Since 95% of the care of diabetes management rests on the person with diabetes, it is important for this individual to find the right diabetes healthcare team, one that is understanding, caring, and educated in the skills of how best to manage diabetes. The members of this team can consist of a family doctor, an endocrinologist, a nurse, a dietitian, a social worker/psychotherapist, a psychiatrist, a pharmacist and a physiotherapist.
A family doctor is usually the first person that the patient comes in contact with. The family doctor, in most cases, can manage a patient’s type 2 diabetes, as long as the patient’s A1C is less than 7.0. If the amount is more than 7.0, the family doctor may transfer the patient to an endocrinology team at a hospital or a specialized endocrinology clinic in the community. Most individuals living with type 1 diabetes are usually part of an endocrinology program, due to the specialization of their diabetes management.
An endocrinologist is a specialized physician who treats individuals with diabetes who may be experiencing difficulties managing their condition. Individuals living with type 1 diabetes, gestational diabetes and type 2 diabetes will attend medical appointments that focus on their diabetes every 3 to 6 months, depending upon the nature of the diabetes.
In between these appointments, individuals may see the nurse, the dietitian and/or the social worker. Some centres may have a physiotherapist. These professionals may also be part of the family doctor’s team as well, and may also work with a community diabetes centre. Other health care team members, depending on one’s needs and the resources available in the community, may include a foot care specialist and eye care specialist.
Most professional members on the team are certified diabetes educators (CDE). This means these individuals have had additional training and education in the area of diabetes. Many nurses, dietitians and pharmacists have met the CDE requirements. Two main goals of these educators are to assist the person with diabetes to self-manage his/her own diabetes, and to assist his or her caregiver(s) to understand diabetes as well. Individual and/or group education sessions are part of the learning process, and often take place at a hospital or a diabetes education centre. These education sessions include information on how to check blood glucose levels, how to administer medication, and how to handle stress and meal planning.
The nurses on the team are responsible for helping the person living with diabetes adjust their medications, such as increasing or decreasing insulin depending upon the individual’s glucose levels. The nurses are also trained to teach about insulin pumps and how to adjust settings for these devices.
The dietitian will focus on what, when and how much you eat and how these components play an important role in regulating blood glucose levels. Maintaining a healthy weight is especially important in the management of type 2 diabetes.
A social worker on the team has two main roles. The first is to provide resources to assist in obtaining diabetes medication and supplies. The second is to provide psychotherapy to help individuals adjust to the emotional feelings of living with diabetes, including depression and anxiety. Sharing tools to learn to reduce stress levels in day-to-day life can also help people with diabetes better manage their disease.
A psychiatrist will receive a medical referral when the individual living with diabetes requires a psychiatric assessment, usually in order to receive psychiatric medication. Some psychiatrists will provide psychotherapy.
A pharmacist is a key member of your diabetes healthcare team. He/she can aid in providing information about your medication and if any of your medications interact with one another. Pharmacists can also provide a medication review, to ensure that you understand your medications and are using them correctly. They may also help you understand the importance of monitoring your blood glucose and can help you interpret your blood glucose levels. Pharmacists can also provide supportive information on managing diabetes.
If your centre has a physiotherapist, he/she will assist with developing a personalized exercise program that will take into account an individual’s blood glucose levels and specific exercise needs. Exercise helps the body lower blood glucose levels, promotes weight loss, reduces stress, improves the mental state and enhances overall fitness. If the centre does not employ a physiotherapist, discuss how best to start to exercise with your family doctor or endocrinologist. Walking around the block is a start and can then be expanded. By making regular exercise part of life, an individual has already taken an important step in managing diabetes. NOTE: Exercise may affect the response to medications. Make sure to test blood glucose regularly before, during and after exercise.
A foot care specialist and eye care specialist are also important members of the health care team and should be seen every year (for your feet) and every 1-2 years (for your eyes).
As you can see, there are a number of members that can make up the diabetes healthcare team. Out of all of the members though, remember, that you are the most important member of the team. If you do not feel comfortable with a team member, please talk to one of the team members who you are comfortable with about your feelings. They may be able to resolve your concern. There is also the option of moving to another health care program.
These team members are for you and work best when you want to attend your appointments because you feel you are getting help with your diabetes management. Diabetes care is for the rest of your life, so it is important to find a professional team that fits for you. See our article How to communicate with the diabetes healthcare team.