Putting Together Your Support Team

Finding the right medical team to help you take care of your diabetes is very important. Healthcare providers may vary substantially in their experience with and approach to type 1 diabetes (T1D). In addition, different clinics are organized in different ways and some may be more suited to your individual needs than others. Here are some tips that might help you find the diabetes team that best fits your needs.

The Team

Finding the right clinic for your T1D care is about more than just finding a good doctor! People with t1d often need input from multiple different kinds of healthcare providers. Members of a diabetes care team might include:

• Endocrinologists (doctors who specialize in diabetes and other hormone disorders) manage the medical aspects of T1D such as insulin dosing, screening for diabetes complications, and caring for complications if they arise, as well as managing other problems that can affect people with T1D (such as thyroid disease or elevated cholesterol).
• Dietitians help with learning accurate carbohydrate counting and how other food components like fat and protein affect your blood glucose levels.
• Diabetes educators (who may be nurses or dietitians) to help with learning all aspects of diabetes management like preventing and treating low blood glucose, using an insulin pump or CGM device, managing exercise and sick days and many other topics.
  Social workers to help you sort through health insurance questions, to help parents make sure their children get the necessary diabetes care they need in school, and various other issues.
• Behavioral health specialists (psychologist, psychiatrist, clinical social worker) to help with the many behavioral changes that are required for individuals and families living with T1D.

Some clinics use a team approach where you can get care from all of these providers at the same time. Other clinics require you to schedule separate visits with different providers, depending on your needs. When you are looking for a doctor for your diabetes, ask the clinic which diabetes care professionals will be available at your visits. If long travel times are an issue, or taking time off from work or school is problematic, look for a clinic that uses a team approach with all diabetes professionals available at the same visit.

Other resources: From time to time, people with T1D need care from other specialists outside of the core diabetes team. These include:

• Ophthalmologists to do yearly checks for development of diabetes-related changes in the eyes
• Podiatrists to help with foot care in adults
• Obstetricians/prenatal diabetes program for women planning pregnancies

Although these specialists are not often a part of the main diabetes care team, it is important that these services are available within the hospital system that you choose or that the clinic you choose can help you get access to experienced providers in these areas.

The Approach

Choose the clinic that best suits your own needs and style. Endocrinologists differ in their approaches to T1D. For example, some favor frequent use of diabetes technologies such as insulin pumps and CGM devices whereas others favor more traditional approaches such as using insulin injections. Some will make most insulin dosage adjustments at clinic visits only whereas others aim to teach you how to make insulin dosage adjustments on your own between visits. Before choosing a doctor, see if you can talk with him or her by phone or email to get an idea of his or her approach to diabetes. Some good questions to ask include:

• How many patients in their care have T1D versus T2D?
• What percentage of their patients is using pumps and CGM devices?
  Does the clinic have the ability to download glucose meters, insulin pumps and CGM devices to review data at clinic visits?
• How easy is it to get in touch with the diabetes team between visits? Can you send blood glucose levels to the team (by email, fax or uploading) for review between visits?
  Do they offer classes?
• When possible, talk with several other adults with T1D and/or parents of children or teens with T1D and hear about their experiences with their diabetes care teams. Your local JDRF office can put you in touch with adults and/or parents living with T1D who will be happy to share their experiences with diabetes care teams in your local area.