by Ann S. Williams, PhD, RN, CDE
Managing your diabetes is a team effort. There are many professionals who could be involved, depending on your particular needs. This column will explain which professional could be involved, which should be in your core diabetes team, and when you might want to involve some of the other professionals.
Your diabetes management team can consist of any or all of the following people:
* A primary care provider (doctor or nurse practitioner)
* An endocrinologist (specialist in diseases of the glands, including diabetes)
* A nurse diabetes educator
* A dietitian
* A dentist
* An eye specialist (ophthalmologist or optometrist)
* A pharmacist
* A mental health professional
* A cardiologist (heart specialist)
* An exercise physiologist
* A nephrologist (kidney specialist)
* A neurologist
* A podiatrist (foot doctor)
* A vision rehabilitation therapist
* Finally, the most important person on your health care team is YOU!
Your core diabetes team should include at least you, a physician, a nurse diabetes educator, a dietitian, an ophthalmologist or optometrist, and a dentist. If you see a specialist, such as an endocrinologist, for your diabetes care, you should have both an endocrinologist and a primary care provider. If you use diabetes medications, you should also have a pharmacist.
Your primary care provider is responsible for your general medical care. This person would be responsible for doing an annual physical examination, taking care of any medical problems that are not specifically covered by a specialist, and referring you to other health care providers when you need them. Many health insurance plans require that each covered person has a primary care provider, and that the primary care makes all referrals to other health care professionals. Usually primary care providers for adults are doctors specializing in either internal medicine or family practice, or nurse practitioners. Sometimes, for people who have a specific medical problem, a specialist agrees to be a person's primary care doctor.
Many people with uncomplicated type 2 diabetes receive excellent care for their diabetes from a primary care provider who has received recent continuing education in diabetes care. If your diabetes is simple to manage, if you are meeting all your diabetes care goals, and you have a diabetes care plan you can live with, then you might decide it's best for you to work with your primary care provider for your diabetes care. However, you might want to see an endocrinologist for your diabetes care if your blood glucose is consistently higher than you want it, if your primary care doctor is not also helping you keep your blood pressure and cholesterol near normal, or if you believe you need a change to make your diabetes care plan more flexible.
An endocrinologist is a specialist in problems of the endocrine system, the glands of the body. Since the pancreas is the gland that makes insulin, most specialists in diabetes care are endocrinologists. In general, everyone with type 1 diabetes should see an endocrinologist. People with type 2 diabetes should see an endocrinologist for diabetes care if they take three or more injections a day, use an insulin pump, or have diabetes complications. If you have other medical conditions, such as asthma or multiple sclerosis, that can make your diabetes management more difficult; if you have other problems of the endocrine system, such as thyroid difficulties, or as mentioned above, you are not meeting your diabetes care goals, you should see an endocrinologist.
Sometimes, people see an endocrinologist only for a consultation, and then the primary care provider takes over the diabetes care again. But for other people, the endocrinologist takes over the medical aspects of the diabetes care, seeing the person regularly to do diabetes-related medical tests and make adjustments in the diabetes care. In this situation, the primary care provider still takes care of all other non-diabetes medical needs. Note: There is a real shortage of endocrinologists in the United States at this time.
You should have a routine follow-up visit with the doctor who takes care of your diabetes every three to six months. Visits should be scheduled more frequently if you are having trouble keeping your blood glucose under control, or if you have some complications from diabetes, or if you are sick. Your doctor will order lab tests when they are necessary, prescribe medications when you need them, and watch for signs of diabetes complications. Your doctor can help you decide when you need to work with any of the other professionals on this list.
A nurse diabetes educator can help you understand all the different parts of your diabetes care, and how they work together. For example, your nurse diabetes educator can teach you about what causes diabetes, the effects of diabetes on the body, physical activity as a way of controlling diabetes, general principles of nutrition for diabetes control, medications, stress management, and emotional and social issues common with diabetes. A nurse diabetes educator can also help you solve problems about how to do any parts of your diabetes care that are difficult for you.
A dietitian can help you understand healthy meal planning. You need to know what kinds of food to eat, how much to eat, and when to eat to keep your body healthy. You need a meal plan designed especially for you, taking into account your personal physical needs, your cultural background, and your likes and dislikes about food. You also can talk with your dietitian about ways to manage your meal plan that will allow you to have much more flexibility than was available in the past.
A dentist can help with care of your teeth and mouth. Because diabetes can affect both teeth and gums, everyone with diabetes should see a dentist at least every six months. Some people with dental or gum problems should see a dentist more often.
An eye specialist can be either an ophthalmologist or optometrist. An ophthalmologist is a physician who specializes in diseases of the eye. An ophthalmologist can do eye screenings, prescribe eyeglasses, contact lenses, eye medications, and low vision aids, and do eye surgery. An optometrist is a non-physician specialist who can do eye screenings, and prescribe eyeglasses, contact lenses, eye medications, and low vision aids. Every adult who has diabetes and has useful eyesight should have a dilated eye exam at least once a year to screen for diabetic retinopathy and glaucoma. If you have problems with your eyes, you may need to have eye exams more often. If you have low vision, an ophthalmologist or optometrist who specializes in low vision care can help you find the tools and techniques that will allow you to make best use of the vision you do have.
A pharmacist can help you understand your medications. You need to know how your medications work, how much to take, when to take them, what side effects to watch for, and whether your medications have any special precautions. If you take medications for other medical conditions, your pharmacist can also tell you whether any of your medications interact in a way that might harm your body.
A mental health professional can be a psychologist, a psychiatrist, or a social worker. A mental health professional can help you if you are having trouble accepting your diabetes or your diabetes treatment, or if you are having trouble making a change you need to make to care for yourself, or if you have depression or high stress that makes diabetes control difficult for you. You do not need to be diagnosed with a mental illness to benefit from working with a mental health professional. Learning to manage stress well, or to change your behavior about eating or exercise are good reasons for a person with diabetes to seek help from a mental health professional who knows about modern diabetes management.
Other health care professionals who might be involved in your diabetes care team include:
* A cardiologist, a heart specialist, can help if you have heart problems.
* An exercise physiologist can help you develop an exercise plan that works for you.
* A nephrologist, a kidney specialist, can help if you have kidney problems.
* A neurologist can help if you have damage to your nerves.
* A podiatrist can help with your foot care.
* A vision rehabilitation therapist can help if you have vision loss that cannot be corrected, by teaching low vision and non-visual methods for doing the tasks necessary for daily living and holding a job.
Finally, YOU are the most important member of your health care team. You are the person who is responsible for doing almost all of your day-to-day diabetes care. You are also responsible for letting the other team members know if something is not working. You are the vital link that makes all the different parts of the team work together, so you can have as healthy a life as possible.