Who Is on Your Diabetes Care Team?
I know from personal experience that caring for diabetes can be complicated; it has many dimensions and varying effects on both body and mind. It makes sense, then, that a variety of healthcare specialists may help with various aspects of living with diabetes. After years of trial and error, I’ve found that understanding what different members of the healthcare profession specialize in or should be responsible for, may help you make the most of the often short time you’re able to spend in their office. You can direct your questions to the professional who is likely to be the most knowledgeable on the specific questions.
People access medical professionals differently, and there are some professionals that people may not even be aware of. Knowledge can be powerful. Here is a look at the professionals who may play a role in helping you live well with diabetes.
Team Member: Primary Care Physician
Who: A primary care physician (PCP), also called a general practitioner (GP), is usually your first point of contact for any health issue. A PCP is a generalist, trained to diagnose and advise on a wide variety of medical problems, often on an ongoing basis. PCPs have received postgraduate training in a primary care program; PCPs are there to answer many different medical questions.
You should see your PCP for an annual checkup, at which he or she will check on how you are doing generally and may highlight any causes for concern. You should also see your PCP if anything unexpected comes up that you aren’t already seeing a specialist for.
Some questions you might reserve for a PCP include:
- I’ve been trying to lose weight for three months, but can’t seem to get anywhere. What should I do differently?
- I’ve been feeling sluggish in the morning. Any medical reason why?
Team Member: Endocrinologist
Who: In addition to your PCP, consider checking to see if you might have access to an endocrinologist. They specialize in treating the endocrine system, which is composed of the set of ducts and glands throughout the body and the hormones they secrete. Diabetes is a disease involving the hormone insulin, and those who specialize in it are called endocrinologists.
Endocrinologists typically undergo several years of training before being certified, and therefore should be able to address many aspects of diabetes. If you visit an endocrinologist, make the most of your time. Help the doctor help you by coming with your blood glucose meter, logbook, your insulin dosage records, your insulin pump (if applicable), and questions prepared. Questions about medications, specific treatment options, and anything else related to diabetes are appropriate for your endocrinologist.
Some questions you might reserve for an endocrinologist include:
- I’ve been reading a lot about new treatments. What are they, and might they work for me?
- I’m worried that my A1C is still too high. Can you tell me what some next steps should be for me?
Team Member: Certified Diabetes Educator (CDE)
Who: A CDE is a health professional – often a nurse, dietitian, or pharmacist – who has been certified to help those living with diabetes understand and manage their blood sugar. A CDE is a good person to go to with questions you have about living with diabetes.
What: Your PCP and endocrinologist, if you have one, can help with medical questions; a CDE is a great resource for questions about eating, exercise, and tips that may help with everyday situations. If you can’t find a CDE locally, consider trying an online resource, such as the Sanofi US CDE Help Team.
Some questions you might reserve for a CDE include:
- I get low every time I take the bus to work. What might I do differently to make sure that doesn’t happen?
- How can I make time for exercise, given my schedule?
- The doctor says I should make sure my basal insulin isn’t peaking in the middle of the night. How can I change that?
Team Member: Registered Dietitian (RD)
Who: An RD is trained to help you manage food and nutrition, which may be a major concern for many people living with diabetes. A dietitian is specifically qualified to help determine your dietary needs; there is often overlap between an RD and a CDE, and many professionals serve in both roles.
Some questions you might reserve for an RD include:
- Is there a maximum number of carbohydrates I should limit myself to each day?
- My breakfast of cottage cheese and strawberries always sends me high. It seems so healthy; am I doing something wrong?
- I get hungry right before I go to bed every night. How might I avoid that?
Team Member: Psychologist/Therapist
Who: It may seem unusual to put a mental health professional on a diabetes healthcare team, but paying attention to the mental burden of diabetes may be important to your long-term well-being. In part because of the daily self-management and care diabetes requires, having a psychological expert may help.
What: If you are unsure where to start looking for a knowledgeable mental health professional, start by contacting the American Psychological Association (APA) or the Behavioral Diabetes Institute, a leading association in the area of diabetes and mental health. Once you find a professional you like working with, don’t be shy about asking questions.
Some questions you might reserve for your psychologist/therapist include:
- I have had diabetes for eight years and I’m tired of measuring my blood sugar and watching what I eat. What do I do?
- I’m going off to college soon and wondering how to tell new friends about my diabetes. How quickly should I share?
- My wife won’t stop bothering me about my blood sugar; she’s always looking over my shoulder, and it drives me crazy. How do I get her to stop?
Team Member: Your Loved Ones
Who: An ideal healthcare team includes the people who are closest to you, both emotionally and physically. Diabetes is 24-7, and so it is crucial that the people you spend your days with are on board with your management plan, and are receptive to being involved to the extent to which you want them involved in your diabetes.
What: Some people with diabetes want their loved ones to know all the details, and to actively participate in healthy meal planning, attending doctors’ visits, and so on. Others hate to be policed by family members and would prefer everyone stay out of it. Whatever your personal preference, there are two guidelines for keeping loved ones on your healthcare team successfully:
- Communicate what you need to your loved ones. If you want involvement, tell them so. If you want space, tell them that. Be clear, and be understanding of their needs, as well.
- Have an emergency plan. Even if you don’t want daily input from your loved ones, it is important that they know what to do in the event of an emergency or natural disaster. Two good starting points, regardless of the type of diabetes you have, are the JDRF Emergency Plan and Are You Prepared? Disaster Response Toolkit.
Team Member: You
Your healthcare team is nothing without you on board! For your own health and safety, it is imperative that you be an active part of your own care. Be educated about your disease, be demanding of your healthcare team, be understanding of those around you, and be optimistic about your outcome. After all, your healthcare team is there to help; push as hard as you can to get the results you want to see.
Karmel Allison was born in Southern California, diagnosed with type 1 diabetes at the age of nine, and educated at UC Berkeley. She now lives with her husband in San Diego, where she is loving the sunshine, working in computational biology at the University of California, San Diego, and is learning to use the active voice when talking about her diabetes. In her spare time, Allison enjoys people, the books of Milan Kundera, rock climbing, and the pursuit of life, liberty, and happiness. Allison is a paid contributor for The DX. All opinions contained in this article reflect those of the contributor and not of Sanofi US, its employees, agencies, or affiliates.
© 2012 The DX: The Diabetes Experience