Type 1 Diabetes Medical Team

Bonnie’s Story:

Know Your Medical Team:

A great resource is available on-line to print and use for setting up your diabetes health care team. Me, My Health and My Diabetes Team. If you prefer to talk to someone at the Canadian Diabetes Association you can find a regional office in your area. Your medical team may consist of but not limited to the medical team shown on this list.

Depending on your individual medical needs your doctor will refer you to the medical team that is right for you. You will also want to check into purchasing a medic alert bracelet.

type-1-diabetes-medical-team

Family Doctor:

Setting up your medical team is very important. Your family doctor is usually the person who has diagnosed your diabetes, if this is not the case you will want to ensure you have a family doctor. Your family doctor will be key in getting the rest of your medical team in place. You will want to have your family doctor complete a blood work requisition form that can be used throughout the year. This way you can have your tests done before you visit the doctor. When you see the doctor request a copy of your blood work, this way when you see other members of your medical team you will have all the information needed. Your family doctor will most likely get you started on medication and monitoring your blood glucose. You will want to keep track of your blood glucose for future visits to the doctor and diabetes nurse educator.

On a personal note – my family doctor has been very supportive in making sure I have the referrals needed for me to work effectively with my diabetes team. Ensure your family doctor is copied on all information from other members of your medical team. My family doctor looks after anything day to day, such as a common cold, yearly medical etc. and then my diabetes team look after my diabetes care. Each appointment is an educational session for me, I have my questions ready and I’m also ready to record any suggestions they may have. At times I can get very frustrated with the numbers just not working out somedays….even when I put so much time and energy into it. One thing a diabetes nurse educator told me that has always stayed with me is “you have diabetes and your blood sugar is going to go up and down, that is just the way it is. their is no magic.”

Diabetes Nurse Educator:

Your family doctor will refer you to the LiveWell Diabetes Program or a similar program in your area. Your diabetes nurse educator will educate you in understanding how the insulin works in your system and then how to manage it with the food you eat and your activity.  Check out the resources at the Canadian Diabetes Association on starting insulin. You will also want to educate you and your family on how to recognize and treat low blood sugar.

The diabetes education centre is where I see the diabetes nurse educator. They offer introductory classes for newly diagnosed diabetics and their family. You will receive information to take home. It may feel overwhelming as you are gaining all of this new knowledge, it will come together for you. The great thing is the more I learn the more I feel better about living well with type 1 diabetes. Your diabetes nurse educator will play a key role in your diabetes management.

On a personal note – I realized at a young age, I needed to know what my blood glucose level was at before I ever gave insulin or I would end up low. I also made a choice at a very young age to use multiply injections as it made it easier for me to be active and avoid low blood glucose. I guess for all the years I lived without actually knowing what my test was unless I went to the lab or tested a urine sample….which was so hit and miss. When blood glucose monitoring systems became available, I made a choice to monitor my blood glucose 5 – 7 times per day every day. It is a way of life and allows me the flexibility to live what I call a normal life. I’m very sensitive to insulin and a small change in my insulin dose will make a big change in my blood glucose level. I have found the best remedy for this is to test frequently. My doctor has given me a blood glucose range:

  • Before meals
  • Two hours after meal
  • Morning target
  • Bedtime target
  • Correction ratio (my correction ratio is 1 unit of fast acting insulin will lower my blood glucose by 3 mmol/L.)

When I test my blood glucose before lunch for example, I will consider the following:

  • My activity before and after my meal
  • Is my test within the target range?  If not consider correction amount needed.
  • What food am I eating that will require insulin.  My carbohydrate to insulin ratio varies depending upon my activity and the time of day.  Each diabetic is different in this area.

I use an insulin pen so it is very easy to discreetly give my needle really anywhere. Depending on my test and due to my insulin sensitivity I will only take my insulin when I start eating my carbohydrates. My rapid insulin which works within 15 minutes so it is very important for me to be eating my carbohydrates when I give my needle. I use the method which is called carbohydrate counting and it has been very effective in controlling my diabetes. Everyone is different in regards to how the insulin will work for you. Timing is important, know the time and duration of your Insulin, which will allow you to understand how it is working in your system.

You have to start somewhere

It is important to start recording your tests for you to better understand how much insulin you need for the amount of carbohydrates you are eating. The only way you can figure out what to do today is to have some idea where you have been prior to your appointment.  Some information is better then nothing. If you only recorded four days rather then seven take the information with you. Your diabetes nurse educator will be able to get you started on a plan that will allow you to lead a healthy life, make sure to set up a follow up appointment, the more you learn the better you will understand what works and what doesn’t. I like to see my diabetes nurse educator every year as she is the person who keeps me up to date on what is new with the clinical practice guidelines, new equipment, new products etc. Things change with your diabetes and what works today may not work in a year.

Dietitian:

type1-diabetes-meal-planning-guideThe dietitian will work with you to set up a healthy meal plan. You will learn how to read food labels and better understand why some foods are better choices then others. Part of the balancing act begins with understanding how the food will break down in your system in order to know how much insulin you will need. The dietitian will usually start by asking you what you would like your eating plan to look like and then they will have a starting point. Today with carbohydrate counting and fast acting insulin you can learn very quickly how to calculate the insulin carbohydrate ratio in the foods you are eating. You will also understand from this visit how exercise will effect the amount of insulin you may need for your food. You may want to review the meal planning guide prior to your appointment to prepare your questions.

 On a personal note – I look at having diabetes as a healthy way to live. This has been proven in my life over and over. When I was first diagnosed and introduced to eating a diabetic meal plan. You were on an exchange diet and you had to eat so many exchanges for each meal, your insulin was given in the morning and it would peak at certain times throughout the day and if you missed that time for your food, you would be low. You could not miss any food which included your ten and three o’clock snack. The options were very limited. Let me tell you I lived on a clock, not realized how restrictive that was until I was later introduced to new insulin and new ways. With the choices today in diabetes management it is a so much easier. I have been a life long learner in all areas of my life and staying up to date on diabetes has allowed me to live a healthy, fun life.

Optometrist:

Your optometrist is a medical professional who will check your vision and look after non-surgical procedures for your eyes. Blurred vision is one of the signs of undiagnosed diabetes due to high blood glucose. You will want to ensure your Optometrist sends all information onto your Ophthalmologist. Your optometrist will advise you how often you need to visit their office.

Ophthalmologist:

Your ophthalmologist specializes in medical and/or surgical treatment for your eyes. You will receive a referral most often from your family doctor or optometrist. Eye care is extremely important and you will want to check out the information on vision care.
On a personal note – Each visit the ophthalmologist they conduct a series of tests. Each visit they dilate my pupils so they can take pictures of the vessels in the back of my eyes, to ensure there are no signs of retinopathy. The equipment available today is all electronic which allows the doctor to look back on what was going on in your eyes from one visit to another. I have been going to an Ophthalmologist every year since I was very young and to date my eyes show no change after 49 years of having type 1 diabetes. You won’t be driving after this appointment and be sure to take dark glasses to wear when your pupils are dilated.

Endocrinologist:

An endocrinologist Is a doctor who specializes in internal medicine and treats disorders of the endocrine glands, such as diabetes. An endocrinologist is often referred to as a diabetes specialist.

On a personal note – I have found over the years it has been very difficult to be seen by an endocrinologist on a regular basis in the province of Saskatchewan. I made a choice years ago that I wanted to maintain the best care available in our health care system and that does include seeing an endocrinologist. This choice is up to you! The staffing has been a very big issue in our province and each time one of our doctors leave we have to get another referral in most cases. Don’t let them push you off their list or make it sound like you do not need to see a diabetes specialist. Family medicine is not set up to mange the needs of a type 1 diabetic.

Living with type 1 diabetes for the past 50 years I have lived through many life changes. Pregnancy was a challenge for me. My first pregnancy they knew very little about diabetes and pregnancy and at that time their were no blood glucose monitors or the medical team available that is needed during pregnancy. What they know today of course would of prevented the loss of my first child at full term. Pregnancy number two I did my research, had the medical team in place and I was in great physical, mental, emotional and spiritual health and ready for this pregnancy. One more twist came my way and I was hospitalized because I was going into pre-mature labour. While on bed rest and on medication to stop the labour I was given the wrong insulin and I thank god the nurse had the insulin bottle in her hand when she said to me “we should just leave this in your room and you could give your own insulin.” I noticing the insulin bottle was fast acting insulin and I asked her is that the insulin you just gave me? She replied “yes dear that is what is on your chart.” I immediately informed the nurse she had given me the wrong insulin and she best call the doctor. As you know I mentioned above how sensitive I am to insulin and this nurse had just given me three times the dose of fast acting insulin. I was hooked up to 100% glucose and had to eat toast and honey for most of the morning to ensure I did not pass out from a severe low blood sugar. The stress this put on my pregnancy with other circumstances caused premature labour and the baby was born early and only lived for one week due to the lungs not being strong enough. After this challenge in our life we made the choice not to have children. Things change and time heals, years later we decided to re-look at our options. All of my records were pulled out of archives and I met with the medical team to find out if there was any reason why I could not have a child with what they have available for diabetes and pregnancy today. I secured my endocrinologists and then with his referral I interviewed obstetrician / gynaecologist who would take me as a patient for my full pregnancy. I had the medical team in place for my entire pregnancy, I didn’t want to wait and see if specialists were needed, I wanted to start with a medical team that would be their with us for the entire pregnancy. This was 100% successful and we went home with a beautiful healthy baby girl.

Pharmacist:

Your pharmacist will be an important link in your medical team. You will want to ensure all your prescriptions are at one location. Have them print a list of medication that you can keep with your file for when you see the doctor. You will want to also make a list of supplements that you are on to ensure the pharmacist and your doctor can ensure their is no interference from one medication to another. Always ask if the medication will affect your blood glucose. You will also want to talk to the pharmacist about any over the counter medications.

Dentist:

Your dentist and oral hygienist will play a very important role in your dental care. The Canadian Diabetes Association have an excellent handout on dental care.

On the personal note – I go to the dentist once a year for a checkup and twice a year for cleaning. This has worked for me and as you know your dentist will tell you how often he feels it is necessary for you to see the dentist.

Podiatrist

A podiatrist looks after the medical and surgical treatment of the foot. This may not be on the list in the very beginning, although it will be important for you to understand the importance of proper foot care. You will want to check out the Canadian Diabetes handout on foot care. Your family doctor will be the best person to determine if you need to see a podiatrist.
On a personal note – it is just in the last year I have been to the podiatrist to ensure optimal foot care is maintained. I found over the years I have always been very careful with my feet.  I wore high heals for years and what would be consider the wrong shoes many times, now I go for comfort in a shoe and stay away from anything that hurts my feet. I have good shoes for any sport that I pursue and I enjoy an active life. I’m very picky about where I go for a pedicure and in most causes I have made a choice to do them myself.
Note: this list may be expanded based on the health care needs of each individual. Your family doctor will know what is best for you.
Live well with diabetes
Thanks Bonnie

Disclaimer – This website does not provide medical advice or treatment recommendations. All content on type 1 diabetes treatment website is for informational purposes and is the personal experience and opinion of the author. Always seek the advice of a licensed physician with you medical questions and concerns.

www.type1diabetestreatment.ca © 2015

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