Your Health Care Team
Your diabetes care team should include a variety of health care providers who each play a role in your health.
You are the most important member of your health care team.
After all, you are the one who is affected by diabetes and cares for it every day. Only you know how you feel and what you're willing and able to do.
You do the exercise.
You make and eat the foods on your meal plan.
You take the medicine or inject the insulin.
You check your blood sugar (glucose) levels and keep track of the results.
And of course, you are the first to notice any problems.
Your health care team depends on you to talk to them honestly and to tell them how you feel.
The Primary Care Provider
The Primary Care Provider, who may be a primary care or family practice physician, is who you see for general checkups and when you get sick.
A doctor with special training (and usually certification) in diseases such as diabetes is called an endocrinologist. If you do not see an endocrinologist, look for a primary doctor, family practice doctor or an internist who has cared for many people with diabetes. Your primary care doctor may also be the one who refers you to specialists or other team members.
Other health care providers who provide primary care include nurse practitioners and physician assistants, who typically work in collaboration with a physician.
If you are looking for a new doctor, your visit should include some time for you to get to know each other. Make sure you feel comfortable talking about the details of your health and lifestyle with this doctor. You might ask:
- Do you have special training in diabetes?
- Are most of your patients people with diabetes? Do you see more people with type 1 or type 2 diabetes?
- What tests will you do at regular office visits? How often will you order these?
- What days are you not here? Who covers on nights and weekends?
- What are your fees? Do you accept my insurance plan?
- Are you associated with other diabetes care professionals, so I will benefit from a health care team?
- Do you refer to an educator or dietitian?
Your doctor's support is important. Your insurance plan may require you to get the doctor's referral for visits to the other health professionals on the team.
Before you leave the office, ask the staff about other details, such as how long a wait patients usually have. Does the doctor's schedule run on time? Is there a set call-in time when you can talk to the doctor on the phone? What is the billing policy?
After the visit, ask yourself:
- Did the doctor really listen to my concerns?
- Was the doctor concerned about my diabetes control?
- Did the doctor answer my questions?
A nurse educator or diabetes nurse practitioner is a registered nurse (RN) with special training and background in caring for and teaching people with diabetes. Many are Certified Diabetes Educators (CDE) and some may have a master's degree. Nurse educators often help you learn the day-to-day aspects of diabetes self-care. They can teach you
- what diabetes is
- how to cope with diabetes and to make changes in your health habits
- how to use diabetes medications
- how to work with insulin and give yourself shots
- how to check your blood sugar
- how to keep track of your diabetes
- symptoms of low and high blood glucose
- how to take care of an insulin reaction
- how to handle sick days
- how to stay healthy if you are pregnant
A registered dietitian (RD) is trained in nutrition and has passed a national exam. An RD may also have a master's degree or may be a Certified Diabetes Educator (CDE). You want to be sure to work with an RD who has training and experience with diabetes. If your doctor does not work with a dietitian, ask him to refer you to one.
Your dietitian helps you figure out your food needs based on your desired weight, lifestyle, medication, and other health goals (such as lowering blood fat levels or blood pressure). Even if you've had diabetes for many years, a visit to the dietitian can help. For one thing, our food needs change as we age. Nutrition guidelines for people with diabetes also change from time to time.
Dietitians can also help you learn how the foods you eat affect your blood sugar and blood fat levels
- to balance food with medications and activity
- to read food labels
- to make a sick day meal plan
- to plan meals
- to plan for eating out and special events
- to include ethnic or foreign foods into your meals
- to find good cookbooks
- to make food substitutions
What Is a CDE?
A CDE is a certified diabetes educator. CDEs may be nurses, dietitians, doctors, pharmacists, podiatrists, counselors, or exercise physiologists. These professionals all work in some way to teach or care for people with diabetes. They may work in hospitals, clinics, diabetes centers, or private offices.
To become a CDE, a health care professional must pass a national test. The test covers physiology, drug treatment, blood glucose testing, complications, mental health issues, and teaching/learning principles. CDEs must pass a recertification test every 5 years. When you see the letters CDE after a health care professional's name, you know the person is specially trained in the care and treatment of people with diabetes.
Find a Recognized Education Program near you.
An endocrinologist is a doctor who specializes in treating diabetes and other diseases of the "endocrine system" — the body's system of glands that produce hormones that control the way the body works. The pancreas is part of the endocrine system, and insulin is one of the key hormones the body needs to function properly.
Besides diabetes, endocrinologists treat diseases involving the bones, the pituitary gland, and the thyroid and adrenal glands.
Many people with diabetes may never need to see an endocrinologist in order to take good care of their diabetes. Most people with type 1 diabetes do see an endocrinologist, especially when they are first diagnosed, and many people with type 2 diabetes may see an endocrinologist if they are having trouble getting their diabetes under control or are developing severe complications.
Some doctors are referred to as "diabetologists" because they have taken a special interest in managing diabetes and its complications, and they may provide excellent diabetes care. However, diabetology is not a board-certified field of medicine like endocrinology.
This doctor is another key member of your health care team, because diabetes can affect the blood vessels in the eyes. When eye problems are caught early, there are very good treatments.
The eye doctor will be either an ophthalmologist or an optometrist.
The American Diabetes Association guidelines say you should see your eye doctor at least once a year. These checkups are the best way to detect diabetic eye disease. Your eye doctor will check for any changes in your eyes. If there are changes, the doctor will treat the problem or refer you to another doctor with special training in that area. Be sure your eye doctor is familiar with how to spot and treat diabetic eye disease.
It's a good idea to ask:
- How many of your patients have diabetes?
- Do you perform eye surgery?
- Will you send regular reports to my primary care or diabetes physician?
Mental Health Expert: Social Worker/Psychologist/Psychiatrist/Marriage and Family Therapist
Mental health professionals help with the personal and emotional side of living with diabetes. A social worker must have a master's degree in social work (MSW) as well as training in individual, group, and family therapy. LCSW stands for licensed clinical social worker. This means the social worker has passed a state exam.
Social workers may be able to help you find resources to help with your medical or financial needs and should hold a master's degree in social work (MSW), as well as have training in individual, group, and family therapy. Some social worker's may even be able to help you cope with many concerns related to diabetes, including problems within the family and coping with workplace situations.
A clinical psychologist who works directly with patients can have a master's or doctoral degree in psychology and is trained in individual, group, and family psychology. A few sessions with a psychologist might help during a time of special stress. On a long-term basis, a psychologist might help work on more lasting problems.
A psychiatrist is a medical doctor who can prescribe medication to treat physical causes for emotional problems. Psychiatrists also provide counseling.
Marriage and family therapists can help you with personal problems in family and marital relationships and problems on the job. These therapists should hold a master's or doctoral degree in a mental health field and have additional training in individual, family, and marriage therapy.
This health professional is trained to treat feet and problems of the lower legs. Podiatrists have a Doctor of Podiatric Medicine (DPM) degree from a college of podiatry. They have also done a residency (hospital training) in podiatry.
Diabetes makes you prone to poor blood flow and nerve damage in the lower legs. You may get infections more often. Sores, even small ones, can quickly turn into serious problems. Any foot sore or callus needs to checked by your primary care doctor or a podiatrist. Do not try to fix these yourself, because you could cause an infection. But do inspect your feet daily for signs of trouble.
Podiatrists treat corns, calluses, and more serious problems. Ask your podiatrist:
- How many of your patients have diabetes?
- Are you familiar with the foot problems diabetes can cause?
- Will you work with my primary care doctor, if needed?
A pharmacist has a wealth of information on medicines: what's in them and how they interact with each other. Pharmacists are highly trained professionals who must know about the chemistry of the products they dispense and what effects, both good and bad, medications have on the body. Therefore, they can also give advice on whether and how any medication you take for your diabetes or other conditions could or will affect your blood glucose levels.
It is important to find a pharmacy you like and to stick with it. This way, the pharmacist can keep an accurate and up-to-date profile of your medical history, allergies, and medications.
Pharmacists do more for you than fill your prescriptions. They alert you to the potential common or severe side effects of any drug you are going to take. With each new prescription, they can review your medication profile to see if any of your current medications might interact with your new prescription. So, in addition to asking your diabetes care provider, you can ask your pharmacist to recommend over-the-counter medicines for colds or other minor illnesses. For example, if your pharmacist knows you take a sulfonylurea, he or she may recommend a cold medicine with little or no alcohol to avoid any possible interaction between the two medications.
People with diabetes are at somewhat greater risk for gum disease. The excess blood sugar in your mouth makes it a good home for bacteria, which leads to infection. See your dentist every six months for a checkup and a cleaning. Be sure to tell your dentist that you have diabetes.
Exercise plays a major role in your diabetes care, no matter which type of diabetes you have. Exercise can help lower blood sugar, help your body better use insulin, and help control your weight. It can also improve your blood fat levels, reduce stress, and improve your overall fitness level. Even if you have diabetic complications, ask your doctor about safe exercises you can do.
The best person to help you and your doctor plan your fitness program is someone trained in the scientific basis of exercise. Your doctor can help you look for someone with a master's or doctoral degree in exercise physiology or for a licensed health care professional who has graduate training in exercise physiology. Certification from the American College of Sports Medicine is another sign that the person has the basic skills needed to plan a safe, effective exercise program. Always get your doctor's approval for any exercise program.
Older adults may need to see other specialists, such as cardiologists, nephrologists, and neurologists.