Your health care team

The most important part of the diabetes health care team is you.
As leader, you are largely responsible for keeping your diabetes health care team on track. You will be responsible for your day-to-day monitoring and treatment. You are also in charge of your exercise and healthy eating program. However you don’t need to do this alone. Your diabetes health care team is there to support and guide you.

But what exactly does the diabetes health care team do?

  • Provide you with ongoing support
  • Offer expert advice and information
  • Monitor the different parts of your body that can be affected by diabetes, such as heart, eyes, feet and kidneys
  • Explain to you and your family different diabetes management options
  • Provide referrals and prescriptions.

As the leader of your diabetes team it is important that you keep the other members informed of any changes to your management or health. This will help your team to provide you with the best advice, treatment options and support.

Click on each icon to find out more about the provider

You GP Aboriginal and Torres Strait Islander health worker Diabetes educator Dentist Dietitian Endocrinologist Optometrist Ophthalmologist Pharmacist Physiotherapist Podiatrist Psychiatrist Psychologist

You

You are the leader of the team and the most important member. You are not alone.

General Practitioner (GP), General Practice Nurse (PN)

Your GP has a central role in overall assessment and diabetes management. Your GP may refer you to their PN to assist with your care planning or other diabetes management strategies. Visit your GP regularly to discuss any problems as soon as they arise.

Find a GP

Aboriginal and Torres Strait Islander health worker

Aboriginal and Torres Strait Islander health workers can support individuals and families in managing diabetes and connect you with other health professionals.

Find a health worker

Diabetes educator

A diabetes educator will provide you with information to manage your diabetes. They can also help you develop action plans for the unexpected (e.g. low or high BGLs).

Find a diabetes educator

Dentist

A dentist assists with oral health and provides treatment.

find a dentist

Dietitian

Your dietitian can provide you with individualised information about healthy eating.

find a dietitian

Endocrinologist

An endocrinologist is a medical specialist who sees people with diabetes, especially those with type 1 diabetes, or those who are pregnant and have diabetes.

find an endocrinologist

Optometrist

Your optometrist assesses eye health and prescribes your glasses.

find an optometrist

Ophthalmologist

An ophthalmologist is an eye specialist who can monitor any changes in your eyes and provide treatment.

find an ophthalmologist

Pharmacist

A pharmacist prepares and dispenses drugs and medicine. They can also give advice about your medicines.

find an NDSS access point

Physiotherapist or Exercise Physiologist

A physiotherapist or exercise physiologist can give advice about exercise choices.

find an exercise physiologist

Podiatrist

A podiatrist will advise you on how to keep your feet healthy and treat foot problems.

find a podiatrist

Psychiatrist

A psychiatrist is a medical specialist who can help people who have emotional and psychological problems.

find a psychiatrist

Psychologist

A psychologist counsels people with emotional and psychological problems and can help you make lifestyle changes such as giving up smoking.

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Annual Cycle of Care

Annual Cycle of Care

The Annual Cycle of Care is a checklist designed to assist you and your health team in keeping your diabetes care on track.

Diabetes changes over time and what works for you today, may not work next year. Diabetes can lead to complications that affect your kidneys, eyes, feet and heart. Therefore it is important for you to understand the Annual Cycle of Care, identify any health concerns early and discuss the best treatment with your health care team. Importantly, you can reduce your risk of diabetes-related complications.

Annual Cycle of Care targets mean different things to different people; therefore it is important that you develop your individual goals with your diabetes health care team. If you don’t understand why these targets are important, or how often you should be getting your checks, discuss this with your doctor. Remember, regular visits to your diabetes health care team will allow you to identify any problems early and discuss the best management and treatment.

Start your checklist now

My Annual Cycle of Care

Check the boxes to help keep your diabetes on track. 

Once complete, you can print out your personalised annual cycle of care to take to your health care team. 

Download a blank Annual Cycle of Care checklist to fill out or have a health professional fill out for you. Download a blank checklist
  1. Start
  2. Healthy weight
  3. Test and checks
  4. Exams and plans
  5. Your care plan
It is recommended to: Have you had
this checked?
Who checks it? Why is this important?

Healthy eating

Review your diet and healthy eating each year

Dietitian, Diabetes educator or GP

Healthy eating assists with general health, weight management and blood glucose levels. Ask for a referral to a dietitian for personalised advice.

Show

Exercise

Review your physical activity level each year

Diabetes educator, GP, Endocrinologist, or Practice Nurse

Exercise lowers blood glucose levels and prevents cardiovascular disease. Just 10 minutes at a time is enough to get benefits. See an accredited exercise physiologist for individualised advice.

Show

Smoking status

Stop smoking

Diabetes educator, GP, Endocrinologist, or Practice Nurse

Smoking will damage your blood vessels. Talk to your GP about the different ways to quit.

Show
It is recommended to: Have you had
this checked?
Who checks it? Why is this important?

Weight

Check your weight every 6 months

GP, Endocrinologist, Diabetes educator or Practice Nurse

Staying in the healthy weight range helps to prevent diabetes-related complications.

Show

Waist circumference

Check your waist circumference every 6 months

Diabetes educator, GP, Endocrinologist, or Practice Nurse

A waist circumference over 94cm for men and over 80cm for women increases your risk of cardiovascular disease.

Show

Body mass index

Check your body mass index every 6 months

Diabetes educator, GP, Endocrinologist, or Practice Nurse

Get help from your health care team to lose weight if you need to. Slow and sustainable is the best way!

Show

Blood pressure

Check your blood pressure every 6 months

Diabetes educator, GP, Endocrinologist, or Practice Nurse

Keeping blood pressure within your target range can reduce the risk of cardiovascular disease. Have your GP check your blood pressure regularly.

Show
It is recommended to: Have you had
this checked?
Who checks it? Why is this important?

Cholesterol

Check your Cholesterol each year

GP or Endocrinologist

Blood and urine tests help keep track of your cholesterol, triglycerides, HbA1c and your kidney function. These checks monitor the effect of diabetes on different parts of your body. Eating well and exercising regularly can assist with keeping these numbers in your target range, however sometimes medications may be required and will be prescribed by your GP.

Remind your health care team to order these checks when you have a blood test.

Show

Triglycerides

Check your Triglycerides each year

GP or Endocrinologist

Blood and urine tests help keep track of your cholesterol, triglycerides, HbA1c and your kidney function. These checks monitor the effect of diabetes on different parts of your body. Eating well and exercising regularly can assist with keeping these numbers in your target range, however sometimes medications may be required and will be prescribed by your GP.

Remind your health care team to order these checks when you have a blood test.

Show

Microalbuminuria

Check your Microalbuminuria each year

GP or Endocrinologist

Blood and urine tests help keep track of your cholesterol, triglycerides, HbA1c and your kidney function. These checks monitor the effect of diabetes on different parts of your body. Eating well and exercising regularly can assist with keeping these numbers in your target range, however sometimes medications may be required and will be prescribed by your GP.

Remind your health care team to order these checks when you have a blood test.

Show

HbA1c

Check your HbA1c each year

GP or Endocrinologist

Blood and urine tests help keep track of your cholesterol, triglycerides, HbA1c and your kidney function. These checks monitor the effect of diabetes on different parts of your body. Eating well and exercising regularly can assist with keeping these numbers in your target range, however sometimes medications may be required and will be prescribed by your GP.

Remind your health care team to order these checks when you have a blood test.

Show

eGFR

Check your eGFR each year

GP or Endocrinologist

Blood and urine tests help keep track of your cholesterol, triglycerides, HbA1c and your kidney function. These checks monitor the effect of diabetes on different parts of your body. Eating well and exercising regularly can assist with keeping these numbers in your target range, however sometimes medications may be required and will be prescribed by your GP.

Remind your health care team to order these checks when you have a blood test.

Show
It is recommended to: Have you had
this checked?
Who checks it? Why is this important?

Feet

Have your feet checked by a health professional at least every six months

GP, Endocrinologist, Diabetes educator, Practice Nurse or Podiatrist

Check your feet daily and report any changes to your health care team. Problems such as blisters, skinbreaks and ulcers can become very serious quickly, particularly if you experience peripheral neuropathy as you may not be aware your feet have been damaged.

Show

Eyes

Have a comprehensive eye examination at least every two years

Optometrist / Ophthalmologist

Regular eye examinations are the best way to monitor any changes in your eyes and vision. Keeping BGLs in your target range can help to reduce the risk of problems with your eyes. If you notice any changes, tell your GP.

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Medications

Have a review of your current medications at least once a year

Diabetes educator, GP, Endocrinologist, or Practice Nurse

Take your prescribed medications correctly. Have your health care team review your medications regularly. Ask for help if you don't understand or if you think you may be experiencing side effects.

Show
It is recommended to: Have you had
this checked?
Who checks it? Why is this important?

Diabetes care plan

Have a review of your diabetes care plan at least once a year

Diabetes educator, GP, Endocrinologist, or Practice Nurse

A diabetes care plan pulls together all of the recommended diabetes activities like healthy eating, exercise and check-ups. Having a plan in place can help you to stay on track and feel confident looking after yourself and your diabetes. Keep it in a central place and refer to it regularly.

Show

Your notes and questions:

Is there anything you would like to remember to ask your health care team at your next appointment? Note it down here.

You can print out your completed annual cycle of care and take it with you to your next appointment!

You're finished!

Thanks for completing the Annual Cycle of Care checklist.

Find out more

Glossary

Aboriginal and Torres Strait Islander health worker

Aboriginal and Torres Strait Islander health workers can support individuals and families in manging diabetes and connect you with other health professionals.

Amount of carbohydrate

The amount of carbohydrate refers to both the serving size and the carbohydrate content of the food.

BGL

An abbreviation of blood glucose level, BGLs refers to the amount of glucose in the bloodstream. 

Blood Glucose Level

The amount of glucose in the bloodstream. Can be measured with capillary (taken from a finger prick) or venous (pathology test) blood.

Carbohydrate

Carbohydrates are one of the body's main energy sources. Carbohydrates are broken down in our digestive system into glucose. This glucose is then released into the bloodstream where it can travel around the body and be used for energy.

Cholesterol

Includes high density liproprotein cholesterol (HDL) and low density lipoprotein cholesterol (LDL). It is ideal to have high HDL and low LDL as HDL helps prevent heart disease by moving fat to the liver to be processed, whereas LDL encourages fat to deposit in our arteries.  

Dentist

A dentist assists with oral health and provides treatment.

Diabetes educator

A diabetes educator will provide you with information to manage your diabetes. They can also help you develop action plans for the unexpected (e.g. low or high BGLs).

Dietitian

Your dietitian can provide you with individualised information about healthy eating.

eGFR

The estimated glomerular filtration rate (eGFR) is a blood test that is used to assess how well your kidneys are working. 

Endocrinologist

An endocrinologist is a medical specialist who sees people with diabetes, especially those with type 1 diabetes, or those who are pregnant and have diabetes.

Glycaemic index (GI)

The glycaemic index (GI) is a way of describing how a carbohydrate containing food affects blood glucose levels.

GP

Your GP has a central role in overall assessment and management. Visit your GP regularly and discuss any problems as soon as they arise. Other members of your team, including specialists, will link in with your GP.

HbA1c

A measure of, on average, how much glucose has been in your blood stream over the previous 2-3 months. It is reported either as a percentage (%) or in mmol/mol.

HDL cholesterol

High density liproprotein cholesterol (otherwise known as 'good' cholesterol) is the type of cholesterol carrier which takes fats from our bloodstream, to our liver for processing. It is ideal to have high levels of HDL cholesterol as this can help prevent heart disease.

Hyperglycaemia

Refers to a raised level of glucose in the blood. Hyperglycaemia occurs when your blood glucose levels are too high. High blood glucose levels are usually considered hyperglycaemia when they are above 15mmol/L.

Hypoglycaemia

Refers to a low level of glucose in the blood. Hypoglycaemia, or a 'hypo', occurs when your blood glucose level drops too low. Low glucose levels are usually considered hypoglycaemia at less than 4mmol/L.

Ketones

Ketones are compounds produced by the body when fat is broken down for energy. Small amounts of ketones in the bloodstream are harmless. However, in large amounts they can be extremely dangerous. People with type 1 diabetes in particular are recommended to check for ketones when their blood glucose level goes above 15 mmol/L. When the level of ketones gets too high an emergency condition called ketoacidosis can occur.

LDL cholesterol

Low density lipoprotein cholesterol (otherwise known as 'bad' cholesterol) is the type of cholesterol carrier which deposits fat in our arteries. High levels of this cholesterol can lead to blockages in the arteries and heart disease.

Macrovascular damage

Damage to the big blood vessels that can lead to peripheral vascular disease, heart attack and stroke.

Microalbuminuria

This urine test measures how much albumin (protein) is released through the kidneys which can indicate kidney damage.

Microvascular damage

Damage to the small blood vessels that can cause eye, kidney, feet and nerve problems.

Monounsaturated and polyunsaturated fats

Monounsaturated and polyunsaturated fats are found in fish, avocados and nuts, as well as olive, sunflower, peanut and canola oil. These fats help to increase HDL cholesterol and decrease LDL cholesterol, which can decrease the risk of heart disease.

Ophthalmologist

An ophthalmologist is an eye specialist who can monitor any changes in your eyes and provide treatment.

Optometrist

Your optometrist assesses eye health and prescribes your glasses.

Peripheral Neuropathy

Refers to nerve damage of the feet or hands, a complication of diabetes, which can occur over time usually as a result of consistently high blood glucose levels.

Peripheral Vascular Disease

Damage to the blood vessels in the legs and feet resulting in limited blood supply, pain and sensation changes.

Pharmacist

A pharmacist prepares and dispenses drugs and medicine. They can also give you advice about your medicines.

Physiotherapist or Exercise Physiologist

A physiotherapist or exercise physiologist can give advice about exercise choices.

Podiatrist

A podiatrist will advise you on how to keep your feet healthy and treat foot problems.

Psychiatrist

A psychiatrist is a medical specialist who can help people who have emotional and psychological problems.

Psychologist

A psychologist counsels people with emotional and psychological problems and can help you make lifestyle changes such as giving up smoking.

Saturated fats

Saturated fats are found in foods like processed and fatty meats, full fat milk products, butter, coconut and palm oils. It is recommended you limit saturated fat in your diet as it can increase LDL cholesterol levels, which may increase your risk of heart disease.

Social worker

A social worker can provide counselling to individuals and families regarding personal and family problems.

Trans fats

Trans fats are found in some processed biscuits and commercially-made bakery products. They act the same way as saturated fats in the body so it's recommended we minimise our intake of these fats.

Triglycerides

A type of fat found in the blood that the body uses for fuel or stores away.

Type of carbohydrate

The type of carbohydrate refers to the glycaemic index (GI) of the food. The glycaemic index (GI) is a way of describing how a carbohydrate food affects blood glucose levels.

The nice thing about teamwork is that you always have others on your side. Margaret Carty