Get in the Game
How to build your winning diabetes health care team
Tina Bloomquist is on a mission. Recently diagnosed with type 1 diabetes, Bloomquist, 37, of Kasson, Minn., is determined to create a personalized diabetes health care team. From knowing how to balance what she eats with how much insulin she needs to figuring out which exercises motivate her most, Bloomquist will lead her new team to bring it all together.
But building such an important team isn't always easy. From a dietitian to a nurse educator to an eye doctor, there's a broad array of people who might fit into your diabetes health care team.
When it comes to knowing how to assemble your team, "it can feel like diabetes boot camp," says Anne Peters, MD, director of the Westside Center for Diabetes at the University of Southern California in Los Angeles and author of the book Conquering Diabetes. So how do you make it through? "Just try to learn a little at a time."
In the Bullpen
Primary care provider
This may be a primary care or family practice physician, an endocrinologist, a physician's assistant, or a nurse practitioner. This is who you see for general checkups and when you're sick. Usually, your primary care provider is your point person, and often the one who would refer you to specialists or other team members if you need them. In some health insurance plans, you will need to consult a designated primary care provider, or PCP, and get a referral before seeing any other specialist.
It's important that your primary care provider be supportive, accessible, and approachable. You should feel comfortable talking with him or her about the details of your health and lifestyle. Be sure that your primary care provider really listens to your concerns and answers your questions well.
Bloomquist has a positive relationship with her family doctor, which has been important, since being newly diagnosed with diabetes can bring forth an array of emotions. "He listens and validates my feelings," she says. "He lets me vent and helps me problem solve. He's wonderful."
A nurse educator is a registered nurse (RN) with special training and experience in teaching and caring for people with diabetes. Some nurse educators, as well as some registered dietitians and pharmacists are certified in the field of diabetes, making them certified diabetes educators (CDEs). Nurse educators have become an integral part of successful diabetes management. They can help you learn valuable day-to-day self-care tactics, such as how to check your blood glucose and how to use insulin.
"Diabetes educators are like life coaches," says Carol Manchester, MSN APRN, BC-ADM, CDE, diabetes clinical nurse specialist at the University of Minnesota Medical Center-Fairview in Minneapolis. "They'll teach you great survival skills."
A registered dietitian (RD) is trained in nutrition and has passed a national exam. An RD may also have special training and experience with diabetes, and may be a CDE, too. If your primary care provider doesn't work with a dietitian, ask to be referred to one.
Your dietitian will help you with a food plan based on your desired weight, lifestyle, medication, and other health goals, such as lowering your blood pressure and cholesterol. Even if you're not newly diagnosed with diabetes, working with a dietitian is important. Nutrition guidelines for people with diabetes change from time to time, and your meal plan may need to change as you age.
Eye doctor (ophthalmologist or optometrist)
Because diabetes can affect the blood vessels in your eyes, you should have an eye exam at least once a year to watch for diabetes-related eye disease. If your eye doctor finds changes in your eyes, he or she will treat the problem or refer you to a more specialized eye doctor. When eye problems are found early, good treatment options are available.
If you have diabetes, excess blood glucose in your mouth makes it a good home for bacteria, which can lead to infection. People with diabetes are at greater risk for gum disease, so it's important to see your dentist every six months. Tell your dentist you have diabetes.
In the Bullpen
As time goes on, your health care needs can change or you might find that you'd like to personalize your self-care plan to include other individuals on your team. Your "second string" of team members may include:
Mental health professional
Social workers, psychologists or psychiatrists, and marriage and family counselors or therapists can help with the personal and emotional side of living with diabetes. During times of stress in dealing with workplace issues, financial challenges, problems in family and marital relationships, or the need for treatment or medication for psychological issues, these professionals offer many options for assistance and relief.
If you take medication for diabetes, a pharmacist can be a valuable resource for information and guidance. Encourage good communication between your primary care provider and your pharmacist to be sure your medication works best for you. Check with your pharmacist before taking any over-the-counter drugs that could interact with your prescription medications or complicate your diabetes. Be sure to tell your pharmacist about any herbal supplements you take and if you have any food or drug allergies.
Foot doctor (podiatrist)
People with diabetes are more prone to poor blood flow and nerve damage in the feet and lower legs. Any foot sore or callus should be checked by your primary care provider. Even small sores can quickly become infected. If you have a serious foot problem, you'll need to see a foot doctor.
Exercise specialist (physiologist)
No matter what kind of diabetes you have, staying physically active plays a major role in your self-care. Exercise can lower your blood glucose, help your body use insulin better, help control your weight, improve your cholesterol level, and reduce stress. Developing a fitness plan can be a big plus. An exercise specialist is someone who's trained and often certified to help you create a safe, effective exercise program that's right for you.
Because diabetes increases your risk of certain health complications, there may be times when you need to add other specialists to your health care team. For example, if you have heart trouble, you may need to see a heart doctor (cardiologist). For kidney problems, you would consult a kidney doctor (nephrologist). If you need to have surgery, a consultation with a surgical specialist may be needed. A woman with diabetes who's planning a pregnancy needs to work closely with an obstetrician, preferably one experienced in high-risk pregnancies.
"Gather a team that helps you create your own plan," says Peters. "Find people who are open to helping you sync diabetes management with your individual lifestyle."
Rules of the Game
Not all health insurance policies or plans cover the same diabetes-related services and assistance, so it's important to check your insurance details before you start building your health care team. Although most states now require diabetes education, equipment, and supplies to be covered in state-regulated health insurance plans (as do Medicare and Medicaid), other services—such as those provided by team members like endocrinologists, podiatrists, and exercise specialists—may not be covered. Become familiar with your health insurance to prevent surprise costs or the need to "cut" team members after you've worked hard to build your team.
The "I" in T-E-A-M
Regardless of who makes the final roster, you will be the captain, the most important member of your health care team. Or, as David Deatkine, Jr., MD, medical director of the St. Vincent's Diabetes Education Center at St. Vincent's Health System in Birmingham, Ala., puts it: "We may be the navigators with the road signs, but you are the driver." For Tina Bloomquist, so far that's meant learning how to track her own blood glucose and adjust her insulin depending on what she eats, when she exercises, and if she's sick or feeling stressed. And as she continues to build her team, Bloomquist will define her own diabetes self-management plan. "I'm learning what's helpful to me and what's not," she says.
After all, it's your life that's affected by diabetes. Ultimately, it's up to you to deal with it every day. Only you know how you feel and what you're willing and able to do to manage your diabetes. You track your blood glucose. You choose to eat healthy foods. You stay physically active. You take medication or inject insulin regularly and as directed by your health care team. And naturally, you are the first person to notice any problems or changes. Your team depends on you to talk openly and honestly about how you feel and what works best for you.
A Maria Gifford is a freelance health writer in Rochester, Minn.