DIABETES: BUILDING YOUR CARE TEAM
A guide to health professionals you and your loved ones may see for diabetes
BY:SHAUNA S. ROBERTS, PHD
A multitude of health professionals are available—and often necessary—to help deal with the physical and psychological challenges faced by those with diabetes and those who care for them. The goal, as the American Diabetes Association points out, is to create a team of these experts to assist you in resuming a normal life. So who heads the team?
Your Role as Team Leader
Diabetes differs from most chronic illnesses in that the patient or the caregiver—not a doctor—is the main healthcare provider. You may see the doctor only every three months or so, but diabetes treatment is a 24/7 reality. That daily care falls on your shoulders.
The main goal of treatment is to keep blood glucose levels close to normal values through diet, exercise and possibly medication. Good control helps you feel healthy and also slows or stops complications, such as diabetes-related kidney disease.
As team leader, you have tasks to handle as regards lifestyle, treatment, prevention and record-keeping. They include:
Lifestyle
Learn all you can about diabetes and its treatment
Set goals with your diabetes doctor
Eat healthfully, exercise regularly and don't smoke
Treatment
Take medication, whether pills or injections, in proper doses at prescribed times
Recognize symptoms of too-low blood glucose levels
Test and maintain a log of blood glucose levels, as instructed
Know what action to take when blood glucose levels are too high or too low
Test urine for ketones (and maintain a log of readings) during illnesses and other times, as the doctor recommends
Adjust doses of diabetes medicines as needed, but only if the doctor has taught you how
Speak honestly with the diabetes team about problems, including your not following the treatment plan; the team can't help improve your control if no one knows why your treatment isn't working as expected
Know when to call the diabetes-care team
Prevention
Check feet daily for sores, blisters, callouses and other problems
Wear protective footwear always
Brush teeth at least twice a day with a fluoride toothpaste; floss at least once a day
Record-Keeping
Track doctor appointments and prescription renewals
Organize and track doctors' bills and insurance reimbursements
Ask each specialist you see to send a report to the diabetes doctor
Maintain a health history that lists surgeries, pregnancies, vaccinations, medical conditions, past and present prescriptions, and past and present doctors
The Core Team
Certain health professionals should play a main role in the care of every person with diabetes. They include:
Diabetes Doctor. Some people prefer to see an endocrinologist—a doctor who specializes in diabetes and related diseases. An endocrinologist is more likely than other physicians to be current on the newest diabetes research and treatment.
Other people prefer to see their family doctor, who already knows them and their medical history well. Some internists are quite knowledgeable about diabetes, but others aren't. Consider seeing an endocrinologist if diabetes is not your doctor's forte.
It's important to choose a single doctor to coordinate all your diabetes care and keep the whole picture in mind. This person designs your diabetes treatment and tweaks it as needed to keep blood glucose levels within the target range. The diabetes doctor can decide when you need to see specialists, make sure your various prescriptions are not at odds, and be the last word when other providers disagree on your treatment.
ADA recommends that doctors perform an HbA1c test-a blood analysis that determines long-term average control—at least twice a year in people who have their diabetes under control. People who have changed therapy or are not meeting their blood glucose goals should be tested quarterly.
Tests for cholesterol and triglycerides (lipids) should be done once a year—more often if lipid goals are not being met, and possibly less often if lipid values are excellent.
At least yearly, doctors should measure blood creatinine, an indicator of kidney function. Doctors should also annually test urine for protein (a sign of possible kidney disease) in all people with type 2 diabetes, as well as in people who've had type 1 diabetes for at least five years.
Doctors should screen patients with diabetes for loss of sensation in the feet (a sign of nerve disease) upon diagnosis and at least once a year after that. Also, they should do a detailed foot exam at least yearly.
Every visit should include a foot check, a blood-pressure measurement and a weight measurement. Other tasks your diabetes doctor may perform at your visit: review of your treatment plan, blood glucose records and medication usage; asking about infections you've had; and examining your mouth, fingers, skin and thyroid.
Eye Doctor. Diabetes can damage eyes. The retina-the light-sensing lining of the eyeball—is particularly susceptible to injury, making it vital to regularly visit an ophthalmologist (an MD or DO, who specializes in care of eyes) or an optometrist (a professional with an OD degree, who is trained in vision care and prescribing corrective lenses). ADA recommends that all adults and teens with type 1 diabetes have a comprehensive eye exam with dilation (enlargement of the pupil to allow easier viewing inside the eye) by an ophthalmologist or optometrist within three to five years after diabetes starts. People with type 2 diabetes should have a dilated comprehensive exam by an ophthalmologist or optometrist soon after diagnosis.
Generally, after that first exam, people with diabetes should be checked annually. However, a person with retinal damage (retinopathy) may need more frequent exams.
Dentist. Diabetes makes people more prone to several oral problems, including gum infections, fungus infections and dry mouth, which is both uncomfortable and cavity inducing. As a result, you should visit your dentist at least twice a year to get your teeth cleaned and your mouth examined. If you are having problems, you may need more frequent visits.
Diabetes Educator. This is a health professional trained to be a Certified Diabetes Educator (CDE). Diabetes educators may also be doctors, nurses, dietitians, pharmacists, exercise physiologists, podiatrists or social workers. They provide people with diabetes and their families with the knowledge and skills needed to care for diabetes at home. For example, they can teach how to test blood glucose levels and interpret the results, help develop healthy eating habits, design a safe and suitable exercise program, review blood-testing techniques, and explain how to handle sick days and reduce complications.
Dietitian. Perhaps the most important component of diabetes treatment is a healthy diet. Most people with type 2 diabetes are overweight, which can make diabetes harder to control. A registered dietitian (RD) is an expert in food and nutrition who can help people with diabetes eat healthfully and lose weight.
The days of one-size-fits-all diabetes diets have passed. Dietitians now tailor meal plans to each person, taking into account food preferences, work or school schedules, ethnic and cultural background, age, other medical conditions, family situation and weight. ADA recommends that every person with diabetes receive a personalized meal plan, preferably designed by a registered dietitian.
Pharmacist. Most people with diabetes need medicine to control it. And since many people with diabetes have other conditions-say, high blood pressure or high cholesterol levels-that require additional medication, a pharmacist can let you know of possible side effects and interactions resulting from drugs for those conditions being taken in conjunction with diabetes medication. Your pharmacist also can advise on such matters as whether a pill can be safely cut in half, how to remember to take all your medicines on schedule, which blood glucose meter may suit you best, and what cold medicines are best for people with diabetes.
By assembling a competent diabetes team and taking charge of your or your loved one's diabetes care, you can make life with diabetes as pleasant and carefree as possible.