“Diabetes is a devastating disease if not treated,” notes Nora Saul, MS, RD, a certified diabetes educator with Joslin Diabetes Center. Thankfully, treatment options are vast—but people living with the disease need to be their own best advocates. People with diabetes should request from their physician a diabetes care review annually. The good news is there are ways to lower your A1c levels without using medication. Try these easy suggestions:

1. Blood glucose review and check of A1C levels*. The A1C test measures the glucose (blood sugar) in your blood by assessing the amount of what's called glycated hemoglobin. An A1C level below 5.7 percent is considered normal. An A1C between 5.7 and 6.4 percent signals prediabetes. Type 2 diabetes is diagnosed when the A1C is over 6.5 percent.
   At your annual check-ins, make note in writing of where your levels are, and where you and your doctor would like them to be.
2. Weight, body mass index, and height. If your weight or BMI have increased year over year, talk to your provider about lifestyle strategies to manage them.
3. Blood pressure, triglycerides, and cholesterol*. At your exams, also make note of these in writing, as well as where you would like them to be.
4. Eyes: Get a dilated retinal exam by an ophthalmologist or optometrist—diabetes improperly treated can lead to diabetic retinopathy, which can cause blindness if not treated.
5. Feet: Have your doctor examine your feet at least once a year, including checks for blood circulation, nerve detection and sensitivity. Check in with your doctor about your foot health more regularly than once a year if you have problems; make sure to share info about redness, swelling, calluses, cracks in the skin, warmth, or pain or discomfort.
6. Kidneys: Have your urine and blood checked at least once a year for albumin and creatinine, the levels of which determine how your kidneys are functioning.
7. Mouth: See a dentist to have your teeth, gums, and tongue checked twice annually, or as often as recommended by your physician.
8. Vaccines: Get the flu vaccine every year, and the pneumonia vaccine, if appropriate for your age and recommended by your doctor.
9. Mental health: Check in with your doctor about your general mental state, including feelings of depression, stress, or sexual dysfunction, both of which can be more common in people with diabetes.
10. General health: Also check in about your diabetes management generally—your  medications, your weight, your energy levels, your diet and exercise regimens, and any other health issues that may have arisen over the past year. If you need more support or education around managing your diabetes, discuss this too. Remember, your health care provider is a key partner in managing your disease.

* May need to be done more regularly. Discuss with your provider.