Your Health Care Team

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In centers that focus on diabetes care, health care professionals often already work as a team. Sometimes, your primary diabetes doctor (internist, family practice doctor, or endocrinologist) will refer you to other health care providers in the same clinic or a building nearby. Or you may need to work with your doctor to build a health care team, adding members as the need arises. Who do you need on your team?

You
You are the most important member of your health care team. After all, you are the one who is affected by diabetes and cares for it every day. Only you know how you feel and what you're willing and able to do. You do the exercise. You make and eat the foods on your meal plan. You take the medicine or inject the insulin. You check your blood sugar (glucose) levels and keep track of the results. And of course, you are the first to notice any problems. Your health care team depends on you to talk to them honestly and to tell them how you feel.

The Primary Care Provider
The Primary Care Provider, who may be a primary care or family practice physician, is who you see for general checkups and when you get sick. A doctor with special training (and usually certification) in diseases such as diabetes is called an endocrinologist. If you do not see an endocrinologist, look for a primary doctor, family practice doctor or an internist who has cared for many people with diabetes. Your primary care doctor may also be the one who refers you to specialists or other team members.

Other health care providers who provide primary care include nurse practitioners and physician assistants, who typically work in collaboration with a physician.

If you are looking for a new doctor, your visit should include some time for you to get to know each other. Make sure you feel comfortable talking about the details of your health and lifestyle with this doctor. You might ask:

• Do you have special training in diabetes?
• Are most of your patients people with diabetes? Do you see more people with type 1 or type 2 diabetes?
• What tests will you do at regular office visits? How often will you order these?
• What days are you not here? Who covers on nights and weekends?
• What are your fees? Do you accept my insurance plan?
• Are you associated with other diabetes care professionals, so I will benefit from a health care team?
• Do you refer to an educator or dietitian?

Your doctor's support is important. Your insurance plan may require you to get the doctor's referral for visits to the other health professionals on the team.

Before you leave the office, ask the staff about other details, such as how long a wait patients usually have. Does the doctor's schedule run on time? Is there a set call-in time when you can talk to the doctor on the phone? What is the billing policy?

After the visit, ask yourself:

• Did the doctor really listen to my concerns?
• Was the doctor concerned about my diabetes control?
• Did the doctor answer my questions?

Nurse Educator
A nurse educator or diabetes nurse practitioner is a registered nurse (RN) with special training and background in caring for and teaching people with diabetes. Many are certified in the field of diabetes. Some may have a master's degree. Nurse educators often help you learn the day-to-day aspects of diabetes self-care. They can teach you

• what diabetes is
• how to cope with diabetes and to make changes in your health habits
• how to use diabetes medications
• how to work with insulin and give yourself shots
• how to check your blood sugar
• how to keep track of your diabetes
• symptoms of low and high blood glucose
• how to take care of an insulin reaction
• how to handle sick days
• how to stay healthy if you are pregnant

Registered Dietitian
A registered dietitian (RD) is trained in nutrition and has passed a national exam. An RD may also have a master's degree or may be a Certified Diabetes Educator (CDE). You want to be sure to work with an RD who has training and experience with diabetes. If your doctor does not work with a dietitian, ask him to refer you to one.

Your dietitian helps you figure out your food needs based on your desired weight, lifestyle, medication, and other health goals (such as lowering blood fat levels or blood pressure). Even if you've had diabetes for many years, a visit to the dietitian can help. For one thing, our food needs change as we age. Nutrition guidelines for people with diabetes also change from time to time.

Dietitians can also help you learn how

• the foods you eat affect your blood sugar and blood fat levels
• to balance food with medications and activity
• to read food labels
• to make a sick day meal plan
• to plan meals
• to plan for eating out and special events
• to include ethnic or foreign foods into your meals
• to find good cookbooks
• to make food substitutions

Eye Doctor
This doctor is another key member of your health care team, because diabetes can affect the blood vessels in the eyes. When eye problems are caught early, there are very good treatments.

The eye doctor will be either an ophthalmologist or an optometrist.

The American Diabetes Association guidelines say you should see your eye doctor at least once a year. These checkups are the best way to detect diabetic eye disease. Your eye doctor will check for any changes in your eyes. If there are changes, the doctor will treat the problem or refer you to another doctor with special training in that area. Be sure your eye doctor is familiar with how to spot and treat diabetic eye disease.

It's a good idea to ask:

• How many of your patients have diabetes?
• Do you perform eye surgery?
• Will you send regular reports to my primary care or diabetes physician?

Social Worker/Psychologist/Psychiatrist/Marriage and Family Therapist
Mental health professionals help with the personal and emotional side of living with diabetes. A social worker must have a master's degree in social work (MSW) as well as training in individual, group, and family therapy. LCSW stands for licensed clinical social worker. This means the social worker has passed a state exam.

Social workers may be able to help you find resources to help with your medical or financial needs and should hold a master's degree in social work (MSW), as well as have training in individual, group, and family therapy.  Some social worker's may even be able to help you cope with many concerns related to diabetes, including problems within the family and coping with workplace situations.

A clinical psychologist who works directly with patients can have a master's or doctoral degree in psychology and is trained in individual, group, and family psychology. A few sessions with a psychologist might help during a time of special stress. On a long-term basis, a psychologist might help work on more lasting problems.

A psychiatrist is a medical doctor who can prescribe medication to treat physical causes for emotional problems. Psychiatrists also provide counseling.

Marriage and family therapists can help you with personal problems in family and marital relationships and problems on the job. These therapists should hold a master's or doctoral degree in a mental health field and have additional training in individual, family, and marriage therapy.

Podiatrist
This health professional is trained to treat feet and problems of the lower legs. Podiatrists have a Doctor of Podiatric Medicine (DPM) degree from a college of podiatry. They have also done a residency (hospital training) in podiatry.

Diabetes makes you prone to poor blood flow and nerve damage in the lower legs. You may get infections more often. Sores, even small ones, can quickly turn into serious problems. Any foot sore or callus needs to checked by your primary care doctor or a podiatrist. Do not try to fix these yourself, because you could cause an infection. But do inspect your feet daily for signs of trouble.

Podiatrists treat corns, calluses, and more serious problems. Ask your podiatrist:

• How many of your patients have diabetes?
• Are you familiar with the foot problems diabetes can cause?
• Will you work with my primary care doctor, if needed?

Dentist
People with diabetes are at somewhat greater risk for gum disease. The excess blood sugar in your mouth makes it a good home for bacteria, which leads to infection. See your dentist every six months. Be sure to tell your dentist that you have diabetes.

Exercise Physiologist
Exercise plays a major role in your diabetes care, no matter which type of diabetes you have. Exercise can help lower blood sugar, help your body better use insulin, and help control your weight. It can also improve your blood fat levels, reduce stress, and improve your overall fitness level. Even if you have diabetic complications, ask your doctor about safe exercises you can do.

The best person to help you and your doctor plan your fitness program is someone trained in the scientific basis of exercise. Your doctor can help you look for someone with a master's or doctoral degree in exercise physiology or for a licensed health care professional who has graduate training in exercise physiology. Certification from the American College of Sports Medicine is another sign that the person has the basic skills needed to plan a safe, effective exercise program. Always get your doctor's approval for any exercise program.