Who are they and what do they do?
Diabetes is a complex and serious condition potentially affecting many systems of your body. Because of this, you may need to visit a range of health professionals regularly, and have them as part of your team. People often ask about what roles different health professionals play in diabetes management and who and when they should see them. There are a number of health professionals who you do need to see regularly, and others who you might call on or be referred to at times. Many of their roles overlap, but each person has their own area of expertise and training.
The number one person in the management of your diabetes is YOU! You will be the person making most of the daily decisions, with the support and back up of your health care team when needed. This includes management of medications and insulin; and food and exercise choices. It also includes things like working out what to do about low and high blood glucose levels, and making decisions about things like alcohol, drugs and eating out.
You will be the one dealing with daily life stress such as other illness, going to work and caring for your family, at the same time as managing your diabetes. Basically you will are the expert about you and your diabetes. This takes time and it is important to take this time, to learn as much as you can. If you are new to your diabetes diagnosis, try not to panic about all there is to learn and not to worry about what you don’t know. Focus on what you are learning and what your priorities are at this moment in time. It is important that you can have easy access to medical care, support and advice when you need it.
Make sure you have an understanding support person who can come to health care appointments with you if needed. Sometimes it is hard to remember everything after the appointment as so much can be discussed in a short time. Writing a list of things you want covered and taking it to the appointment can also help.
General Practitioner/Local Doctor
For many people with diabetes, the General Practitioner (GP) is your central health care professional. It is often a good idea to start with your GP if you have any questions or needs for your health in general and/or your diabetes. GP’s are provided with specific information and support around managing diabetes and in particular, type 2 diabetes.
For people with type 2 diabetes GP’s continue to provide most of the medical advice and care. GP’s are well informed and should keep up to date with diabetes risk factors, tests and management. They can order a variety of blood and urine tests, provide prescriptions and make adjustments to medications. They can also keep a check on all the risk factors, such as your blood pressure and cholesterol, as well as managing any other illnesses and providing things like flu shots.
People with type 1 diabetes will generally see a diabetes specialist or Endocrinologist for central management of their diabetes. They will often visit their GP in between times. This might be for checks on blood pressure and HbA1c/A1c for example, prescriptions and things like driving tests, flu shots and managing any other illnesses or concerns. However we are all different and you need to create the best health care team for you.
You can find information about general practice in Australia at: www.adgp.com.au
Endocrinology is the area of medicine that deals with problems of the whole endocrine system and its specific secretions called hormones. Insulin is one of these hormones. Hormones are molecules that act as signals from one type of cell to another. Those secreted by the endocrine glands travel mainly through the blood. Although every organ system secretes and responds to hormones the clinical specialty of endocrinology focuses on the endocrine organs, i.e. the organs whose main function is hormone secretion, such as the pituitary, thyroid and adrenal glands, the ovary and testes, and the pancreas.
An Endocrinologist is a doctor who specializes in managing and dealing with these conditions. Endocrinologists work across a range of conditions such as thyroid disease, adrenal gland disease and diabetes. People with type 1 diabetes, an autoimmune disease, can be more at risk of other autoimmune diseases of the endocrine system.
Endocrinologists are usually the central health care professional in the management of type 1 diabetes. People with type 2 diabetes might also see an Endocrinologist when there are complications, changes or more complex difficulties with their management. Endocrinologists are experts in diabetes care and up to date with research, management and advances in management options and technology. They work in hospitals, diabetes centres and private practice. You can ask your GP about referral to an Endocrinologist.
Diabetes education is a key element in management of diabetes, as the focus is on teaching you how to “take the reins” rather than managing for you, or “treating” your diabetes. Diabetes Educators are often nurses but can also be professionals like Exercise Physiologists, Pharmacists, Social Workers, Psychologists, Aboriginal Health Workers, Podiatrists and Dieticians. Diabetes Educators have received a qualification in one of these areas and have then studied at an accredited University to obtain Diabetes Education qualifications and specialise in diabetes management.
Diabetes Educators work closely with doctors and other allied health professionals and are required to maintain and develop their knowledge and skills in the area of diabetes. They can help you to learn about what diabetes is and how to manage it. They can also teach you the practical things about how you can manage your diabetes, such as information about medications, blood glucose checking and insulin injections. They can provide support, counselling and advice in their particular area of expertise. Diabetes Educators are often based at hospitals, diabetes centres, community health centres and general practices. There are also some in private practice.
You can find information about diabetes education in Australia at: http://www.adea.com.au
People with diabetes can have a variety of problems with their feet. It is very important that people with type 2 diabetes have their feet checked as soon as possible after diagnosis and regularly thereafter. It is also important that people with type 1 diabetes have their feet checked regularly.
The podiatrist will assess your general foot health and function as the way you walk can impact on whether you develop sores on your feet. They can make things like orthotics to enable you to walk more comfortably. They will also look for things specific to diabetes, such as nerve damage (neuropathy) and circulation in your feet. People with diabetes can be more prone to infections, so keeping your feet healthy is important. This is critical if you have nerve damage in your legs and feet as you can injure your foot or leg without knowing it and end up with lots of problems. Diabetic foot ulcers are a major risk for amputation. Prevention is the best treatment.
Most Endocrinologists and Diabetes Educators can also check for nerve damage and pulses in your feet when you see them and you can ask them to do this for you. You don’t need a referral but can access podiatrists via your doctor or diabetes educator, in private practice or through the hospital system. Diabetes Australia in your state might also be able to connect you with a podiatrist.
The following link will take you to a website where you can search for a podiatrist in your state: http://www.apodc.com.au/
People with diabetes are at risk of a variety of problems with their eyes and in particular retinopathy. Early detection and treatment can delay or prevent this problem. People with type 2 diabetes should have their eyes checked from diagnosis to determine if there are any problems and as often as the doctor recommends after that.
People with type 1 diabetes should have their eyes checked within a year or so of diagnosis and regularly after that depending on how things are going.
People who have had diabetes for more than 10 years are at higher risk of eye disease and it is important to remember that with type 2 diabetes, you can have had diabetes for many years prior to diagnosis, so early checks are important. Young people who have had type 1 diabetes since early childhood are also likely to have some changes in their eyes as they reach their young adult years and should keep regular checks. Such changes might be minor and not vision threatening, but still require monitoring. Pregnancy is also an important time to have checks more often as changes in the eyes can happen in pregnancy.
The practice of ophthalmology includes prevention of blindness, promotion of eye health, and the rehabilitation of those with visual disability. Ophthalmologists are trained in both medicine and surgery, treatment of paediatric and adult patients, and provision of primary care as well as highly specialised treatment. You will need a referral from your doctor to see an Ophthalmologist.
There is a lot of information out there about food and diets and it can be very confusing to say the least!
Management of type 2 diabetes by diet alone is common for many people in the first instance. Even once medication and /or insulin are commenced in type 2 diabetes, food management remains vital.
People with type 1 diabetes need to learn about healthy food choices and in particular the amounts and types of carbohydrates in foods and how to manage their insulin to carbohydrate ratios.
Management of food is not just about keeping the blood glucose levels down and losing weight, it is also important in keeping a healthy heart and circulatory system, which is critical in all diabetes management for long term health.
Dietitians are university-qualified experts in nutrition and dietetics. They have the skills and training to provide food and nutrition advice to meet individual health and lifestyle needs. Dietitians are able to provide sensible, individualised advice about good food choices and life long eating habits that can help with management of diabetes. You can find dietitians in public hospitals and clinics and in private practice and do not need a referral from a doctor.
When choosing your nutrition professional, look for an Accredited Practising Dietitian (APD). The APD credential is a public guarantee of nutrition and dietetic expertise. APDs undertake ongoing training and education to comply with the Dietitians Association of Australia’s (DAA) guidelines for best practice. They are committed to the DAA Code of Professional Conduct and Code of Ethics and to providing quality service.
You can find information about dietitians in Australia at: http://www.daa.asn.au/
Social Workers, Psychologists, Counsellors and Psychiatrists
The management of the psychological and emotional side of diabetes is very important. This includes the effects of diabetes on psychological and social wellbeing. Diabetes can affect your mental health, work, financial situation, relationships and social life. What is happening in your life will also impact on your diabetes management and so it is important to address other problems so that you can get better management of diabetes. At the end of the day everything is connected. At Diabetes Can’t Stop Me we offer a range of different counselling options here.
People with diabetes might find it helpful to see a Social Worker, Psychologist , Counsellor, or Psychiatrist at a variety of points. Some people find that they need advice and support in dealing with diagnosis of diabetes, diabetes burnout or specific problems like depression or anxiety for example. Many people find that managing diabetes is tough at times and just need to reach out for some support occasionally. Other people might find problems that they need longer term help in managing or they might suffer with a major psychiatric illness.
Social Workers – Social workers offer counselling using a variety of techniques such as Cognitive-Behavioural Therapy (CBT), Mindfulness, ACT and Narrative Therapy. Many will use a range of techniques, with the focus on enabling you to resolve the problems present in your life. Social Workers also look at the societal and structural systems that affect people’s lives and lead to problems. They understand, utilize and connect people with community resources.
Social workers deal with things like the issues surrounding life events and human development, family conflicts and relationships, disabilities, and violence. Social Workers also address problems such as inadequate housing, health and work problems. Social workers are trained professionals who have qualifications obtained at University. They practice in a wide variety of settings, including family services agencies, community mental health centres, child welfare, private practice, schools, hospitals, businesses, nursing homes, courts, prisons and public and private agencies.
Look for a Social Worker who has studied at University and is a member of the Australian Association of Social Workers (AASW). Bear in mind that a “Counsellor” who has completed only a short course in counselling is not a Social Worker. You do not need a doctor’s referral to see a Social Worker but can access some Accredited Mental Health Social Worker’s via a Mental Health Plan from your GP.
You can find information about social work in Australia at: http://www.aasw.asn.au
Psychologists – Psychologists are trained in the psychological and/or behavioural components of mental illness and health. Psychologists receive their degrees from University. All psychologists must complete a Bachelor of Arts or Science program before enrolling in a psychology programme.
Psychologists often focus on cognitive-behavioural therapies, rather than the biological components of mental illness. Psychologists also work in research with emphasis on statistical analysis. Psychologists are taught about human development, individual differences in behaviour and dysfunctional behaviour. Psychologists work in lots of settings including hospitals, clinics, private practice, schools and universities. Many people living with problems such as eating disorders, depression, and alcohol or drug addiction are referred to psychologists for therapy sessions. You do not need a doctor’s referral to see a Psychologist but can access registered Psychologist’s via a Mental Health Plan from your GP.You can find out more about Psychology here: http://www.psychology.org.au/
Counsellor – Counsellors assist people to better understand themselves by explaining options, setting goals and helping them to take action. There are no formal qualifications required to be a counsellor, however most professionals will have a degree or diploma in counselling, psychology or social work.
Psychiatrists – A psychiatrist is a physician fully trained in general medicine. Psychiatrists are trained as general physicians first followed by a residency and internship in a hospital or clinical setting. Since psychiatrists are trained as medical doctors they can prescribe medication. Your GP can of course prescribe medication such as antidepressants as well. As doctors, Psychiatrists are particularly trained amongst other things, to know about the biological components of mental illness and disease. Psychiatrists often work in hospital settings and practice privately and are called upon to treat severe mental illnesses such as schizophrenia, manic-depression, and paranoia. You will need a doctor’s referral to see a Psychiatrist.
You can find out more about Psychiatry here: http://www.ranzcp.org/
People with diabetes are at a greater risk for developing gum disease and other dental problems. The bacteria that cause gum disease love high sugar levels and can progress and spread rapidly and infections in and around the teeth can occur. People with diabetes can also be more prone to things like oral thrush. It is therefore very important to see your dentist regularly, at least once or twice a year. Find more information here http://www.ada.org.au/
Pharmacists are very important in diabetes care as they can be a helpful resource in regards to the variety of medications that people with diabetes might need to use. It is a good idea to get to know your local Pharmacist. There is often a lot of useful information available at chemists, as well as support. There will usuallu be regular screening available for things like blood pressure and blood glucose. You can always ask for advice at your local chemist and they will refer you to your doctor where needed. You can find out more here http://www.psa.org.au/
Paediatricians are the key medical care providers for many children and adolescents living with diabetes, particularly those who live outside of major capital cities. Paediatricians are specialists in the care of babies and children. They will have general medical knowledge in the care of babies, children and adolescents and may also specialise in a particular area of children’s health. To become a paediatrician doctors must complete six years of extra training after they finish their medical degree. There are general paediatricians and specialist paediatricians such as paediatric cardiologists, gastroenterologists, developmental experts, etc. Some work in the country, some in private practice in the metropolitan area and some in hospitals.
Exercise Physiology is a very important part of the team. People with diabetes can access an Exercise Physiologist privately, or via the GP on a health care plan. Exercise Physiologists are 4-year university qualified allied health professionals who specialise in the delivery of exercise, lifestyle and behavioural modification programs for the prevention and management of chronic diseases and injuries. They provide physical activity and behaviour change support for clients with conditions such as cardiovascular disease, diabetes, osteoporosis, depressions, cancer, arthritis, COPD and many more. These professionals can help you to find exercise that will work for you and your abilities.
Find out more here: http://www.essa.org.au/exercise-physiology/
You might also be referred to a variety of specialists such as those below, if there are any complications with your diabetes and general health.
- Cardiologist – specialises in the heart and cardiovascular system
- Nephrologist – specialises in disorders of the kidneys
- Physiotherapist – works on muscular and physical aches, painsand abnormalities, as well as joint problems, posture etc
- Neurologist – specialises in diagnosing and treating nerve damage and neurological disease, such as diabetic neuropathy
- Gastroenterologist – specialises in problems with the stomach and digestive system and can help with things like diabetic gastroparesis (delayed stomach emptying).