Which Diabetes Doctor Are You Forgetting to See?
Diabetes is a head-to-toe disease that requires full-body treatment. If you're not seeing these doctors regularly, you might be missing out on lifesaving health care.
High blood sugar problems don’t just boost the numbers on your meter. They reach into every cell of your body—shutting down nerves, hampering blood flow, and amping up blood pressure. Along the way, these disturbances increase your odds for everything from muffled hearing and heart attacks to blurry eyesight and big-time foot problems.
The solution? Well-managed blood sugar, plus a health-care team with plenty of well-trained specialists. You’re probably already seeing your family doctor, internist, or endocrinologist. And we hope you’re taking advantage of insurance for a certified diabetes educator and/or registered dietitian for healthy living and food advice.
But to truly take care of yourself, consider adding some (or all) of these experts. The payoffs include a brighter smile, sharper vision, a happier outlook—and a lower risk for major diabetes complications like heart attacks, strokes, and even amputation.
Deep in your inner ear, diabetes can damage nerves and tiny blood vessels. This can slowly muffle your ability to hear the world around you, especially high-frequency sounds like women’s and children’s voices. In a recent National Institutes of Health study, people with diabetes were twice as likely to have hearing loss as those without blood sugar problems. A hearing check can’t reverse damage, but it can boost your motivation to keep your blood sugar controlled to slow future damage, and can help you take the steps to hear clearly again, says audiologist Debbie Abel, AuD, a senior education specialist with the American Academy of Audiology. Signs of trouble that merit a check? “Turning the TV up, not hearing the turn signal in your car or your telephone ringing, and not understanding what people around you are saying are all warnings of potential hearing loss,” Abel says. If you’ve been exposed to extremely loud noise on a regular basis—at work or because you attended lots of rock concerts or ran loud lawn equipment every weekend—your risk for hearing loss is even higher, she says.
Make an appointment: Get a hearing check if you suspect a problem or if you’d like a baseline for comparison with future tests. Your family doctor can do a basic hearing test but may miss more subtle signs of trouble that an audiologist or a physician specializing in hearing loss will spot. An audiologist will perform a thorough exam, can monitor you to see if your hearing loss worsens, and can help you make adjustments, such as getting a louder ringer for your phone or a hearing aid.
2. Ophthalmologist or Optometrist
Over half of all people with diabetes skip annual eye checks, yet high blood sugar (plus the high blood pressure and circulation problems that go with it) nearly doubles your risk for cataracts (cloudy lenses) and glaucoma (damage to the optic nerve that can cause vision loss). It can also make tiny blood vessels in your eyes swell, leak, and grow wildly, leading to diabetic retinopathy, the leading cause of blindness in working-age adults (20 to 74). Blurriness, a dark spot in the center of your vision, or “floaters” are warnings that deserve fast attention, but trouble usually starts years before you notice anything. “A yearly eye exam will find signs of diabetic retinopathy early, when healthy lifestyle changes and treatment are most effective,” says Charles P. Wilkinson, MD, professor of ophthalmology at Johns Hopkins School of Medicine.
The American Academy of Ophthalmology (AAO) says 90 percent of diabetic eye disease can be prevented with regular eye tests and better control of your blood sugar, blood pressure, and cholesterol. If retinopathy is more advanced, laser surgery can shrink blood vessels to prevent growth and bleeding. Early signs of glaucoma can be treated with eyedrops or laser surgery to protect your optic nerve.
Make an appointment: Yearly, with an ophthalmologist or optometrist for a comprehensive eye exam. In a proper diabetes eye exam, your doctor will dilate your pupils (usually with eyedrops) so he or she can closely examine your retina and optic nerve; the pressure inside your eyes will also be measured. Both types of vision specialists can monitor retinopathy; for surgery, however, you need an ophthalmologist.
Cuts, scrapes, blisters, and bug bites on your feet are a big deal if you’ve got diabetes. “High blood sugar and reduced blood flow due to diabetes interfere with healing, but if you have nerve damage from high blood sugar, you may not notice a problem immediately,” says Crystal Murray Holmes, DPM, an assistant professor of podiatry in the University of Michigan Medical School’s Division of Metabolism, Endocrinology & Diabetes. The result: A small problem can morph into a big infection, fast. No wonder some 66,000 people with diabetes undergo foot and lower-leg amputations each year; 80 percent are the result of foot ulcers, which often start as seemingly minor wounds. “Eighty-six percent of these can be prevented with good foot care at home and regular foot exams by a podiatrist and family doctor,” Holmes says.
Make an appointment: See a podiatrist if you’re at high risk for foot problems (from nerve damage, poor circulation, or past foot ulcers), and make sure your primary care doctor checks your feet at every visit. “Your doctor should look for skin and nerve damage, circulation problems, and signs that your shoes are rubbing your skin,” says Holmes. Spotting problems early allows your doctor to treat small skin dings before they progress to serious damage or to recommend a footwear switch.
High blood sugar and low levels of protective saliva (a side effect of many medications) double your risk for gum disease, which worsens blood sugar control. Yet people with diabetes often skip the dentist. “Taking care of your teeth and gums reduces infections that boost inflammation throughout your body, raising blood sugar,” says Marjorie Jeffcoat, DMD, professor and dean emeritus of the University of Pennsylvania School of Dental Medicine. In a new study of 91,524 type 2 diabetes patients, Jeffcoat found that people who got treatment for gum disease had 33 percent fewer hospital stays and 13 percent fewer doctor visits over three years.
Make an appointment: Get a checkup and cleaning at least twice a year. “Some people with diabetes should see the dentist three or four times a year,” Jeffcoat says. Your dentist should check for signs of gum disease—by measuring the space between your gums and teeth—and refer you to a periodontist if needed, she says.
5. Mental Health Counselor
Staying on top of diabetes can be hard work, but a social worker, psychologist, psychiatrist, or other mental health counselor can give you support to protect against an “invisible” diabetes complication: depression. In the United States, 18 percent of men and 28 percent of women with diabetes have depression, report Washington University School of Medicine researchers. Low moods can make taking good care of yourself more difficult, and depression can boost inflammation, which can affect blood sugar levels.
A brief (eight- to 12-week) problem-solving type of counseling called cognitive behavioral therapy has been shown to lift moods and help people with diabetes. In a British study of 344 people with diabetes, depression, and high blood sugar, counseling improved A1C levels (a test of long-term blood sugar control) significantly. It helps over the phone or via the Internet. In one University of Michigan study of 291 people with diabetes and depression, 58 percent of those who got 12 weekly phone-counseling sessions followed by monthly calls for nine months saw their depression lift. They also began to exercise regularly and saw their blood pressure improve.
Make an appointment: See a mental health specialist if you suspect depression, have signs of burnout (like exhaustion or feeling overwhelmed), or just want better coping skills. Start by talking with your primary care doctor; sometimes, symptoms of poor blood sugar control, like low energy, disrupted sleep, and increased appetite, can mimic depression. Find a cognitive therapist certified by the Academy of Cognitive Therapy at academyofct.org.
Diabetes is a triple whammy for your heart and the some 100,000 miles of blood vessels in your body, doubling or even quadrupling your risk for a heart attack or stroke, boosting your odds for heart failure, and raising your risk for painful artery clogs in your legs called peripheral artery disease. It’s a threat you can’t afford to ignore, yet many do: Sixty-five percent of all deaths in people with diabetes are the result of heart and blood vessel disease, yet six in ten people with blood sugar problems said in one recent national survey that they didn’t even know about the danger.
The first step: Work with your family doctor or endocrinologist to stay on track with a healthy lifestyle and medications if necessary. Consider seeing a preventive cardiologist—a specialist who can do advanced testing and provide more intensive cardiovascular care—if your primary care doctor recommends it, says William Zoghbi, MD, FACC, president of the American College of Cardiology.
Make an appointment: “People with diabetes who have a history of or present symptoms of heart disease should be considered for referrals,” Zoghbi says. “These include heart attack, bypass surgery, or angioplasty, as well as a history or present symptoms of chest pain or pressure associated with exertion or emotional stress, unusual shortness of breath, swelling of legs, palpitations, or fainting.” A cardiologist can help if you have trouble keeping your blood pressure and cholesterol within healthy ranges, he says.