My Doctor Online The Permanente Medical Group

Symptoms

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When blood sugar drops too low or drops very quickly, your body usually sends you signals or symptoms. Symptoms of low blood sugar develop suddenly and often include feeling sweaty, shaky, or dizzy.

You may also feel some of these symptoms:

• Hunger
• Headache
• Nervousness
• Confusion
• Irritability or crankiness
• Fast heartbeat
• Tingling around your mouth or in your fingers
• A general sense that something is not right
• Sudden change in your mood

You need immediate medical care if your symptoms are more severe. Symptoms of dangerously low blood sugar include:

• Slurred speech
• Heavy breathing
• Poor coordination with clumsy movements
• Seizures
• Loss of consciousness

If you have any of these symptoms, get immediate medical help. If someone is with you, ask them to call our advice line immediately. The advice nurse will tell you what to do next. If you are alone, dial 911 or call for an ambulance. It is not safe for you to drive.

Risk Factors

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If you take certain diabetes medications, you are at risk for having low blood sugar. These medications include:

• Insulin
• Sulfonylureas, such as Glipizide or Glucotrol
• Alpha-glucosidase inhibitors, such as Miglitol

You may also increase your risk of low blood sugars if you don't eat regularly.

Hypoglycemia Unawareness

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If you have had diabetes for a long time or have nerve damage (neuropathy), you may not feel symptoms of low blood sugar. This condition is called hypoglycemia unawareness. With hypoglycemia unawareness, it is possible for blood sugar to drop very low and even cause you to pass out. If you experience hypoglycemia unawareness, we recommend these ways to stay safe:

• Check your blood sugar frequently, including before driving. With certain blood sugar levels, you may need to eat a carbohydrate snack to prevent your blood sugar from dropping too low.
• Talk with us about your personal blood sugar targets. Your targets may need to be slightly higher to prevent low blood sugar reactions.
• Have a glucagon kit available. A glucagon kit contains glucagon, a hormone that increases blood sugar. It is injected like insulin. This injection will increase your blood sugar back to a safer range. We will teach your family member or friend how to give you a glucagon injection if you pass out as a result of low blood sugar. We will give you a prescription for glucagon if you are at risk for very low blood sugar.

Prevention

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Monitoring your own blood sugar on a regular schedule is an important part of preventing low blood sugar. You can also reduce your chance of having low blood sugar by:

• Eating your meals and snacks on time.
• Eating enough carbohydrates.
• Taking your diabetes medication or insulin as directed.
• Learning if you need to decrease your insulin dose or eat more carbohydrates before exercise.
• If you choose to drink alcohol, eating at the same time.

When you take insulin or diabetes pills that may increase your risk of developing low blood sugar, it is important to plan ahead and treat low blood sugar right away if it occurs. Other important tips include:

Always carry a sugar source. You can buy glucose tablets or gel in a supermarket or pharmacy without a prescription. You may also wish to carry your glucose meter.

Wear a MedicAlert bracelet or identification that identifies you as a person with diabetes in an emergency.

Tell others you live or work with that you have diabetes. Teach them how to help if you become too confused to treat your own low blood sugar or if you pass out.

Test your blood sugar before driving a motor vehicle. Low blood sugar while driving can be dangerous to you and others.

Treatment

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If you feel symptoms of low blood sugar, we recommend checking your blood sugar and treating it if your blood sugar reading is below 70 mg/dL. If your meter is not with you, we recommend treating without waiting to check your blood sugar. Here are the treatment steps:

Step 1. Eat or drink a fast-acting sugar source containing 15 grams of carbohydrate. Examples are:

• 3 to 4 glucose tablets
• 1 tube glucose gel
• ½ cup (4 ounces) juice
• ½ cup (4 ounces) regular soda
• 8 to 10 Life Savers candies
• 3 teaspoons sugar (3 packets)
• 5 to 6 hard candies

If you take Miglitol, the only effective way to treat low blood sugar is with glucose tablets or gel. Other sugar sources will not work for you.

Step 2. Wait 15 minutes and check your blood sugar again. If your blood sugar is still below 70 mg/dL, repeat step 1.

Step 3. If your next meal is more than 1 hour away, eat a snack with 15 grams of carbohydrate to keep your blood sugar up. Examples are half a small sandwich or 6 crackers with cheese or peanut butter.

Step 4. Think about what caused your blood sugar to drop too low. Plan how you can prevent low blood sugar in the future. 

Tell us if you have frequent low blood sugar readings or symptoms. We will discuss changes in medication or treatment.

Call us right away if you:

• Have low blood sugar below 60 mg/dL 2 times in the same day.
• Have low blood sugar below 60 mg/dL without symptoms.
• Need assistance to treat a low blood sugar reaction.

Have a friend or coworker call if you lose consciousness and make sure friends and coworkers know that you have diabetes and what to do if you lose consciousness.

Your Care with Me

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We urge you to call if your blood sugar gets:

• Very low (typically under 70 mg/dL or a target we have set for you)
• Very high (typically over 300 mg/dL or a target we have set for you) 

And especially if you have symptoms such as:

• Dizziness
• Cold sweats
• Shortness of breath

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.

Diabetes and Pregnancy

If we know about your diabetes when you become pregnant, I may help you enroll in the Kaiser Regional Perinatal Nursing Services Program. You should call them for advice: 1-800-439-8376 (they have someone on call at all times).

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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.

• For nonurgent questions or concerns, you can e-mail me using this site. You can also book an appointment online to see me in person.
• If your concerns are immediate, or you simply prefer to use the telephone, please call our Appointment and Advice line, which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or book an appointment for you. 

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How We Coordinate Your Care

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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.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization.  We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

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:

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

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.

If I refer you to a specialist

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.

If you are due for preventive screenings or tests

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.

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Convenient Resources for You

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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:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions and schedule appointments.
• View your past visits and test results.
• View your preventive services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at our medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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