THE MEDICAL TEAM: The Primary Team
Your first line of defense and assistance in caring for your loved one with diabetes
BY:SHAUNA S. ROBERTS, PHD
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 and is therefore 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 well knows them and their medical history. Some internists are quite knowledgeable about diabetes, but others aren't. Consider seeing an endocrinologist if diabetes is not your doctor's forte. Whomever you choose, this diabetes doctor should: coordinate all your diabetes care, designing and tweaking treatment as needed; decide when you need to see specialists; make sure your various prescriptions are not at odds; and be the last word when other healthcare providers disagree on your treatment.
The diabetes doctor should also:
1. Perform an HbA1c test—a blood analysis to determine long-term averagecontrol—at least twice a year in people who have their diabetes under control;people who have changed therapy or are not meeting their blood glucosegoals should be tested quarterly
2. Test for cholesterol and triglycerides (lipids) annually (more frequently if lipid goals aren't being met; possibly less often if lipid values are excellent)
3. Measure blood creatinine (a kidney-function indicator) at least annually
4. Test urine for protein (a sign of possible kidney disease) annually in all people with type 2 diabetes, as well as in people who've had type 1 diabetes for at least five years
5. Screen for loss of sensation in the feet upon diagnosis and at least annually after that
6. Perform a detailed foot exam at least annually
7. Check foot condition, blood pressure and weight at every visit
8. Review treatment plan, blood-glucose records and medication usage at every visit
9. Ask about recent infections at every visit
10. Examine mouth, fingers, skin and thyroid at every visit
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) by an ophthalmologist or optometrist within three to five years after diabetes starts. People with type 2 diabetes should have this exam soon after diagnosis. Generally, after that first exam, people with diabetes should be checked annually. However, a person with retinal damage (retinopathy) may need exams more often.
Dentist. Diabetes increases susceptibility to oral problems, including gum infections; fungus infections; and dry mouth, which is both uncomfortable and cavity inducing. As a result, dentists should be visited at least twice a year and more often if the patient is having problems.
Certified Diabetes Educator. A CDE may also be a doctor, nurse, dietitian, pharmacist, exercise physiologist, podiatrist or social worker with the knowledge and skills needed to care for diabetes at home. For example, a CDE 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.
Registered Dietitian. An RD is an expert in food and nutrition who can help people with diabetes eat healthfully and lose weight, which are among the most important components of diabetes treatment. RDs 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 an RD.
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 inform you of possible side effects and interactions resulting from drugs for those conditions being taken in conjunction with diabetes medication. Pharmacists also advise on 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, what cold medicines are best for people with diabetes and more.
For more on The Medical Team, click on:
The Secondary Medical Team
Dealing with Multiple Doctors