Without support, diabetes is painfully hard. Total independence is not a good Idea. In my previous blog, “How Denial Impacted My Life as a Diabetic,” I talked about the impact of denial on my life. Maybe if I were less independent, I would have avoided some of my sufferings. Now, the important question is, “How do you do that?” The answer is by building the support team you need.
The Support Team
A basic support team for a person living with diabetes should consist of the following:
- Primary Care Physician (PCP)
- Endocrinologists (Diabetes Specialists)
- Certified Diabetic Educator (CDE)
- Registered Dietitian
- Psychotherapist (Licensed Clinical Social Worker)
- Ophthalmologist or Optometrist (Eye Doctor)
- Podiatrist (Foot Doctor)
All of the professionals above have the capability to help you avoid immediate and future suffering.
You will need to see some of the doctors several times a year and some only once a year. The list seems big but when you break it down it is not as bad as it sounds. For a person with diabetes under good control, it totals out to be around 11 appointments a year—that is less than once a month. At first, it will be substantially more but will lessen as you get the hang of self-management.
Once a Year
You will need to see your PCP once a year to get your general check-up. If you are sick, you should see them in case you have a bacterial or viral infection.
It is important to see your eye doctor at least once a year, as diabetic retinopathy has no symptoms in the early stages. Retinopathy happens due to damaged blood vessels in the retina. It begins with leaking fluids, which enter the eye and lead to blindness. If caught early enough, vision may not be affected, but once it becomes noticeable, it is likely that you will have some vision loss even with surgery.
Make sure that your eye doctor is fully versed in working with diabetes patients. While at the eye doctor, make sure to get a dilated eye exam to check for retinopathy.
Another doctor you need to see once a year is a podiatrist, who specializes in the functioning of the foot and lower parts of the leg. He is the doctor most likely to detect neuropathy of your lower extremities and check for proper blood flow. Neuropathy causes numbness, pain, and unawareness to injuries in the foot. If untreated, it can lead to infections and amputation.
More Than Once a Year
One health professional you need to see 2-4 times a year is an endocrinologist for your diabetes check-up. There you will go over your hemoglobin A1c, a test that measures your average blood sugar over the past three months. You will also get other tests done during your visit, as well as some management advice. Don’t expect the endocrinologist to resolve all your issues in the 15 minutes you have with them. Save your questions for the certified diabetic educator, who should be able to give you expert direction and referrals, when needed. Hopefully, your endocrinologist has one on staff, as it would be best to see the educator/nurse every three months.
At the beginning of your diabetes diagnosis, however, you may need to see the CDE more as they are training you on how to manage your diabetes and live comfortably with the illness.
Most visits with the CDE last an hour. At their office, you review your blood sugar logs, hemoglobin A1c, and discuss problem areas around management. They are your guides to diabetes self-management and many follow-ups with the other health professionals on your team to ensure you get the best health care possible.
Additionally, see the dentist two times a year. Problems with the gums can lead to insulin resistance and diabetes increases the risk of gum disease.
As Needed (a “Must” for Most)
After diagnosis, it is important to see a registered dietitian, preferably one who is also a CDE, to address your food needs based on lifestyle, medicine, and other health goals. The dietitian you will go over meal plans, balancing food with the medication, carb counting, label reading, the impact of food on blood sugars, and other management tools. Once you have learned good diet management, you may only need to see the dietitian on an as-needed basis. For example, if you are going on a diet then you may want to see a dietitian first to make sure it’s safe.
Seeing a mental health professional like a psychotherapist can be crucial, especially right after diagnosis. Issues like denial, depression, anxiety, loss of lifestyle, and anger are common in the beginning and can linger for years without professional help.
A psychotherapist is usually seen weekly to help maintain good emotional health in the face of daily trauma brought about by fluctuating blood sugars, relationship problems, and lack of family support. A psychotherapist can help resolve diabetes burnout, which is when you are physically and emotionally exhausted to the point that you may stop testing your blood sugars or even stop taking medication such as insulin.
Diabetes brings about many emotional and relationship problems. Having a non-biased individual to talk to in a safe and caring environment is crucial to long-term emotional health and happiness while living with a chronic illness such as diabetes.
Managing diabetes is a full-time job. The more work you put into it, the happier your life will be. Remember, you can schedule all these visits over the course of a year, and after a while, it becomes part of your yearly routine. Like, going to the beach every weekend of the summer season, it’s routine. If you are having problems, anyone on your health care team can help take care of you or point you in the right direction.
For one-stop shopping, go to a diabetes clinic in your area that has most of the above professionals working there. That will make it a little easier, especially after being diagnosed with diabetes. Until my next blog entry, have a great week.
Eliot LeBow, LCSW, CDE, is a diabetes-focused psychotherapist. His private practice, located in New York City and is also available via Skype. LeBow, who has been living with type 1 diabetes since 1977, treats the many diverse cognitive, behavioral, and emotional needs of people living with type 1 and type 2 diabetes.
All the advice included in this blog is therapeutic in nature and should not be considered medical advice. Before making any changes to your diabetes maintenance program, please consult with your primary physician or endocrinologist.