Diabetes Tests Worksheet
Below is a list of important tests. Provide the information requested to see how you’re
My last A1c test was on ________. This blood test measures blood sugar control over
the past 60 to 90 days. A1c should be tested 2 to 4 times a year, depending on how
well your blood glucose is managed and whether you have had a recent change in your
diabetes medicines. The target A1c level is mostly below 7%.
My blood pressure is _______. Both the American Heart Association and the American
Diabetes Association recommend blood pressure of less than 130/80 mm Hg for people
with diabetes. Have your blood pressure checked at every visit to your provider.
I have an appointment for a foot exam on ________. Inspect your feet every day for
signs of redness, warmth, swelling or calluses. In addition, you should have your
feet inspected by your provider during every visit and have a complete sensory foot
exam done every year.
My next dilated eye exam is on ________. People who have diabetes should have a dilated
retinal examination every year. Remember that this is a special eye exam that is not
the same as having your vision checked for glasses.
I last had my fasting lipid profile on ________. Lipid profile tests should be done
at least once a year so that you and your healthcare provider can develop a plan to
reduce your risk. A 50% reduction from your baseline LDL cholesterol is the goal.
My appointment for my urinary protein/microalbumin test is on ________. Measuring
your urinary protein will give you and your provider information about the health
of your kidneys and blood vessels. You should have an annual test for urinary protein/microalbumin
if you have type 2 diabetes or if you have had type 1 diabetes for more than 5 years.
I last had my kidney function tested on ________. A blood test of your estimated glomerular
filtration rate (how effectively your kidneys are functioning) should be done at least
once a year to further asses the health of your kidneys.
Although these are suggested guidelines for care, please check with your healthcare
provider and insurance benefits plan for coverage.