Coming together is a beginning.
Keeping together is progress.
Working together is success.
Diabetes is a chronic condition, which means it lasts for a lifetime and requires ongoing care. Diabetes can also affect many parts of the body, sometimes in obvious ways but sometimes in ways that can only be detected by sensitive laboratory tests in the early stages. Although many people successfully manage their diabetes year after year, doing so is challenging and requires acquiring knowledge, learning certain skills, and being able to adapt to change.
Given the lifelong and complex nature of treating diabetes, it’s no surprise that people with diabetes often see many health-care providers on a routine basis. In fact, it’s often said that diabetes is best managed with a team approach. That is, the person with diabetes should have a team of health-care providers to help him manage the condition on a daily basis and to treat any complications that may develop.
Many diabetes centers and clinics already use a team approach to treat diabetes. People who do not get their care at such a center, however, may need to do some of their own legwork in establishing a diabetes team that works together and communicates among the members.
The starting lineup
No matter who else is on the team, the person with diabetes is the key player. He is the one who knows himself and his diabetes best. He also knows the most about his ability to manage his diabetes. The rest of the team can help the person with diabetes acquire knowledge, learn skills, and set goals, but because the person with diabetes provides most of his own care, ultimately he is the one in charge.
Besides the person with diabetes, typical team members in diabetes management include a physician, a registered nurse, and a registered dietitian. A pharmacist and in many cases a mental health professional round out the team for optimal diabetes care.
Physician. Most people with diabetes see either a family practice physician or a physician specializing in internal medicine for most of their diabetes care. This is the team member who will prescribe medicines for you, recommend target blood glucose goals, order laboratory tests, examine you, encourage you to exercise, and look out for your overall health. Your physician may also refer you to other team members for specialty care, nutrition education, and diabetes education and training.
Family physicians are specially trained in preventive medicine, while doctors of internal medicine (also called internists) have special training in the prevention and treatment of diseases of adults. Endocrinologists are internists with advanced, specialized training in the care of endocrine diseases, which include diabetes, thyroid disorders, growth hormone deficiency, osteoporosis, cholesterol disorders, hypertension, and obesity. About 20% of people with diabetes get their primary diabetes care from an endocrinologist.
When selecting a physician to treat and manage your diabetes, it is imperative that that person have expertise as well as experience with the current standards of diabetes care. One way to find such a physician is to use the National Committee for Quality Assurance Recognized Physician Directory. (See “Rounding Up Your Team” for contact information.)
Registered nurse. Nurses that specialize in diabetes care and education are very active in helping people with diabetes learn to control their condition. In addition to instructing people individually, many nurse-educators lead group diabetes classes, and some also lead diabetes support groups.
Registered dietitian. The registered dietitian is the nutrition expert on your team, and because nutrition is such an important part of diabetes management, it’s a good idea to seek out a dietitian who is knowledgeable about diabetes. Your dietitian should be able to explain how various foods affect your blood glucose level and help you work out a meal plan that meets both your nutrition needs and your diabetes goals. In addition to offering one-on-one sessions for individualized planning, many dietitians also lead diabetes education classes. These can be helpful for learning about nutrition and for sharing recipes and ideas with others.