Table 1. Insulin Therapy According to Severity of Type 2 Diabetes Basal and meal-real insulin needs managed similarly to type 1 diabetes. …
To our patients:
These are general recommendations for health screening based on national
standards
Adults age 18 to 40: Exams at least every 2 years
DISCUSSION:
Update personal and family medical history
Assessment advice: tobacco, alcohol and substance use, diet, exercise,
dental health, sexuality,
depression, domestic violence, injury prevention, cancer,
cardiovascular heart or stroke disease risks, advance
directives
PHYSICAL EXAMINATION:
Measurements of height, weight, blood pressure
General physical examination head, neck, chest, heart, abdomen, limbs
Instruction on testicular self-exam for males, breast self-exam for females
Pelvic exam in women every 1-3 years see below for Pap
Testicular exam by physician every 2 years
LAB AND X-RAY TESTS:
Cholesterol: Lipid profile total, HDL and LDL cholesterol every
5 years over age 20
Fasting blood sugar : At doctors discretion if family history of
diabetes, history of gestational
pregnancy diabetes, overweight, high blood pressure
or high cholesterol, or Native American, Hispanic or
African
American descent
Pap in women: Annually for 3 years then at least every 3 years if
patient has ever been sexually
active start age 21 or 3 years after first
intercourse Option- HPV test over 30
Mammogram: Baseline at 35 Also need physical breast exam by doctor, for
maximum
detection of cancer
Infectious disease screening: Rubella screening in women if not
previously done
Varicella chicken pox blood test if no history of
the disease
HIV screen offered to all adults
If at high risk: TB, hepatitis B and C screening
Sexually transmitted disease screening gonorrhea and chlamydia in
sexually active women under 25,
Others as desired
IMMUNIZATIONS:
Tetanus and diphtheria booster every 10 years Tetanus, diphtheria and
pertussis booster once
Rubella or MMR measles-mumps-rubella, varicella chicken pox if not
immune
Hepatitis B if high-risk, series of 3 shots
HPV vaccine Gardasil for women under age 26 to prevent cervical cancer
Annual flu shot and
one-time pneumonia shot for people with chronic illness
OTHER SCREENINGS:
Mouth, skin, breast, colon or other cancer screening depending on risk
Ultrafast heart scan or stress test if risk factors for heart disease;
chest CT screen if risk for lung cancer
To our patients:
These are general recommendations for health screening based on recent
national standards
Adults age 40-64: Exams every year
DISCUSSION:
Update personal and family medical history
Assessment advice: tobacco, alcohol and substance use, diet, exercise,
dental health, sexuality,
depression, domestic violence, injury prevention, cancer,
cardiovascular heart
or stroke disease risks, menopause, osteoporosis, prostate
cancer screening, advance directives
Teach testicular and breast self-exams
EXAMINATION:
Measure height, weight, blood pressure
General physical examination head, neck, chest, heart, abdomen, limbs
Breast exam in women every year; pelvic exam every 1-3 years see below for
Pap
Rectal Exam with examiners finger every year starting at 40: for
prostate men and stool blood men, women
LAB, EKG AND X-RAY TESTS:
Cholesterol: every 5 years if previously
normal Lipid profile total, HDL
and LDL
Fasting blood sugar every 3 years; or every 1 year if family history of
diabetes, history of gestational
pregnancy diabetes, overweight, high blood pressure or high
cholesterol, Native
American, Hispanic or African American descent
Pap every 3 years if previously normal for 3 years in a row Option: HPV
test in women over 30
PSA prostate screening-consider every year between age 50-65 Discuss pros
cons with practitioner
Every year over 45 if there is a family history of prostate
cancer or in men of African-American descent
Stool occult blood screening obtain stool sample at home to detect if any
hidden blood present:
every year over age 50; or starting at 40 if family history of
colon cancer
Colonoscopy/Sigmoidoscopy: every 5-10 years after age 50 Colonoscopy
preferred If family
history of colon cancer, start at 40, or 10 years before the
youngest relative developed
colon cancer
Mammogram: consider between 40 and 49 after discussing risks and
benefits with doctor
Recommended annually after 40 if family history of breast cancer
in first-degree relative All women should have a mammogram
every year starting at age 50
Bone density: Women at menopause Men at risk of osteoporosis smoking,
alcohol, poor nutrition,
emphysema or lung disease, steroid use, family history of
fractures
EKG: one-time baseline at 40-50 Resting EKGs are not useful to
detect heart disease
IMMUNIZATIONS:
Tetanus and diphtheria every 10 years Tetanus, diphtheria and pertussis
once, through age 64
Hepatitis B if at risk and not previously immunized
Measles if born after 1956 and have not received 2 measles immunizations
Pneumococcal vaccine one-time dose if certain chronic illnesses
Influenza vaccine every fall if chronic illness, over 50, or working in
vital public role police, fire, safety,
teacher, health care or a long-term-care facility for children
or adults
Zostavax one-time shot age 60 to prevent shingles
OTHER SCREENINGS:
Mouth, skin, or other cancer screening depending on risk
Infectious disease screening: HIV in all adults
If at high risk: TB, hepatitis B and C, sexually
transmitted disease
Ultrafast heart scan optional; Stress test if
risk factors for heart
disease every 5 years in patients with diabetes over age 40 Chest CT
screen if risk for lung cancer
Recommendations for health screening based on national standards
Age 65 to 80:
DISCUSSION:
Update personal and family medical history
Assessment and counseling: tobacco, alcohol and substance use, diet,
mobility,
exercise, depression, advanced directives living will and
health care power of attorney, memory and mental difficulties,
domestic violence, elder abuse, dental health, sexuality,
activities of daily living, fall risks, home safety, CPR classes
for household members Teach breast self-exam
EXAMINATION:
Measure height, weight, blood pressure
Vision screening, question about hearing difficulty and order hearing test
if indicated
General physical examination head, neck, chest, heart, abdomen, limbs
Pelvic exam
if symptoms from urinary, pelvic or rectal areas
LAB AND X-RAY TESTS:
Cholesterol lipid profile every 5 years to age 75
Fasting blood sugar every year in a high risk group [high risk includes
family history of
diabetes, history of gestational pregnancy diabetes,
overweight, high blood pressure or high cholesterol, Native
American, Hispanic or African American]
Consider PSA for prostate cancer screen if estimated 10 years life
expectancy
Pap may be stopped at age 65-70 if at least 3 previous Paps have been
normal and patient is judged to be low risk Option: HPV test
Mammogram every 1-2 years to age 80, discuss with physician after that age
Digital Rectal Exam with examiners finger every year: checks
for prostate cancer and blood in stool
Stool occult blood screening stool sample at home to detect hidden blood:
every year
Colonoscopy or Sigmoidoscopy scope to look for colon cancer: every 5-10
years
Bone density: Women at menopause Men at risk smoking, alcohol, poor
nutrition,
emphysema or lung disease, steroid use, family history of
fractures
EKG: baseline once if otherwise healthy and not done before Not useful
for screening
TB test if in high risk group institutional care, chronic illness, contact
with
others with TB, low income, immigrant, alcoholic, Native
American, health care worker or volunteer
If at high risk: HIV, TB, hepatitis B and C testing
Ultrafast
heart scan or stress test if risk for heart disease stress test
every 5 years if
diabetes
Lung cancer screening: Chest CT if at risk
IMMUNIZATIONS:
Pneumococcal pneumonia vaccine once May need booster every 5-10 years
Influenza flu vaccine: every fall between October and December
Tetanus and diphtheria vaccine every 10 years
Zostavax: One-time shot after age 60 to prevent shingles
