Doctors and Nurses:

Navigating the Who’s Who of a Diabetes Clinic

Did you know that there are many different types of doctors and nurses in your diabetes clinic? A doctor might not be a diabetes doctor; they might be a senior house doctor, and a nurse may not be a nurse; they could be a healthcare assistant.

* Disclosure: This blog post was written by Thriveabetes cofounder, Gráinne, and originally posted by her on Blood Sugar Trampoline on 3rd July 2019. However, it is also updated from the “Doctors and Nurses” chapter of the 2012 Type 1 Starter Kit. Republished with permission.

Being diagnosed with type 1 diabetes is overwhelming for many reasons. Beyond the flood of information on how to stay alive, you're suddenly introduced to a team of medical people: nurses, dietitians, endocrinologists, and figuring out who does what can be confusing. I remember sitting through appointments nodding at advice, only to leave wondering: Who was that? What exactly do they do? And even more confused when their advice conflicted.

Over time, I learned how valuable it is to understand who’s who in my diabetes team. It not only cleared up my confusion but also helped me direct my questions to the right people, saving everyone time and reducing frustration. This webpage explains some of the most common medical people you will meet during your diabetes clinic appointment. These are the people who’ll support you long term, so it’s important to build a relationship based on mutual respect.

Your Clinic

People with type 2 diabetes may be managed by their GP or a diabetes clinic; it depends on their individual situation. However, all people diagnosed with type 1 diabetes are referred to a diabetes clinic in a hospital.

The Diabetes Clinic is made up of a multidisciplinary team. You should have access to a diabetes specialist doctor (Endocrinologist or Diabetologist), a diabetes nurse specialist, and a dietitian. Not all diabetes clinics will have all of these disciplines.

The following is based on my experience attending several clinics over 30 years of living with type 1 diabetes.

Arrival

The first person you will meet when you arrive at your clinic is the secretary, where you check in. This person pulls your physical file out and places it in the queue. Then you go to the waiting room.

Next, you may see between two and four or more healthcare professionals.

Healthcare Assistant

The healthcare assistant will take your blood pressure, weight and some details about any external health checks you have had since your last appointment, such as your annual Retina Screening or a Podiatry screening. It’s always good to look these dates up in advance. They may also ask you if you need anything. They WILL NOT interpret Hba1c levels, blood glucose readings, give advice on insulin use, titration, or medication changes.

Diabetes Nurse Specialist (DNS)

In my experience, the DNS is the backbone of diabetes care. They were the ones who taught me the essentials of diabetes, how to inject insulin, use my glucose monitor, and manage everyday challenges. They are also the ones I turn to for troubleshooting, whether it’s adjusting my insulin for a big meal or navigating new technology. If you take one thing from this blog, let it be this: build a strong relationship with your DNS.

A DNS is a nurse who has gained quite a bit of experience and has also done a 1-year postgraduate course specialising in diabetes, and often has the professional title of Clinical Nurse Specialist CNS. There are also DNS who have become Advanced Nurse Practitioners.

The Intern or Non-consultant hospital doctor (NCHD)

The Intern or NCHD is a term used in Ireland to describe qualified medical practitioners who work under the supervision of a consultant in a particular speciality.

In order to register fully with the Irish Medical Council, graduates are required to complete a minimum of two months and a maximum of three months in a speciality, which is why you will probably never see them again.

The role of the NCHD is to assess and discuss your case with their supervising consultant.

Have you ever noticed that a doctor will often leave the consultation room and not really explain why? This is usually to confer with their supervisor: probably your consultant endocrinologist. If your clinic visit is uneventful, your visit may be completed at this point. However, if you have asked to see your consultant or if you have highlighted an issue or concern, you may have to go back to the waiting room and wait for your consultant.

Endocrinology Registrar

You may come across a Specialist Endocrinologist Registrar in your clinic. This is a fully trained doctor who is just finalising his/her specialist training in endocrinology. It might sound like they’re not your best choice - but think about it - they just finished med school this century, so they should be right up to speed with the latest and greatest!

Endocrinologist or Diabetologist: The Specialist Diabetes Doctor

Endocrinologists focus on the hormonal system, and for us, that means insulin and blood sugar control. It’s recommended that you see your diabetes specialist 2-3 times per year, and you’ll soon be calling them your ‘Endo’.

I’ve learned that finding the right consultant for me is important. If your current consultant doesn’t seem like the right fit, you have the option to switch—either through a referral in the public system or by going private.

Dietitian: Making Food Work for You

How food impacts glucose levels is one of the biggest factors in diabetes management. Your dietitian is the food expert. I used to dread dietitian visits, thinking I’d be scolded for eating ‘bad’ foods. But modern diabetes care has evolved. A good dietitian helps you work with your favourite foods rather than eliminating them. Do ask lots of questions like “how much insulin do I need to eat pizza and chips?” Gone are the days when we were told to give up all sweet treats and desserts. There is a lot of information about how foods affect our glucose levels, and we have CGMs now and much better insulin to help us.

If your clinic doesn’t have a dietitian, your GP may be able to refer you to the diabetes community care dietitian. Alternatively, you may find a dietitian who specialises in diabetes and practices privately. The Irish Nutrition and Dietetic Institute website (www. indi.ie) has a list of all the registered dietitians in Ireland. If you do take this route and you have private health insurance, you may qualify for a rebate.

Other Key HEALTHCARE PROFESSIONALS

Pharmacists: Your lifeline for diabetes supplies and last-minute emergencies.

Mental Health Professionals: While rare in diabetes clinics, emotional support is just as vital as medical care. Peer groups and online resources can fill the gap.

Lessons Learned and Future Plans

Reflecting on my journey, I’ve learned that taking charge of my own care starts with understanding my team. Knowing who to approach for different concerns has made my appointments smoother and more productive. In the future, I plan to advocate for more accessible diabetes mental health services, as emotional well-being is often overlooked in care plans.

If you’re navigating your own diabetes journey, my advice is simple: ask questions, build relationships with your healthcare providers, and find a team that works for you. It may take time, but it’s worth it.