Test Your Knowledge

Some questions may be relevant only to specific providers. Patients should keep in mind the following information for the following professionals:

• Nurse educator or certified diabetes educator (CDE). This is someone who helps patients learn about their diabetes and how to treat it. Patients should find out whether a prospective educator is certified.

Once they have selected an educator, patients should generally follow the lead of the educator but should not hesitate to raise any questions or concerns. Questions for a diabetes educator, working with an endocrinologist or other lead physician, may include matters pertaining to glucose monitoring, other self-tests such as ketone tests, medication, lifestyle changes and unusual symptoms such as dizziness or fatigue.

• Registered dietitian. During the formation of a meal plan, patients should tell their dietitian about medications they take to control their diabetes. Patients should also share their personal food preferences, and it may help to bring in a food diary that records details of meals over a period of time.
  
  Once a meal plan has been established, it will be reviewed from time to time. Lifestyle interventions, such as exercise and quitting smoking, may also be recommended by a dietitian. Patients should express any concerns they may have about their diet.
  
  
• Ophthalmologist. Patients should ask prospective eye doctors about the percentage of their patients who have diabetes, and whether the physician performs laser retinal surgery (photocoagulation)photocoagulation for diabetic retinopathy). In addition to a dilated pupil exam and funduscopy, will the patient receive other eye tests such as perimetry (visual field testing), tomography (measurement of pressure inside the eye), pachymetry (measurement of the cornea’s thickness), gonioscopy (inspection of each eye’s drainage angle) and fundus photography?

Patients should be ready to report details to the physician that include their level of glucose (blood sugar) control, blood pressure and any complications related to diabetes or other conditions they may have. They will also want to ask how they can reduce their risk of diabetic retinopathy, glaucoma, cataracts and other eye diseases.

• Pharmacist. Patients should bring their medications with them when they go to the pharmacy with questions. It is also crucial that pharmacists know about all of the prescription drugs, over-the-counter drugs and supplements the patient uses if they are to provide information about possible drug interactions. Individuals should ask whether any medications or supplements they are taking can affect their glucose levels.
  
  
• Dentist. People with diabetes are at increased risk for gum disease and should be sure to inform their dentist of their condition. Patients should ask about the best methods to prevent gum conditions. Diabetic heart patients may need to take antibiotics when undergoing dental work.

• Exercise physiologist. Exercise is a cornerstone of most diabetes treatment plans. A physician may refer a patient to an exercise physiologist, trainer or other expert. Patients may want to ask about the individual’s experience in working with diabetes patients, about which types of exercise are recommended and which may need to be avoided, about the interaction of exercise and blood sugar, and about exertion and heart rate.

There are many other medical specialists that diabetic patients may need to see occasionally or regularly. These include:

• Podiatrist. Some people with diabetes will need to see a foot doctor, as foot problems are a common and serious diabetic complication. Patients should ask prospective podiatrists about how many patients with diabetes they treat, how often a complete foot exam is needed and what it will include, what treatments may be needed for serious conditions such as ulcer or Charcot foot, what foot care the patient should perform at home, whether the patient can perform nail care or needs to have the podiatrist do it, and whether diabetic shoes, socks, inserts, skin thermometers or other products are recommended.
  
  
• Gynecologist/obstetrician. Yeast infections and sexual dysfunction are common in diabetic women. Women with diabetes who are pregnant, or are considering pregnancy, will need to see a specialist with experience in high-risk pregnancies and diabetes-related pregnancy issues. This applies to women with type 1, type 2 or gestational diabetes or other forms of diabetes.
  
  
• Urologist. Many diabetic men experience sexual dysfunction, including impotence. In addition, men with diabetes face the same common prostate disorders that other men have.
  
  
• Cardiologist. Many people with diabetes will need to see a cardiovascular specialist because they have atherosclerosis, diabetic angiopathy and high blood pressure. Patients may wish to ask whether cardiac tests such as a stress test should be routinely needed, what their blood pressure is and should be, what their cholesterol levels are and should be, how often cholesterol testing should be performed, whether cholesterol drugs or antihypertensives are needed, what diet and exercise plan is recommended, and how to quit smoking.
  
  
• Neurologist. The nerve disease diabetic neuropathy is a common complication of diabetes. Patients need to know how often they should have a neurological exam and specific tests such as electromyography, nerve conduction velocity studies and quantitative sensory testing, and what their options are if treatment is needed.

• Nephrologist. Kidney disease (diabetic nephropathy) is a serious complication of diabetes. Patients are advised to ask about the merits of microalbuminuria testing, proteinuria testing, glomerular filtration rate and waste product tests to detect and monitor renal damage, whether dietary changes will help (e.g., reduced salt or low protein), whether medications such as ACE inhibitors or angiotensin-II receptor blockers are advised, and about the need for dialysis or a kidney transplant if end-stage renal failure is approaching.
  
  
• Dermatologist. Skin conditions often develop with diabetes. Patients may wish to ask about treatment options and prevention methods such as skin care.
  
  
• Therapist/psychologist. Patients with diabetes face many issues that can create extra stress or lead to depression. A therapist or psychologist may be able to recommend methods or counseling to help deal with stress or other mental health issues at work, home and school.
  
  
• Rehabilitation therapists. There are a variety of circumstances where diabetic patients may work with a physical therapist, occupational therapist or speech language pathologist. For example, patients may receive outpatient therapeutic monochromatic infrared as a treatment for neuropathy, inpatient instruction in using adaptive equipment such as a shower bench after a leg amputation, or speech therapy after a stroke. Patients may wish to ask about the therapist’s level of experience in addressing diabetic issues, how long therapy may be needed and what treatment methods and assessments will be used.