Meet the Members of Your Diabetes Care Team

Diabetes is a complex disease which can seriously affect your health. Because of the range of health complications that can result from diabetes, you may find yourself relying on a team of diabetes healthcare professionals to help manage your condition rather than one or two specialists. The health complications of uncontrolled diabetes can result in:

Cardiovascular disease

People with Type 2 diabetes are more likely to develop and die from cardiovascular disease (CVD), including heart attacks, strokes, and heart failure, than people who do not have diabetes, says the American Heart Association. This is because people with diabetes, particularly Type 2 diabetes, may have the following conditions that contribute to their risk for developing CVD: high blood pressure, abnormal cholesterol and high triglycerides, obesity, lack of physical activity and poorly controlled blood sugar. [1]

Chronic kidney disease

In the United States about 1 in 3 people with diabetes have diabetic nephropathy, which is chronic kidney disease (CKD). It occurs because diabetes damages blood vessels in the kidneys that filter waste from blood. This can lead to kidney damage and high blood pressure. Diabetic nephropathy can lead to kidney failure.[2]

Diabetic neuropathy

Diabetic neuropathy or nerve damage is one of the common complications of diabetes affecting as many as half the people with the disease. Over time, high blood glucose levels or blood sugar can damage nerves throughout the body. Nerve damage in the legs and feet is most common with diabetic neuropathy, although it can also cause damage with the digestive system, urinary tract, blood vessels, and heart.[3]

Diabetic Retinopathy

Diabetic retinopathy is a microvascular (small blood vessel) condition due to the long-term effects of diabetes. The condition occurs when high blood sugar damages blood vessels in the retina, which is the light-sensitive layer of cells in the back of the eye. The damaged blood vessels can swell and leak resulting in blurry vision. In the advanced stage, vision may become completely blocked if there is a lot of bleeding.

Skin infections

Skin infections are common side effects of diabetes. In fact, skin problems may be the first sign that you have diabetes. Some of the skin problems may be common to others who do not have diabetes, such as bacterial infections, fungal infections, and itching. Other skin problems happen only to people with diabetes. Since diabetes also affects the immune system, it can make it more difficult for your body to fight off infections.[4]

Who is on your diabetes healthcare team

With many potential healthcare complications, your diabetes healthcare team may include a team of medical and healthcare professions.

Primary Care Provider (PCP): You want to see your PCP, whose staff will include nurse practitioners and physician assistants. This team will be responsible for your general medical care, which includes physical exams, lab tests, and medication prescriptions. The team will help you develop a plan to manage your diabetes daily, which includes what your target blood sugar should be, if you should lose weight, what foods you should eat and what medications you need to take, among other issues. Your PCP will refer you to other medical specialists, as necessary.

Endocrinologist: An endocrinologist is another physician among diabetes healthcare professionals who may be part of your team. Endocrinologists specialize in diseases that affect endocrine gland disorders, such as diabetes. (The endocrine system produces hormones, including insulin.)  For some people, an endocrinologist may be your primary care doctor.

Certified Diabetes Care and Education Specialist (CDCES): A CDCES is a diabetes healthcare professional who will provide you with diabetes self-management education and support. They have extensive training and experience with people who have diabetes and have passed a credential board exam.

Your diabetes education specialist can create a daily diabetes self-management plan that includes how to monitor your blood glucose level, what foods you should eat, how your medications work and even how to deal with the emotional challenges of living with a chronic disease.

Registered dietician: As an expert in nutrition, a registered dietician will collaborate with you to make healthy food choices to manage your blood glucose level and reach and achieve body weight goals to help delay or prevent diabetes complications.

Podiatrists: A podiatrist is certified and trained to prevent, diagnose, and treat conditions associated with the foot and ankle.  When you have diabetes, taking care of your feet is critical. Foot complications affect more than 20 percent of patients treated with diabetes and the American Diabetes Association (ADA) reports that 20 percent of patients with diabetes are hospitalized because of foot problems.^[5]

Your podiatrist will: [6]

·         Check your pulse and the circulation in your feet.

·         Look for cuts, bruises, or infections.

·         Check sensation in your feet.

·         Educate you about:

o    Risks to your feet associated with diabetes

o    The importance of daily foot monitoring; what to look for

o    Proper care of feet and nails

o    Right footwear

Ophthalmologist or optometrist: You want to have a comprehensive eye exam with an ophthalmologist (a medical doctor specializing in eye and vision care) or an optometrist (provides primary vision care) when you are diagnosed and afterwards annually unless you need more treatment because of the rapid spread of retinopathy.

Dentist: Your diabetes may cause a higher risk of gum disease, which makes your dentist part of your diabetes healthcare team. You want to let your dentist know your condition.

Mental health professional: Among diabetes healthcare professionals, a mental health professional can be of significant help. Your previous normal life and all its activities may be turned upside down. A mental health expert can help you manage the emotional issues that come with having a chronic disease.

Pharmacist: A pharmacist can help answer questions about what is in a medication and how it can affect blood sugar. They also can advise how medications interact with each other.  Questions you will want to discuss with your pharmacist:[7]

·         When is the best time to take this medication? Should I take it before or after eating?

·         How will this drug interact with my current medications?

·         Are certain over-the-counter drugs or herbal supplements safe to use with prescribed medications?

·         Are there any foods I should avoid?

·         What are the side effects of the medications?

·         What is the best way to store the medication?

·         What should I do if I miss a dose?

·         Is there a generic version of the medication?

Fitness instructor: Exercise lowers blood glucose levels and makes the body more sensitive to insulin to counter insulin resistance. [8]  Exercise also helps to reduce anxiety, which often comes with managing the disease and the uncertainties around potential complications. A physical activity specialist, who may be an exercise physiologist, personal trainer, or physical therapist, can recommend exercises that are safe to ensure you get the most out of your exercise program.

Questions for your diabetes healthcare team

Once you have established your diabetes healthcare team, the CDC recommends the five following questions to make sure you are on track managing your diabetes. [9]

1)      How do I manage my ABCs, which include A1C test to measure blood sugar, blood pressure, and cholesterol? Also stop smoking or do not start.

2)      How will I know if my medications are working?

3)      How can I learn more about managing diabetes?