more than to lie in bed with a good book or a bad movie. Yet that's when you need to focus even more on diabetes self-care.

The key to sick days with diabetes is doing all of the thinking ahead of time. That way, when you don't feel like concentrating, you can simply follow the plan.

Involve your diabetes care team in developing your sick day plan—ask them when you should call for help, how often you should check your blood glucose and ketones, what medicines to take and what to eat.

What to do at the first sign of illness

Understanding how illness might affect your blood glucose can help you take the right steps to care for yourself. For example:⁴

• If you use insulin, don't stop taking it. Even if you are having trouble eating, you will likely need extra insulin to combat the hormones that often cause high blood glucose during illness. Follow your healthcare provider's recommendations.
• Monitor blood glucose levels and urine ketones frequently — every four hours or so if you have type 1 diabetes.
• Stay hydrated. Drink calorie-free, caffeine-free, clear liquids.
• Make sure you eat according to your regular meal plan. Keep easy-to-eat, fast-acting carbohydrates available. They can be useful in treating a low, as well as substituting for a meal. If you feel nauseated or are vomiting, try a sports drink, juice, regular soda or even frozen fruit bars to get the carbs you need.
• Talk to your diabetes care provider about any medications you take, or any unexpected blood glucose results you experience while taking them. Some cold medicines, antibiotics and other prescription and over-the-counter drugs are known to affect blood glucose levels.

The key to successfully navigating an illness is preparation. By creating your sick day plan and kit before you experience the first signs of illness, you'll be ready to attack a virus head-on.

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¹American Diabetes Association. When you're sick. Available at: http://www.diabetes.org/living-with-diabetes/treatment-and-care/whos-on-.... Accessed April 30, 2016.

²EndocrineWeb. Diabetic neuropathy symptoms. Available at: https://www.endocrineweb.com/guides/diabetic-neuropathy/diabetic-neuropa.... Accessed February 15, 2017.

³WebMD. Diabetes and infection: how to spot the signs. Available at: http://www.webmd.com/diabetes/guide/infections-linked-diabetes. Accessed February 15, 2017.

⁴Mayo Clinic. Hyperglycemia in diabetes. Available at: http://www.mayoclinic.org/diseases-conditions/hyperglycemia/basics/sympt.... Accessed February 15, 2017.