I like to refer to diabetes as a team sport. Even if you are the greatest soccer player in the world, you want to be surrounded by a great team. Depending on the situation different players with different skill-sets will be needed. Here I provide a list of different healthcare providers and what role they may perform in the treatment of diabetes. It is not meant to be exhaustive or comprehensive, but rather to provide an overview.
Before delving into the list, I have a question for you. Who is the most important person on your diabetes team? Look below for our answer.
Primary Care Physician (PCP): this person is your go-to doctor, he or she will manage all your health conditions, and they are responsible for forming a management plan for any ailments that you have including your diabetes. This role may be filled by other physicians or physician extenders such as: Internal medicine doctor (aka Internist), Hospitalist, Family Practice doc, General Practitioner (GP – this title is not used much anymore, but your mother or father likely had one), Physician Assistant, Nurse Practitioner. Sometimes other specialists will act as your PCP, such as Endocrinologist. I have listed PCP first as they are critical to your care. The remaining providers will be listed alphabetically.
Diabetes Educator: this is often a registered nurse, but not always. The diabetic educator can be a formidable ally in your diabetes journey. Knowledge is power, and the educator will assist you with learning about how diabetes is affection you, and what you can do about it. The diabetes educator can also help you locate the best areas to find information that you will be able to understand.
Infectious Disease: a physician who treats bacterial, fungal or viral infections. It is sometimes necessary to involve the infectious disease team, this can be more common when a patient has diabetes. With diabetes, increased glucose in the blood stream effectively jams the immune system, rendering it less effective. This can increase the severity of an infection, and can prolong an infection.
Nephrologist: a physician who treats conditions of the kidneys. In diabetes the increased amount of glucose in the blood can damage the kidneys, this is called diabetic nephropathy. If left untreated, or if the glucose is too high too long, it can permanently damage or destroy the kidneys. This may necessitate dialysis, which is a process where your blood is cleaned of toxins by a machine, instead of by your kidneys.
Nurse Practitioner (NP): similar to primary care physician above. This is a physician extender and it will be more common for patient’s to be treated by mid-level practitioners. These practitioners complete training, but do not have a residency. They work under the supervision of a physician (MD or DO). Duties are similar to primary care physician above, and they will treat medical ailments including diabetes.
Nutritionist: this allied health professional can have several different titles, in the hospital usually called a registered dietitian (RD). If you are at risk for diabetes, or have already been diagnosed with diabetes, it is critical that you become aware of what you are eating. A nutritionist will help devise a meal plan, and will provide education so that you will understand how the food you eat is helping or hurting you. Nutrition is a vast field, but the potential gains are worth investing time in this area.
Opthalmologist: a physician that treats disorders of the eyes. In diabetes as glucose increases in the blood some of the sugars may stay in the eye creating floaters. Diabetic retinopathy is caused by damage to the blood vessels at the rear of the eye. These disorders can present subtly, which is why every person with diabetes should receive a yearly eye exam.
Orthotist/Prosthetist: fabricates assistive devices. Wide variety of products ranging from orthotics and diabetic shoes, all the way to replacements for a lost limb. In diabetes some patients will lose protective sensation in their feet, this is called neuropathy. As neuropathy progresses it will become more difficult for the patient to protect the feet which may result in callus formation, ulceration, infection and possible amputation. A prescription for diabetic shoes and inserts must be written by a podiatrist or PCP.
Physician Assistant (PA): similar to primary care physician above. This is a physician extender and it will be more common for patient’s to be treated by mid-level practitioners. These practitioners complete training, but do not have a residency. They work under the supervision of a physician (MD or DO). Duties are similar to primary care physician above, and they will treat medical ailments including diabetes.
Podiatrist: this person will treat conditions of the foot, ankle and lower leg. It is important to have an annual diabetic foot exam, this is best conducted by a podiatrist. Podiatrist will be critical if you have loss of sensation in your feet or any ulcerations. Podiatrists work with you to ensure foot health, and work to prevent infection and amputation. Diabetes is the driver for non-traumatic lower extremity amputations worldwide. More on podiatry here.
Vascular surgeon: this is a surgeon who evaluates and treats conditions of the blood vessels. Over time we all experience a build-up of detritus in our arteries and veins, as this progresses it can occlude (block) the vessel making it difficult or impossible for the blood and nutrients to pass. This can happen in any vein or artery, in the arteries it is called peripheral arterial disease (PAD). In the feet PAD will make it more difficult to repair any damage that is done, this is important as most of us are ambulating on our feet and doing micro-trauma all day long. If this damage cannot be repaired, ulcers and infection may result. Diabetes makes healing more difficult, and is often seen in the company of PAD. One final note, any tobacco use greatly increases the chances of having PAD, if you are using tobacco products please get help.
Winning in the sports world requires that hundreds if not thousands of hours are spent in mastery of a skill. But even after this, the outcome does not depend on one player alone. To be victorious in a team sport, the team must come together for the best result. In the medicine world, the best results for the patient will also occur when the team of doctors works well together.
**Above I asked you who the most important person on your diabetes team is, which team member did you choose?
The correct answer is YOU! You have the most invested, and you have the most to lose. You are ‘all-in’ all the time. If you guessed correctly, you are already on the right track. Please make sure and subscribe to our newsletter, and let friends and others with diabetes know about our site. You can also find us on Facebook and Twitter.
