Your Health Care Team
Diabetes is a systemic disease that has the potential to affect every part of your body, so preventive care by a team of trained experts is an absolute essential. In addition to your primary-care doctor, you'll be seeing a number of specialists.
Your primary-care physician may be able to provide initial screening for diabetes-related complications, but she may also refer you to another doctor who has specialized training in the area of concern. Ophthalmologists, mental health providers, nephrologists, and podiatrists are just a few of the other care providers who can help you stay healthy and avoid complications.
Ophthalmologists and Retinologists
The blood vessel damage associated with diabetes puts you at risk for diabetic retinopathy and other vision problems. Ideally, you should see an M.D. trained in eye diseases — an ophthalmologist — to treat existing eye disease and to screen for problems. You may also choose to visit a retinologist — an ophthalmologist with specialized training in retinal diseases.
An optometrist (an eye care professional who is not a physician) may also provide screening services for diabetic retinopathy. The ADA recommends an annual dilated-eye exam for all people with type 1 within five years after diagnosis and for those with type 2 diabetes shortly after diagnosis. Your doctor may recommend less frequent exams after several normal eye exams, or more frequent checks should you develop signs of retinopathy.
Mental Health Professionals
The psychological toll of diabetes can also be a tremendous burden, both emotionally and physically. Up to 20 percent of people living with diabetes also suffer from depression. Therapists, psychiatrists, psychologists, and/or trained counselors can help you cope with the stresses of diabetes; support groups are also a great resource for coming to grips with diabetes and learning from the experiences of others.
Nephrologists
Because diabetes is the number-one cause of chronic kidney disease, you may see a nephrologist — a physician specializing in renal care. If kidney disease progresses to ESRD (end-stage renal disease), a nephrologist will also be in charge of prescribing dialysis treatments.
Podiatrists
Proper foot care and regular exams of the feet are extremely important in diabetes care, so a podiatrist, or foot doctor, is also a key member of the health care team. Podiatrists can detect and treat neuropathy (nerve damage) of the feet and foot ulcers. They can also help educate patients on preventive foot care.
Fact
Laws governing patient access to medical records vary by state. Some providers may charge a fee to cover the costs of copying and retrieving patient files. Others may only release records to physicians rather than directly to you. Check with your state department of health for policies in your area.
Other Team Players
Other specialists who may be on your health care team include the following:
Gastroenterologist: A physician who specializes in diseases and disorders of the digestive tract
Gynecologist: A doctor specializing in women's reproductive medicine
Obstetrician: A physician who monitors pregnancy and birth
Urologist: An M.D. with special training in treating the urinary tract
Neurologist: A specialist of the central nervous system and brain, who treats CNS disorders such as neuropathy (nerve damage)
Dermatologist: A doctor who treats skin diseases and disorders, and may have special training in wound care
Physical therapist: A trained health care professional who assists in strength and mobility recovery through exercise and other techniques
Coordinating Care
With an army of specialists treating your diabetes and related complications, communication is essential. In an ideal world, all of your doctors would follow up with your primary physician quickly and consult with another specialist promptly when your medical problems extend outside of their area of expertise. In reality, you may face missing lab reports, contradictory treatment recommendations, and other obstacles.
Short of hiring a personal secretary to keep track of your complex medical schedule and rapidly expanding charts, there are a few things you can do to ensure that all your providers are on the same page. If your primary provider refers you to a specialist, call forty-eight hours before your appointment to make sure the new physician has all the clinical information she needs from your regular doctor. And when you go to your appointment, ask the specialist what her office procedure is for following up with your primary provider. Here's what else you can do:
Offer to deliver treatment reports from specialists to your primary-care provider and vice-versa.
Ask for hard copies of lab results and diagnostic tests so you have a backup and don't waste a trip to the doctor's office if they don't get delivered.
Keep a running list of all medications that are prescribed by your various physicians and bring it to your doctors' appointments.
Take notes of questions, concerns, and new issues raised at your appointments so you can share them with your primary provider.
Remember, your health care providers work for you, but you are the one ultimately in charge of your own health care. Don't be shy about following up on your treatment, and don't let any doctor or medical staff make you feel guilty about doing so. If they do, it may be time to consider finding someone new.
