By Athena Philis-Tsimikas, M.D.
For some people living with type 2 diabetes, working with a primary care physician may be all they need to keep their blood sugars under control and prevent complications. But for others, successfully managing diabetes may require more help than a primary care doctor can provide. In such cases, we often refer patients to specialists who can address the specific challenges they’re facing, and help them develop a care plan tailored to their individual needs.
There are a number of reasons we might refer a patient to a specialist. Here are some of the most common:
1. You Need Help Understanding How to Monitor Your Blood Sugar
If you’re just learning how to manage your diabetes, or you need help with questions such as when and how to test your blood sugar — and what the results mean — a certified diabetes educator (CDE) can help. CDEs are specially trained in diabetes care and management, and can teach you how to best care for yourself day to day. Many CDEs are registered nurses and dietitians, and all pass a national test to become certified.
2. You Need Help Losing Weight or Eating Better
Being overweight and having diabetes often go hand in hand. Excess weight can increase your risk for cardiovascular disease, but research has shown that even moderate weight loss can help lower that risk. Whether you need to lose weight, or just want to learn how to make more diabetes-friendly food choices, a referral to a registered dietitian (RD) can be a good first step. Your RD can advise you on your daily dietary needs, how to read food labels and make food substitutions, how to plan for restaurant meals and special events, and more. Your RD can also help with dietary questions if you have cardiovascular disease or other diabetes complications. If losing or maintaining your weight is the goal, we may also refer patients to an exercise physiologist. In addition to helping with weight loss and maintenance, exercise can lower blood sugar, improve the way your body uses insulin, and help manage stress. An exercise physiologist can develop a safe, effective exercise program customized to your needs and interests.
3. You Need Help With Insulin Management
Again, this is where a CDE can provide a wealth of information and guidance. When we have patients who are new to insulin use, are transitioning from injections to a pump, or have other questions, a CDE is our first referral. Many offer classes or one-to-one training.
4. You Want to Talk to Others Who Have Type 2 Diabetes
While your physician is your best source for medical information, talking with other people who have diabetes can provide practical ideas and perspectives that help make living with diabetes easier. This is where support groups come in. Sharing experiences and information can provide encouragement and motivation while reducing stress. Check with your local American Diabetes Association chapter for support groups in your area.
5. Diabetes is Affecting your Work or Personal Life
Diabetes is a physical disease, but it can affect you emotionally as well. It can also impact your work, school, or personal life — especially if you have sick days. When this happens, we refer patients to social workers or counselors who are trained to help you learn to cope with stressful times, and can connect you to other resources for support and assistance.
Most likely, your doctor has a network of diabetes care specialists available, and can put you in touch with the right person to help. Or, check with your local American Diabetes Association chapter for contacts in your area.
Athena Philis-Tsimikas, MD, is an endocrinologist and the corporate vice president for the Scripps Whittier Diabetes Institute at Scripps Health in San Diego.
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