I haven't had any issues yet although I admit so far I've only done Utgarde Keep..

I really only use 2 buttons on my DK. Button one is Death and Decay (F1 Key).

I have button 2 as a macro:

#showtooltip
/startattack
/cast Rune Strike
/castsequence reset=target Icy Touch,Plague Strike,Pestilence,Blood Strike,Scourge Strike,Death Strike

I have that macro bound to the "1" key, and as a secondary binding alt+2

Now, on my 4 shamans I have a standard DPS macro that splits into 3 parts - this macro is bound to the '2' key

#showtooltip
/castrandom [target=focustarget,mod:alt] Lightning Bolt,Chain Lightning
/cast [target=focustarget,mod:ctrl] Chain Lightning
/cast [target=focustarget,nomod] Lightning Bolt

Last, I have a macro on all 4 shamans bound to my '3' key that lesser healing waves my tank on all 4, or if i use ctrl chain heals the entire group.

Ok so when I'm pulling I basically target a mob I want to pull and hit the '1' key on my DK to icy touch him - then I immediately hit F1 to drop a death and decay in front of me. Around this time the whole group of mobs is running into my Death and Decay which holds aggro very well. Now I just spam alt+2 and my DK will spam rune strike when its available and keep running through the castsequence - meanwhile my shamans are throwing lightning bolts and chain lightnings like crazy. if for some reason my DK needs healing I change from spamming alt+2 to spamming 1 and 3 with 2 of my fingers - DK will keep dropping rune strikes and the castsequence meanwhile all 4 shamans will do lesser healing wave on my DK, then back to alt+2 until everything is dead.

Really its only like 3 buttons for the entire combat - very easy, requires next to no thought. Haven't had to do anything more than that yet, although in the future I could see myself needing to use icebound fortitude, bone armor, anti magic shield/zone, etc, but I can just click on these.