There is more to treating diabetes than checking blood sugars with a glucose meter and keeping your blood sugar levels within a specific range. Most people with diabetes have a health care team in place to help them manage their care. Discover when and why you should see an endocrinologist with diabetes as they, too, should be part of your health care team.
People with diabetes typically work with a health care team including a primary care physician, internist, dentist, ophthalmologist, podiatrist, diabetes nurse educator, fitness trainer and dietitian. Another person who may be part of your health care team is an endocrinologist.
An endocrinologist has extra, specialized training to diagnose and treat illnesses that affect your endocrine system, hormones and glands. An endocrinologist starts their journey with 4 years of college. This is followed by 4 years of medical school. Then they study 3-4 years of internal medicine as an intern, then resident. The next step is a fellowship in endocrinology for 2-3 years specializing in the treatment of hormone conditions. They then must sit for an exam, and pass, to be called a board-certified endocrinologist. This process may take up to 10 years. The training does not stop there. They must take yearly courses and earn CME credits. Every 10 years they must recertify and document at least 50 CME units. An endocrinologist is a true specialist in diabetes, but you will still require a primary care doctor for other medical conditions. Hormone disease treatment is constantly changing, and endocrinologists have access and advanced knowledge in the most innovative treatments and therapies. Disorders of the endocrine system are chronic and may require lifelong care and management from the endocrinologist. Endocrinologists treat lipid disorders, metabolic bone disease, calcium problems, menopause issues, adrenal disease, Cushing’s or Addison’s, fluid and electrolyte disorders, thyroid issues, growth disorders and all forms of diabetes, including gestational diabetes. A “diabetologist”, usually is an internist who specializes in the treatment of diabetes, but they are not board certified in endocrinology. Endocrinologists specialize in hormone problems including the hypothalamus, pituitary, thyroid, parathyroid, thymus, adrenals, pancreas, ovaries and testes. The pancreas is directly related to diabetes. The most common aspect of an endocrinology practice usually concerns thyroid disease, both hyperthyroidism and hypothyroidism, and all types of diabetes.
When seeing an endocrinologist for diabetes, they will begin with a physical examination including listening to your heart, checking blood pressure, taking your pulse rate and respirations, feeling for pulses in your feet, checking skin turgor or elasticity, checking soles of your feet and doing lab tests including a fasting glucose, urine tests for protein, sugar or blood cells, A1C, cholesterol and electrolytes. They will ask about your medical history including current symptoms, previous medical conditions, exercise, smoking and eating habits and require a list of your current medications, vitamins and supplements. The endocrinologist also needs to be fluent in diabetes complications including cardiac disease, kidney disease, nerve disease and eye disease. When necessary, they will refer you to a cardiologist, nephrologist, neurologist or retinal ophthalmologist for specific complications.
Insulin is a central hormone the body needs to function, and your pancreas is part of the endocrine system. With diabetes, there is no secretion, or an inadequate secretion of a hormone called insulin by the pancreas. Your primary care physician may be capable to treat your diabetes if it is straight forward, otherwise, they will refer you to an endocrinologist. A specialist may be required to help assist with your diabetes self-management program. Many patients with diabetes who require multiple insulin injections and different kinds of insulin may need the extra expertise of an endocrinologist to prescribe the insulin regimen.
Most people with type 1 diabetes are advised to see an endocrinologist especially when the condition is new and they are still learning. It may be difficult for the primary care physician to prescribe an insulin protocol with all the existing supplies. The patient needs to learn how to use a glucose meter, give an insulin injection, whether they prefer a vial and syringe, an insulin pen and pen needles or an insulin pump. The endocrinologist will make the decision based on your health insurance, your personal preference and your dexterity. People with type 2 diabetes may also be referred to an endocrinologist when they develop complications or have difficulty managing their blood sugars and A1C levels. An endocrinologist holds the most knowledge specifically about diabetes and can help you manage your diabetes in the best way possible.
In certain situations, a general physician might not be completely comfortable caring for diabetes or could lack the resources to educate a patient. Endocrinologists provide patients with essential information about taking care of diabetes. This helps the patient to be well-trained and motivated to participate fully in their own diabetes self-management program. Encourage your physician to send you to a diabetes self -management program as well. Diabetes education is almost always covered by health insurance.
When a patient with type 1 diabetes is on routine therapy and experiences hypoglycemic reactions and/or has high blood sugar levels, they are frequently referred to an endocrinologist. Treatments may include a basal-bolus program of injections or use of an insulin pump. It is important to work with a doctor who is experienced and familiar with these types of regimens.
When a patient with type 2 diabetes is on diabetes medication yet still has elevated A1C levels they may be referred to an endocrinologist. A second or third oral diabetes medication may be added, or insulin may be required. The endocrinologist may also reassess work schedules, smoking habits and stress factors in the patient’s life which all can influence blood sugars. They may also refer the patient to a dietitian, a smoking cessation class or physical therapist.
A diabetes complication such as nephropathy, neuropathy or retinopathy may require a patient to see an endocrinologist or another specialist to review the status of the patient’s diabetes treatment program. Research reveals aggressive therapy of such complications can slow down the progress of the disease.
A patient can request a consultation with an endocrinologist to discuss certain concerns. Several insurance plans may require a referral from your primary care physician, so check with your plan. If a patient is hospitalized and has out of control high blood sugars, an endocrinologist may be consulted. A pediatric endocrinologist may be recommended for a child or adolescent with diabetes.
Acute illness such as the flu, bronchitis or pneumonia may make blood sugars soar and could require the outpatient assistance of an endocrinologist.
There are many reasons to see an endocrinologist when you have diabetes. They can assist you with gaining control over diabetes for optimum health and developing a diabetes self-management plan that works for you.
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She is a member of the American Diabetes Association as well as the South Florida Association of Diabetes Educators. She worked with the education department of NBMC to help educate the hospital's in-patient nurses about diabetes. She practices a healthy lifestyle and has worked as a personal fitness trainer in the past.
She was one of the initiators of the North Broward Diabetes Center (NBMC) which started in 1990 and was one of the first American Diabetes Association (ADA) certified programs in Broward County, Florida for nearly two decades. Robbie has educated patients to care for themselves and has counseled them on healthy eating, heart disease, high lipids, use of glucometers, insulin and many other aspects of diabetes care. The NBMC Diabetes Center received the Valor Award from the American Diabetes Center for excellent care to their patients. Robbie has volunteered over the years as leader of many diabetes support groups.