The Diabetes Team

Author: Judy Kohn, RN, BSN, CDE

Last Updated: Thursday, October 18, 2007

Q: "I am newly diagnosed with type 2 diabetes and am scheduled to attend diabetes classes. I am already feeling overwhelmed with all of this and am looking forward to getting some help. In some of your answers, you refer to the diabetes team. What is the team?”

A: There are two common phrases that apply to my answer: "It takes a village to raise a child" and "Two (or more) heads are better than one." You will soon learn in your class that diabetes can affect the entire body, so it helps if you have access to a variety of experts to help you manage your condition. In fact, Standards of Care have been established by the American Diabetes Association (ADA) for managing diabetes; these standards provide guidelines for how often you should see your doctor, what areas should be examined, the lab tests that are required, and what topics should be covered in your education program.

The Team Approach: Core Team and Supporting Players

Your primary care provider will recommend the experts for you to see. Some large diabetes centers have all the team members working under one roof; however in most situations, the experts may be located in different places.  There are some key members—i.e. the “core team” that all people with diabetes should see, and then there are other team members, somewhat like "supporting players" whom you may see depending on your individual needs.

The Core Team

• Primary Care Provider
  • Your doctor may be a family practice physician or an endocrinologist (a doctor with special training and certification in endocrine diseases such as diabetes). Your primary care doctor may refer you to an endocrinologist or other members of the team.
  • Other healthcare providers who may provide primary care include nurse practitioners and physician assistants who work in collaboration with a physician.
• Nurse Educator
  • A diabetes nurse educator or nurse practitioner is a registered nurse (RN) with special training in diabetes. Many RNs are certified in the field of diabetes (called Certified Diabetes Educators, or CDEs). 
  • The nurse educator will teach you all about diabetes and the self-management skills involved in keeping your diabetes in good control. In some settings, the nurse may assist in adjusting your diabetes medication dosages.
  • If your doctor does not know of a nurse educator with experience in diabetes, ask for a referral.  You can find a diabetes nurse educator in the related links below, from the American Association of Diabetes Educators.
• Registered Dietitian
  • A registered dietitian (RD) has a minimum of a bachelor's degree in nutrition, and also may be a CDE. A dietitian will help you determine your food needs based on your weight, lifestyle, medication, and other medical conditions.  You can learn how foods affect your body, and also how to plan for special situations such as eating ethnic foods, dining out, parties or holidays, and sick days.
  • If your doctor does not know of a dietitian who has training and experience with diabetes, ask for a referral.  You can find a dietitian in the related links below, from either the American Dietetic Association or the American Association of Diabetes Educators.
• Eye Doctor
  • The ADA guidelines recommend you see your eye doctor (either an ophthalmologist or an optometrist) at least once a year. Be sure to see an eye doctor who either specializes in eye disease or has experience in knowing how to spot and treat diabetes eye disease. Usually your primary care provider will recommend someone appropriate for you.
• Dentist
  • People with diabetes are more prone to gum or other dental disease, so it is important that you maintain regular visits with your dentist and dental hygienist for teeth cleaning and check-ups.
• Pharmacist
  • The pharmacist not only fills your prescriptions, but also provides information on diabetes supplies and over-the-counter meds and how they may affect your blood glucose. It is best if you find a pharmacy you like, and go there for all your medication needs. This way, your pharmacist can keep an up-to-date record of your medical conditions, allergies, and medications, and alert you to possible side effects or drug interactions.

Other Team Members

Depending on your individual situation and needs, you may interact with other experts listed below.

• Podiatrist
  • A Podiatrist has a Doctor of Podiatric Medicine (DPM) degree, and specializes in treatment of the feet and problems of the lower legs. 
  • You will learn that people with diabetes can be prone to foot problems, but that proper foot care and regular check-ups can prevent many problems. Your primary care provider will usually do your regular foot and leg exams, but may refer you to a podiatrist for specific problems.
• Social Worker/Psychologist/Psychiatrist/Marriage and Family Therapist
  • Depending on your situation, these experts are mental health professionals who can help you with the personal and emotional aspects of coping with diabetes.
  • Examples of issues they can assist you with include:  marital problems, workplace situations, family problems, other mental health problems, or financial issues requiring resources from a social services network.
• Clergy /Support Groups
  • You may find support from the spiritual guidance and counseling services of religious leaders.
  • Many people appreciate the interaction and friendship from a diabetes support group to learn new ideas or methods to cope with the daily challenges of diabetes management.  Support groups are also helpful to spouses and caregivers. In addition, there are support groups specifically for people who use or are interested in using insulin pumps.
• Exercise Physiologist/Physical Therapist/Occupational Therapist/Personal Trainer
  • Some diabetes centers have an exercise specialist on staff to help tailor an exercise regimen to meet your needs.
  • If you have certain physical problems or injuries, you may be referred to a physical therapist to help you manage pain or improve mobility, and design customized exercises.
  • You may be referred to an occupational therapist if everyday activities (such as dressing, cooking, or driving) are difficult to do.
  • You may choose to work with a personal trainer through a health club or gym to coach you through an individualized fitness routine.
• Neurologist
  • If you have nerve damage from uncontrolled or long-term diabetes, you may be referred to a doctor who specializes in the nervous system.
• Nephrologist
  • Should you have problems with kidney function, you would be referred to a doctor who specializes in kidney problems.

How to Get the Most from Your Visits

Once you find the diabetes team that is right for you, here are some tips to help you get the most from your visits:

• At your first visit: Bring your insurance card and past medical history information with you.
• Write out a list of your concerns to review with your diabetes team.
• If possible, bring a companion to listen and take notes.
• Be up front with your team and express your concerns and goals.
• Take off your shoes/socks at each visit to ensure that your feet are checked at each visit.
• Be as specific as possible about any problems or symptoms.
• Be sure to always bring your blood glucose record book, as well as a food record if you are seeing the dietitian. Your records are only as good as the corresponding comments, so include notes explaining variations in your routine (such as exercise days, illness, stress, overeating).
• Be honest in your records and your discussion with the team—trying to please the team with "good records" will only hurt you rather than help you.
• Bring a list of all your medications (prescription and over-the-counter) to review with your doctor.
• Ask about side effects of any medication and be sure you understand how to take it.

Conclusion

As you can now see, there are many people to help you manage your diabetes. Just keep in mind that it is your job to be at the center of the hub, making sure everyone is working together to provide you the best healthcare possible. Let your healthcare team know you’re serious about managing your diabetes, and that you want to be an active partner with them.

Best wishes for managing your diabetes and achieving the best control possible.

Related Questions

Diabetes Education
Q: "In your answers, you often mention discussing things with the diabetes team, or you suggest seeing a diabetes educator and dietitian. I was diagnosed with diabetes 2 months ago and was told to cut out sweets, but I have not been referred to see anyone else. Is it necessary that I see a diabetes educator?"

Standards of Care
Q: "How can I be sure I’m getting all the right tests and exams for diabetes?"

Tests and Visits
Q: "The Diabetes Standards of Care mention regular lab and blood pressure checks, but what are the specific goals and frequency?"

tion Advice
Q: "Can you provide me with some nutrition recommendations for a diabetic diet? I am newly diagnosed and am afraid to eat anything!"

Pharmacists and Medication Interactions
Q: "I have been recently diagnosed with type 2 diabetes, non-insulin dependent. I also have arthritis. After returning to my normal medications one at a time, which include Bextra® (see note), a cox2 inhibitor, my glucose shot up to 247. On another medication, Effexor®, my glucose barely rose to 65. I have since stopped taking both; can you give me any advice as to where I can find information on safe medications for diabetics? I have a wonderful pharmacist, but I hate to tie her up with researching my meds so often."

Dental Care
Q: "Please explain the importance of oral hygiene for people who have Type 2 diabetes."

Foot Care
Q: "Would you explain foot care?"

Diabetic Neuropathy
Q: "I have been experiencing numbness in my feet and toes. I have Type 2 diabetes and am currently taking Glucophage 850mg, 2 times a day. Is this condition reversible?"

Related Links

American Diabetes Association
http://www.diabetes.org

Diabetes Self-Management
http://www.diabetesselfmanagement.com

American Association of Diabetes Educators
http://www.diabeteseducator.org

American Dietetic Association's Nationwide Nutrition Network
http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/index.html

DOC12807-Rev-A 10/07