Are you having back pain with any of the following?
We understand that you are experiencing one or more of the health issues that might be impacting your back pain.
We recommend that you discuss these health issues with your doctor before proceeding with this program.
Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.
Diabetes is a condition that makes it difficult for your body to regulate blood sugar levels. Managing diabetes means adopting healthy behaviors and taking medication as directed to stay healthy and prevent complications.
When you have diabetes, your body is not able to regulate blood sugar levels, because it either does not produce enough insulin or does not use insulin effectively (insulin resistance). Diabetes may also be a result of a combination of these two factors. Insulin is a hormone made by the pancreas that helps glucose (sugar) move from the blood into the cells. In the cells, glucose is made into energy for the body. Because of low levels of insulin or insulin resistance due to diabetes, too much sugar remains in the blood.
There are three types of diabetes – type 1, type 2, and gestational – and in all cases, blood sugar levels are too high. While low blood sugar levels (hypoglycemia) can be dangerous in the short term, high blood sugar (hyperglycemia) can harm your health over time. By taking care of diabetes, you can greatly reduce the chance of developing heart disease, stroke, kidney problems, erectile dysfunction, retinopathy (blindness), and other serious complications.
Lifestyle habits make a big difference in successfully managing your blood sugar, staying healthy, and preventing complications. Healthy lifestyle habits may mean you need less medication, have more energy, and feel better overall. Healthy habits for people with diabetes include:
The main types of diabetes are:
Prior to developing type 2 diabetes, many people have an elevated blood sugar level that we call prediabetes. With prediabetes, fasting blood glucose (sugar) is slightly elevated but not high enough to be considered diabetes. Having prediabetes means you are more likely to develop type 2 diabetes in the future. However, by losing weight and being more physically active, you can prevent or delay diabetes from developing.
The more risk factors that describe you, the greater chance you have of developing prediabetes and type 2 diabetes. Risk factors for developing this type of diabetes include:
Many people with diabetes do not have any symptoms. If you do experience symptoms of high blood sugar levels, they may include:
Women who develop gestational diabetes usually have no symptoms. We will check you for gestational diabetes during your pregnancy.
Untreated or uncontrolled diabetes can damage several parts of the body and can lead to very serious additional health problems. Any part of the body can be affected. Some of the major ones are:
If you have symptoms of diabetes, we recommend getting a blood test for fasting blood sugar (glucose). Depending on your age, weight, and other risk factors, we recommend a fasting blood glucose test at least every 5 years. We may recommend the fasting blood glucose test every year if you have these risk factors:
Before this blood test, you will need to fast overnight for 12 hours. Your test result is reported in milligrams of sugar (glucose) per deciliter of blood (mg/dL).
|Test results||Blood sugar level (mg/dL)|
|Normal||Less than 100|
|Prediabetes||100 to 125|
|Diabetes||126 or higher|
If the first blood test is high, we may ask you to have another fasting blood test on a different day to confirm the diagnosis.
Alternatively, you may have a non-fasting blood test for a Hemoglobin A1C and estimated average glucose (eAG), which measures your average blood sugar over the past 2-3 months. A Hemoglobin of 6.5 or over is diagnostic of diabetes.
Our goal for treatment is to keep your blood sugar, blood pressure, and lipids (cholesterol and triglycerides) as close to normal as possible. Studies have shown that controlling these reduces the chance of developing complications like heart attack and stroke. We will prescribe tests to monitor your levels. If your results are frequently above the target ranges, we will adjust your treatment plan. In addition, we may conduct other tests such as an eye and feet exam, a retinal screen, and a microalbumin analysis to test for kidney function.
If you have gestational diabetes, you may need to test your blood sugar as often as 4 times a day during your pregnancy to reduce the risk of health problems for you and your baby.
Hemoglobin A1c and estimated average glucose (eAG) is a blood test that measures your average blood sugar during the past 2 to 3 months. This test helps us understand how well we are able to keep your diabetes under control. We recommend a hemoglobin A1c and eAG blood test at least every year, and possibly more often if we are adjusting your treatment plan.
Talk with us about your personal target for A1c and eAG. Typical ranges are:
|A1c target (%)||eAG target (mg/dL)|
|Most people||Below 7||Below 150|
|People older than 65 or with additional health conditions||Below 8||Below 180|
For most people with diabetes, the target blood pressure is 139/89 or less. Lower blood pressure means less stress on your heart and blood vessels, eyes, and kidneys. Ask us about the blood pressure target that is best for you.
Lower LDL cholesterol and triglyceride (blood fat) levels reduce your risk for hardening of the arteries, heart attack, and stroke. Your test results are reported in milligrams per deciliter of blood (mg/dL). Target ranges for most people with diabetes:
|Total cholesterol||Less than 200|
|Triglycerides||Less than 150|
|LDL cholesterol||Less than 100|
|HDL cholesterol||More than 50 for women; more than 40 for men|
For some people with diabetes and heart disease, we aim for LDL cholesterol less than 70 mg/dL. Talk with us about your lipid targets.
In addition to eating a healthy diet and exercising, most people with diabetes benefit from medication that helps keep blood sugar, blood pressure, and/or cholesterol levels in the target ranges. If you are pregnant, planning to become pregnant, or are at risk for pregnancy, it’s very important that you talk to us. Controlling blood sugars early in pregnancy helps prevent birth defects.
The type of medication that we prescribe depends on your specific condition. We often start with a low dose of pills or insulin and ask you to check your blood sugar with a blood glucose meter. If your blood sugar stays above your target range, we will recommend increasing the dose, adding another oral medication, or adding insulin. If your blood sugar is frequently below target (hypoglycemia), we will discuss changes in your treatment. Types of medication include:
Studies have shown that certain medications can reduce the risk of developing diabetes complications. Because of their protective benefit, we often recommend these medications even if your blood pressure and lipids are in the target ranges. Depending on your age and medical conditions, common types of preventive medications may include:
Diabetes medications and pregnancy
Some diabetes medications should not be taken by women trying to get pregnant or who are at risk for pregnancy, because they can cause birth defects. If you have diabetes and want to get pregnant, please talk to us. It is best to have your diabetes under good control before trying to get pregnant. Diabetes can complicate your pregnancy and create risks for your own health and the health of your baby. If you are a woman of childbearing age (15 to 49) and are not planning to get pregnant, you must use a highly effective form of birth control if you are taking certain medications for diabetes or medications to prevent diabetes complications (such as ACE inhibitors or ARBs).
Lifestyle habits make a big difference in successfully managing your blood sugar, staying healthy, and preventing complications. Healthy lifestyle habits may mean you need less medication, have more energy, and feel better overall. Healthy habits for people with type 1 and type 2 diabetes include:
Making changes in your daily habits can be challenging. We recommend learning about managing diabetes and making changes one step at a time. Many people find it helpful to enroll in diabetes classes or join a support group for people with diabetes. It is also important to ask for support from friends and family members.
Healthy eating and maintaining a healthy weight are important ways to manage blood sugar, blood pressure, and lipids (cholesterol and triglycerides). You do not need to eat special diet foods. You can eat the same healthy foods as everyone else in your family. With all types of diabetes, including gestational diabetes, it is important to pay attention to:
How much you eat. Eat portions that are right for your weight and activity level. Eating too much leads to weight gain and higher blood sugar levels. Eating too little means you will not get enough energy from your food.
When you eat. Eat on a regular basis to prevent overeating and control blood sugar. Skipping or delaying meals can cause blood sugar to drop too low. Many people find it helpful to eat a meal or healthy snack at least every 4 to 5 hours.
What you eat. Choose a variety of foods from all food groups: vegetables, fruit, whole grains, lean protein foods, and nonfat or low-fat dairy products.
We recommend gradually working up to 30 minutes or more of physical activity on most days, at a comfortable pace for you. Being physically active helps control your blood sugar, blood pressure, and lipids. It can also reduce stress and improve your mood, give you more energy, and reduce your chance of heart disease and stroke. If you are pregnant, being active can help control your blood sugars.
If you are just beginning to exercise, talk with us about activity that is right for your fitness level and health condition. Here are some tips for being physically active:
If you have type 1 diabetes and your blood sugar is above 250 mg/dL, check your urine for ketones (a sign that your body does not have enough insulin). You can check for ketones at home by testing your own urine using ketostix that we prescribe for you. If there are moderate or high ketones in your urine, do not exercise. Contact us right away to discuss your treatment.
If you have type 1 diabetes, before you exercise, check your blood sugar and eat a carbohydrate snack if necessary. While you are exercising, watch for symptoms of low blood sugar (hypoglycemia). Carry a fast-acting sugar source with you, like glucose tablets or gel, or fruit juice. You may also consider wearing a MedicAlert bracelet than can identify you in an emergency as a person with diabetes.
You can keep yourself healthy by monitoring (checking) your own blood sugar, blood pressure, and feet. We recommend you keep a log of this information.
Check your blood sugar. It is important to know your blood sugar targets. We will discuss your personal targets and how often to check your blood sugar. For many people, the blood sugar targets are:
We may modify these targets to fit your lifestyle and health goals. If you are pregnant, we will talk with you about what your target blood sugars should be.
Monitor your blood pressure. If you have high blood pressure, you can periodically check your own blood pressure with an automated blood pressure monitor. Let us know if your blood pressure is frequently outside your target range, so we may adjust your treatment plan.
Take care of your feet. Foot injuries or infections are more common with diabetes. Taking care of your feet daily helps prevent problems. By checking your feet daily, you are more likely to notice problems early so we can start treatment right away.
Stress has many effects on the body, including increasing blood sugar and blood pressure. People who are stressed often struggle with lifestyle habits like healthy eating, exercising, checking blood sugar, and remembering to take medications. Many people notice higher blood sugar levels when they are stressed or angry.
Though most people feel stressed at times, ongoing stress can get in the way of managing diabetes. Learning and practicing methods to cope with stress can help you manage diabetes and enjoy life. Some ways to cope with stress include:
Your feelings can affect your blood sugar, and having diabetes can affect mood. Depression is more common in people with diabetes, although we do not know why. Let us know if you frequently feel sad, angry, irritable, or hopeless. These may be signs of depression. The good news is there are behavioral treatments and medications to help you feel better.
Even when you have risk factors for diabetes, studies show you can delay or prevent prediabetes or type 2 diabetes by:
Being physically active on most days. We recommend gradually working up to 30 to 60 minutes of activity every day. Physical activity decreases insulin resistance, which leads to diabetes. Studies show that walking for 30 minutes 3 times per week reduces the chance of developing diabetes.
Losing weight if you are overweight. Studies show losing 5 to 7 percent of your weight reduces the chance of developing diabetes. For example, if you weigh 200 pounds, losing 10 to 15 pounds can make a difference.
Eating a healthy diet. Eat fewer calories by eating less fat and fatty foods and choosing smaller portions. Include a variety of vegetables, fruit, and whole grains in your diet. Limit your intake of sugary foods and alcohol.
We urge you to call if your blood sugar gets:
And especially if you have symptoms such as:
If you are pregnant and your blood sugars get very low (hypoglycemia), call 911.
As part of your routine care, I will order lab tests to screen for diabetes at the appropriate time, based on your risk factors. If you have prediabetes, you can enroll in the prediabetes class without a referral for more information and support.
If we determine that you have diabetes, I will work with you to help manage it. We have a comprehensive program to help you live well with diabetes and maintain your health. I will refer you to a Diabetes Education class. You will be prescribed a glucose monitor, and you or your family will be trained to use it. We have online tools and classes to help you with physical activity, healthy nutrition, smoking cessation, and weight management.
I will likely prescribe medication. As we continue to monitor your blood sugar levels, blood pressure, and cholesterol levels, we will send you for follow-up tests and make adjustments as needed.
If you have difficulty getting your blood sugar under control, I may recommend that you work closely with a Diabetes Care Manager to help you achieve ideal blood sugar, blood pressure, and cholesterol levels. If you have diabetes and you are working with a Care Manager, you may call him or her directly. If you are interested in a referral to this program, please contact me.
If we know about your diabetes when you become pregnant, I may help you enroll in the Kaiser Regional Perinatal Nursing Services Program. They have someone on call at all times, and you should call them for advice: 1-800-439-8376.
You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.
Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology and health education, makes getting your care easier for you.
Another major benefit is our comprehensive electronic medical record system which allows all of the doctors and clinicians involved in your care to stay current on your health status and to collaborate with each other as appropriate.
When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.
We will work together to monitor and assess how your medications are working and make adjustments as needed. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you and I will send the prescription electronically in advance of your arrival at the pharmacy.
If refills are needed in the future, you can:
For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures we will schedule an appointment with the radiology department. When the results are ready I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.
My specialty colleagues are readily available to assist me if I need additional advice about your condition. In some cases, I may contact them during your visit, so we can discuss your care together. If we decide you need a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.
As part of our commitment to prevention, additional members of our health care team may contact you to come in for a visit or test. We will contact you if you are overdue for cancer screenings or conditions which may require monitoring.
My goal is to provide high quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.
My Doctor Online is available 24/7 so that you can access and manage your care where and when it is most convenient. From my home page you can:
If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.
This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.