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Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help...

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Checkbook for Diabetes Health
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Page 1: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

Checkbook for Diabetes Health

Page 2: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

All about your checkbook

Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps you keep track of tests you have had. This may help you take steps to stay healthy.

How to use the Checkbook for Diabetes Health• Bring this checkbook to all visits with your health care provider (HCP)• With your health care provider, write your test targets on pages 5, 6, 7 and 9• Write your test results in the spaces on pages 11 through 14• Track your blood sugar values in the daily blood sugar graph on pages 15 through 61• Use your results to talk about your treatment plan with your health care team

Page 3: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

This checkbook belongs to:

Name:

Street Address:

City: State: Zip Code:

Phone Number: ( )

In Case of Emergency, Call: ( )

Email:

Area Code

Area Code

Page 4: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

Important information 3

Use the spaces below to write out the names and phone numbers of the people on your health care team.

Health Care Team Name Phone Number

Primary care doctor

Diabetes educator

Endocrinologist (Diabetes doctor)

Ophthalmologist (Eye doctor)

Podiatrist (Foot doctor)

Pharmacist

Page 5: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

Diabetes may affect many parts of your body, such as your heart, eyes, and feet. Getting regular medical tests may help you and your health care team manage your diabetes and may help reduce problems.

Test How test is done Learn more here

Tests to have every visit

Blood pressure Cuff wrapped around the arm Page 6

Foot check Examined by HCP Page 10

Tests to have 2–4 times per year

A1C Blood test Page 5

Tests to have every year

Cholesterol (blood fats) Blood test Page 7

Comprehensive eye exam Dilated eye exam Page 8

Albuminuria test Serum creatinine for kidneys

Urine test Blood test

Page 9

Comprehensive foot exam Examined by HCP Page 10

* American Diabetes Association (ADA). Standards of medical care in diabetes. Diabetes Care. 2015; S1-S93.

4Recommended tests*

Page 6: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

Blood sugar targets

Checking blood sugar (glucose)

Keeping your blood sugar close to normal is important. Be sure to check your blood sugar daily as your health care provider directs. Have A1C tests to see how your blood sugar has been controlled over the past few months. A high A1C level is linked to a greater chance of diabetes health problems, such as problems with your eyes or kidneys.

Talk with your health care provider. He or she can tell you what you should be doing and what targets are right for you.

Help manage your blood sugar by:• Checking your blood sugar• Staying physically active• Eating the right foods and portion sizes• Taking your medicines

ADA targets Your targets

A1C: less than or equal to 7% for patients in general

Blood sugar before eating: 80–130 mg/dL

Blood sugar 1-2 hours after eating: less than 180 mg/dL

Talk with your HCP about the target that’s right for you.

5

Page 7: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

Checking blood pressure

Having high blood pressure raises your risk for heart disease, stroke and other health problems.

Talk with your health care provider about which steps are right for you.

You may help manage your blood pressure if you:• Stay at a healthy weight• Get regular physical activity• Eat less salt• Take medicines as your health

care provider recommends• Check your blood

pressure regularly

Blood pressure target

Talk with your HCP about the target that’s right for you.

Lessthan

mm Hg140

Lessthan 90

6

ADA target Your target

Page 8: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

Cholesterol targets

Checking cholesterol (kol-ESS-ter-awl)

Problems with cholesterol (blood fats) raise your risk for heart disease. Managing cholesterol may help lower the risk.

There are 3 kinds of cholesterol to have tested:• LDL cholesterol. This is known as “bad” cholesterol.

It can clog arteries and cause heart problems• HDL cholesterol. This is known as “good” cholesterol.

It may lower your risk for a heart attack• Triglycerides. High amounts of this fat are often found

in people with diabetes

ADA targets Your targets

LDL: less than 100 mg/dL

HDL: men: more than 40 mg/dL women: more than 50 mg/dL

Triglycerides: less than 150 mg/dL

Talk with your HCP about the target that’s right for you.

7

Page 9: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

Checking your eyes

Diabetic retinopathy (ret-in-OP-uh-thee) is an eye disease caused by diabetes. It may lead to loss of sight or blindness.

You should have a comprehensive eye exam every year.For this exam, eye drops are used to enlarge your pupils. Th is will cause your vision to be blurry for a few hours. You may need to have someone drive you home after your exam.

You may help lower your risk for this eye disease by managing your blood sugar levels.

Diabetic retinopathy (ret-in-OP-uh-thee) is an eye disease caused by diabetes. It may lead to loss of sight or blindness.

For this exam, eye drops are used to enlarge your pupils. Th is will cause your vision to be blurry for a few hours. You may need to have someone drive you home after

You may help lower your risk for this eye disease by

8

Page 10: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

Checking your kidneys

Diabetes may cause kidney problems. This means that your kidneys cannot clean your blood properly. A special urine protein test (albuminuria test) can find early signs of kidney damage. This test checks for small amounts of protein (albumin) in your urine – which can be one of the signs of kidney damage or kidney disease. A second test to check kidney function is a blood test called a serum creatinine test. This test checks for creatinine in the blood. Creatinine is a waste product. Normally, the kidneys filter it from the blood. When the kidneys don’t work properly, there will be too much creatinine in the blood.

To help protect your kidneys, your health care provider may suggest that you manage:• Your blood pressure• Your blood sugar

9

Kidney test targets

Your targets

Urine protein1: under 30 mg/g creatinine*

Serum creatinine2: men: 0.7 to 1.3 mg/dL* women: 0.6 to 1.1 mg/dL*(Normal value ranges may vary slightly among different labs)

Talk with your HCP about the target that’s right for you.

* These are units of measurement. mg/g means milligrams per gram. mg/dL means milligrams per deciliter.

1. American Diabetes Association (ADA). Standards of medical care in diabetes. Diabetes Care. 2015; S59.

2. Creatinine Blood Test. 2013. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/003475.htm. Accessed: February 12, 2015.

Page 11: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

The foot exam

Checking your feet

People with diabetes may develop problems like wounds or sores with their feet. If the problem gets very serious, it may lead to amputation. Your health care provider must check your feet to see if you have foot problems or if you are at risk for them.

Help take care of your feet by:• Preventing cuts and bruises on your feet• Washing and drying your feet every day• Using a mirror daily to check for cuts or other problems• Wearing socks and shoes at all times• Asking your health care provider if you need to see a foot

care specialist or wear special shoes• Getting a complete foot checkup (comprehensive foot

exam) at least once a year by your health care provider

Your HCP will check for feeling or numbness in your feet, as well as blood flow. Your HCP will also look for sores or cuts on your feet.

10

Page 12: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

Your test results: Year 1

Bring this checkbook to each visit with your health care provider. Write your test results in the spaces below. Compare these results with the targets your health care provider set with you.

Test ADA Target* Your Target

Visit 1 Date:

Visit 2 Date:

Visit 3 Date:

Visit 4 Date:

Every visit Blood pressure

Less than 140/90 mmHg

FeetExaminationat each visit

2–4 times per year A1C

Less than or equal to 7%

Weight N/A

* Targets vary. Ask your HCP what target is best for you.

Results from each visit

11

Page 13: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

Bring this checkbook to each visit with your health care provider. Write your yearly test results in the spaces below. Compare these results with the targets your health care provider set with you.

Test Target* Date/Result

Every year Cholesterol (blood fats)

LDLLess than 100 mg/dL

HDLMen: more than 40 mg/dLWomen: more than 50 mg/dL

Triglycerides Less than 150 mg/dL

Kidneys Urine (protein) test

Less than 30 mg/g creatinine

Serum creatinine testMen: 0.7 to 1.3 mg/dLWomen: 0.6 to 1.1 mg/dL

Comprehensive eye exam Dilated eye exam

* Targets vary. Ask your HCP what target is best for you.

Results from YEARLY tests

12

Page 14: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

Your test results: Year 2 13

Bring this checkbook to each visit with your health care provider. Write your test results in the spaces below. Compare these results with the targets your health care provider set with you.

Test ADA Target* Your Target

Visit 1 Date:

Visit 2 Date:

Visit 3 Date:

Visit 4 Date:

Every visit Blood pressure

Less than 140/90 mmHg

FeetExaminationat each visit

2–4 times per year A1C

Less than or equal to 7%

Weight N/A

* Targets vary. Ask your HCP what target is best for you.

Results from each visit

Page 15: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

14Bring this checkbook to each visit with your health care provider. Write your yearly test results in the spaces below. Compare these results with the targets your health care provider set with you.

Test Target* Date/Result

Every year Cholesterol (blood fats)

LDLLess than 100 mg/dL

HDLMen: more than 40 mg/dLWomen: more than 50 mg/dL

Triglycerides Less than 150 mg/dL

Kidneys Urine (protein) test

Less than 30 mg/g creatinine

Serum creatinine testMen: 0.7 to 1.3 mg/dLWomen: 0.6 to 1.1 mg/dL

Comprehensive eye exam Dilated eye exam

* Targets vary. Ask your HCP what target is best for you.

Results from YEARLY tests

Page 16: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

Recording your blood sugar value 15

Checking your blood sugar is an important part of managing diabetes. Your health care provider will tell you when you should check your blood sugar. You can use this daily blood sugar graph to record your blood sugar numbers.

It’s important to discuss these results with your health care provider. Share this information at your next visit.

Use these steps to record your blood sugar numbers on the graph:

Write the date you take your blood sugar

Write the time you take your blood sugar

Write your blood sugar value

Mark an (x) for the blood sugar value on the graph

At the end of the day connect all the x’s

The example below shows how to record your blood sugar numbers on this graph.

1

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Page 17: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 18: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 19: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 20: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 21: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 22: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 23: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 24: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 25: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 26: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 27: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 28: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 29: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 30: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 31: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 32: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 33: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 34: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 35: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 36: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 37: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 38: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 39: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 40: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 41: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 42: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 43: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 44: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 45: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 46: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 47: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 48: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 49: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 50: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 51: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 52: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 53: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 54: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 55: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 56: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 57: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 58: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 59: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 60: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 61: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 62: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

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Page 63: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

Remember…

You’re not alone. Everyone on your health care team is here to help you learn more about managing your diabetes.• Bring this checkbook to all visits with your health

care providers• Write your test results in the checkbook• Track your blood sugar values in the daily blood

sugar graph• Ask your health care provider about changes to your

treatment plan based on your test results• Keep working with your health care team to make

progress toward your targets

Sticking with these steps could help you stay healthy.

62

Page 64: Checkbook for Diabetes Health - UnitedRx · Diabetes may be hard to manage. This checkbook can help you know what tests you need and how often you should have them. It also helps

For more information, visit:

American Diabetes Association www.diabetes.org

American Association of Diabetes Educators www.diabeteseducator.org

National Diabetes Information Clearinghouse www.diabetes.niddk.nih.gov

HE96978 0515 PRINTED IN USA © 2015, LILLY USA, LLC. ALL RIGHTS RESERVED.


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