Treating diabetes: why you need the right team on your side

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Diabetes is a complex illness that affects many parts of the body. 

Diabetes is a complex illness that affects many parts of the body. So it’s important to have a healthcare team made up of different experts who can work together to give you the best care.

Disease of the blood vessels

“Many people think there are only two types of diabetes,” says Dr Chris Greyling, an endocrinologist at Mediclinic Durbanville. “Type 1, an autoimmune condition that affects both children and adults, and type 2, which is often linked to obesity and an unhealthy lifestyle. But there are also other forms of diabetes related to pregnancy, hormones, and genetics,” he explains. “Diabetes damages the inner lining of blood vessels, so in essence, it’s a disease of the blood vessels.”

Microvascular complications

Dr Greyling explains that diabetes can lead to microvascular complications, affecting the small blood vessels in the eyes, nerves and kidneys. This is more common, though not limited to, people with type 1 diabetes.

When microvascular complications affect the eyes, they can impair vision. In fact, diabetes is one of the leading causes of preventable blindness in Africa and worldwide, often resulting in retinopathy. This includes conditions such as proliferative retinopathy, bleeds (which can cause retinal detachment), and ultimately blindness.

“The entire nervous system can also be affected in different ways,” Dr Greyling adds. “For example, diabetes is one of the main causes of chronic kidney disease, which can progress to the point where dialysis is needed.” 

Macrovascular complications

Macrovascular complications affect the large blood vessels and can lead to serious heart and circulation problems, including coronary artery disease, atrial fibrillation, angina, heart attacks, and heart failure. Diabetes can also cause calcification of the carotid arteries that supply blood to the brain, making it a major risk factor for transient ischaemic attacks (TIAs) and strokes.

Peripheral vascular disease affects the large blood vessels in the legs, sometimes leading to severe blockages that may require bypass surgery or even amputation.

People with diabetes also face a much higher risk of sepsis, especially when foot ulcers fail to heal.

A team approach: The endocrinologist

These wide-ranging complications are the reason why diabetes patients need the correct care from a diverse team of specialists.

Endocrinologists, who diagnose and treat disorders of the endocrine system – the glands and organs that make hormones – play a key role in this team. They manage complex cases, coordinate care, and help patients understand their condition and complications. Dr Greyling explains that endocrinologists also manage hyperglycaemia (high blood sugar) in hospital patients, treat rare forms of diabetes, and empower treating physicians with up-to-date advice and information. They also stay involved in research and development of new treatments.

Specialists and educators

Because diabetes can affect so many parts of the body, patients often need care from a range of specialists. Apart from the endocrinologist to oversee and coordinate much of the care, these may include:

• Ophthalmologists (especially retina specialists) to detect and treat eye problems like retinopathy.
• Cardiologists to manage heart and circulation issues.
• Surgeons who treat infections such as sepsis.
• Orthopaedic surgeons to help with conditions like osteoporosis and carpal tunnel syndrome.
• Podiatrists and other clinicians to care for the feet.
• Dietitians to provide healthy eating advice.
• Dermatologists to treat rashes or other skin conditions.
• Urologists to manage urinary or related problems.
• Neurologists to treat nerve-related complications.

Dr Greyling also recommends including a diabetic nurse educator, who can offer practical guidance on day-to-day management, such as correct injection techniques.

Some specialists may be needed for specific cases, for example, paediatricians for children with type 1 diabetes, and obstetricians/gynaecologists for pregnant women with diabetes.

Regular check-ups

“Regular follow-up is extremely important,” says Dr Greyling. “Annual eye examinations and dilated fundoscopy is essential, as well as yearly foot examinations. Be on the lookout for complications, but remember that your medical team is there to help prevent them.”