Your type 1 diabetes (T1D) care team

The team

Finding the right healthcare team for your type 1 diabetes (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) help with learning all aspects of diabetes management like preventing and treating low blood glucose, using an insulin pump, CGM or Flash GM device, managing exercise and sick days and many other topics.

Social workers can help parents make sure their children get the necessary diabetes care they need in school, and various other issues.

Behavioural health specialists (psychologist, psychiatrist, clinical social worker) help with the many behavioural changes that are required for individuals and families living with T1D.

Some healthcare providers use a team approach where you can get care from all of these providers at the same time. Others require you to schedule separate visits with different providers, depending on your needs. When you are looking for a doctor for your diabetes, ask 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 to you and that you can access experienced providers in these areas.

The Approach

Choose the healthcare team 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 Flash GM, 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 first visiting a new doctor, see if you can talk with them 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/Flash GM devices?

Does your healthcare provider have the ability to download data from glucose meters, insulin pumps and CGM devices to review 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.

Breakthrough T1D can help 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.