Who You Need on Your Diabetes Healthcare Team
(excerpted from Think Like A Pancreas: A Practical Guide to Managing Diabetes With Insulin by Gary Scheiner MS, CDE, DaCapo Press, 2011)
Surrounding yourself with a quality health care team is like putting together a winning basketball team roster. Each player has a role, yet all should work collaboratively for your benefit. Your job is to assemble the team and hold them accountable for doing their jobs. That means you may have to fire or trade some players from time to time, but that’s OK.
You can opt for a “prepackaged” medical team, but if you’re putting one together yourself, look for the following professionals to create your own team of diabetes healthcare all-stars:
A Certified Diabetes Educator (CDE)
A CDE is often a nurse or dietitian, but it can also be a pharmacist, exercise physiologist, physician, mental health counselor, or anyone in the healthcare field with advanced training in diabetes management. Your CDE should be able to coach you through the complexities of living day-to-day with diabetes. CDEs are expert teachers, as well as skilled clinicians. If you can find a CDE (or physician) who also has diabetes, you can tap into a gold mine of both personal and professional experience.
To locate a CDE in your area, talk to your doctor or search the American Association of Diabetes Educators database at https://nf01.diabeteseducator.org/eweb/DynamicPage.aspx?Site=AADE&WebCode=AADEDiaE.
Different physicians have different levels of expertise in treating diabetes.
- Endocrinologists typically have the most experience and skill in diabetes care. However, some endocrinologists specialize in treating other endocrine disorders (pituitary or thyroid problems, for example) or are more adept at treating people with Type 2 diabetes who don’t use insulin.
- Internal medicine doctors (internists) usually treat a variety of chronic health conditions, diabetes being just one of them. Some internists have a great deal of expertise in treating diabetes; others tend to refer their insulin-using patients elsewhere.
- General practitioners (family doctors) typically treat many short-term and long-term illnesses and have only a basic understanding of how to manage diabetes.
Look for a physician who is board certified; this ensures that they receive continuing education and are updated on the latest treatment methods. To find a board-certified physician, search the American Board of Medical Specialties’ database at http://www.abms.org/verify-certification/.
Regardless of the type of physician you hire, he or she is responsible for screening for complications, prescribing the necessary tests and medications, intervening in case of a crisis, keeping you abreast of the latest developments in diabetes care, and making sure that your blood sugar control is on track. If your physician is not meeting these minimum criteria, fails to answer your questions to your satisfaction or does not support your pursuit of new technologies, management approaches or other healthcare specialists, consider looking for someone else.
A Registered Dietitian (RD)
Given the heavy influence that food has on diabetes control, it pays to have a nutrition expert in your corner. An RD can work with you to increase your knowledge and skills in carbohydrate counting, weight control, sports nutrition, special occasion dining, vegetarian meal planning, alcohol safety, and dietary management of conditions such as hypertension, gluten intolerance, and elevated cholesterol. To find an RD who specializes in diabetes, search the American Dietetic Association database at http://www.eatright.org/find-an-expert.
A Mental Health Counselor
With all the pressure placed on people with diabetes to manage blood sugar levels while still dealing with life, a mental health counselor can be a valuable member of your health care team. Mental health professionals (social workers, psychologists, and psychiatrists) can help with issues such as stress, depression, eating disorders, sleep disturbances, obsessive/compulsive behaviors, anxieties, relationship difficulties, financial hardship, and job discrimination. If you are experiencing issues that may be interfering with your ability to take proper care of yourself, don’t hesitate to ask your physician for a referral to a mental health professional.
The Exercise Specialist
Exercise remains a hot topic in diabetes because of all the benefits it has to offer. However, you can also get yourself in hot water if you exercise improperly. Severe hypoglycemia, acute injuries, and worsening of diabetic complications are among the risks for people with diabetes who exercise. An exercise physiologist is a healthcare professional who understands the physical, psychological, and metabolic effects of exercise. He or she can help you design an exercise plan, formulate strategies to prevent hypoglycemia, manage blood sugars during sports/competitive activities, and reduce your risk for injuries and other complications. Look for an exercise physiologist who is also a diabetes educator; many ADA-recognized diabetes centers and programs affiliated with large medical institutions offer the services of exercise physiologists.
Given the complexity of diabetes and the many organ systems it affects, it would be wise to include a few other specialists on your health team. These could include:
- a podiatrist (for preventive foot care and treatment of foot problems)
- a ophthalmologist (for routine eye exams and treatment of eye disorders)
- a dentist (for ongoing tooth/gum care and treatment of periodontal disease)
- a nephrologist (for treatment of kidney disorders)
- a neurologist (for treatment of nerve disorders)
- a cardiologist or vascular surgeon (for treatment of large blood vessel diseases)
This excerpt has been edited mainly for length and updated to include new links
Gary Scheiner and his team of clinicians at Integrated Diabetes Services are available for individual consultations via phone and the internet. Visit www.integrateddiabetes.com call 1-610-642-6055 for more information.
If you would like to purchase a signed copy of Think Like a Pancreas, call Integrated Diabetes Services directly at (877) 735-3648; (outside the US 1-610-642-6055), or order it through the IDS store here.
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