Updated April 02, 2007

Teaming Up for Better Diabetes Control

by Laura Hieronymus, M.S.Ed., A.P.R.N., B.C.-A.D.M., C.D.E., and Kristina Humphries, M.D.

According to the American Diabetes Association, people with Type 2 diabetes should have an initial dilated and comprehensive eye exam shortly after diagnosis with diabetes. People with Type 1 diabetes should have an initial dilated and comprehensive eye exam within five years of diagnosis. Following the initial examination, everyone with diabetes should have eye examinations on an annual basis, unless advised otherwise by their eye-care professional.

Women with diabetes who are planning a pregnancy are advised to receive a baseline comprehensive eye examination as well as counseling on the possibility of development and/or progression of diabetic retinopathy associated with pregnancy. Women should also have a comprehensive eye examination in the first trimester of pregnancy and monitoring during and following pregnancy, as recommended by an ophthalmologist.

Optometrist. Like ophthalmologists, doctors of optometry (ODs) examine, diagnose, treat, and manage diseases, injuries, and disorders of the eye. Optometrists are also trained to detect the ocular manifestations of systemic conditions, such as high blood pressure and diabetes, and to refer people to other health-care specialists for eye surgery and/or further medical evaluation. Unlike ophthalmologists, optometrists do not perform surgery. Therefore, if a person requires laser or surgical treatment of the eye, the optometrist will refer him to the appropriate ophthalmologist (such as a retinal specialist).

No matter what sort of eye doctor you see, it’s important to find one who is knowledgeable about and experienced with the eye complications of diabetes.

Obstetrician-gynecologist. Women with diabetes visit the obstetrician-gynecologist for much the same reasons as women who don’t have diabetes: cancer screenings, other preventive health-care services, birth control, and treatment of any conditions or diseases affecting the reproductive system and sometimes the urinary tract.

Women with diabetes who plan to become pregnant are urged to discuss their plans with their obstetrician (and other members of the diabetes team) before becoming pregnant. This is because of the high risk of developing pregnancy complications if blood glucose is not in optimal control before and during the pregnancy. Planning ahead gives you time to bring your blood glucose into “tight” control before conception and to consider how you will deal with the need to maintain tight control over the course of the pregnancy.

In some cases, a woman with diabetes who is pregnant may be referred to a perinatologist, an obstetrician with specialized training in managing high-risk pregnancies.

Exercise physiologist. Exercise physiologists prescribe exercise regimens based on a person’s needs, strengths, and weaknesses. Depending on their training and place of employment, they may administer certain fitness tests before making their recommendations.

Exercise physiologists who work with people who have diabetes should be familiar with the effects of exercise on blood glucose control. They should also understand how exercise can interact with diabetic complications in both positive and negative ways.

Anyone can benefit from meeting with an exercise physiologist to work out a fitness plan. It can be especially beneficial for people with little exercise experience and for those with any kind of diabetes complication, including cardiovascular problems.

Physical therapist. If you are unable to be physically active or carry out activities of daily living because of an injury, disability, or complication of diabetes, your physician may refer you to a physical therapist for treatment. A physical therapist can help you maximize your physical function by assessing what is limiting your ability to move and working with you to strengthen, stretch, or otherwise rehabilitate your body as needed. In many cases, a physical therapist will show you exercises to do at home in addition to working with you in an office setting or rehabilitation facility. Physical therapists can also treat certain kinds of pain and teach people to use assistive devices such as walkers and canes.

Also in this article:
Maximize Your Team Meetings
Rounding Up Your Team

Laura Hieronymus is the program coordinator for an American Diabetes Association–recognized education service, and Kristina Humphries is a practicing endocrinologist. They are diabetes care and education providers at Drs. Borders & Associates, PSC, in Lexington, Kentucky.

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