My Doctor Online The Permanente Medical Group

What Monitoring Tells You

.

Monitoring tells you your blood sugar level. This will help you know if your level is too high or too low. With this information, you can decide what action to take.

High blood sugar (hyperglycemia). This is a blood sugar reading consistently above 180 mg/dL or above your recommended target range. It can develop because of:

• Eating too much carbohydrate
• Being sick or having an infection
• Being stressed
• Not taking enough diabetes medication or insulin

Low blood sugar (hypoglycemia). Blood sugar less than 70 mg/dL is too low for most people who take diabetes pills or insulin. If you take certain diabetes pills (sulfonylureas or alpha-glucosidase inhibitors) or insulin, it's important to know the symptoms of low blood sugar, how to treat low blood sugar, and how to prevent it.

  Low blood sugar can develop because of:

• Skipping or delaying a meal
• Being more active than usual
• Not eating enough
• Taking too much diabetes medication or insulin
• Drinking alcohol without eating

Blood Sugar Targets

.

When you monitor your own blood sugar, it is important to know your blood sugar targets. Talk with us about your personal targets. For many people, the blood sugar targets are:

Checking Your Blood Sugar

.

Follow the specific directions included with your glucose meter. Here are general steps for checking your blood sugar:

• Wash your hands with warm water and soap.
• Slide a test strip into your meter. 
• Lightly prick the side of your finger with the lancet device to obtain a very small drop of blood.
• Place the blood drop on the test strip.
• Check the reading displayed on the meter. 

The meter measures your blood sugar in about 5 seconds and displays the reading. The meter automatically saves the reading in its memory, along with the date and time.

When you are diagnosed with diabetes, we will prescribe a glucose meter and necessary supplies like test strips and lancets (small needles used to prick your finger). We will show you how to use your meter and recommend how often to check your blood sugar.

Our Health Education Department has information about classes, videos, or DVDs to help you learn more about using your glucose meter. You can also learn more in the owner's booklet that comes with your meter or on the website of your meter's manufacturer. If your meter is not working properly, we recommend calling the customer service number listed on the back of your meter.

When to Check Your Blood Sugar

.

Talk with us about when to check your blood sugar. Our recommendation usually depends on:

• Your type of diabetes: type 1, type 2, or gestational 
• Your medication or insulin plan
• If your blood sugar levels are frequently high or low
• If you are pregnant or planning a pregnancy
• How often you want to monitor your blood sugar

We also recommend checking your blood sugar when you are:

• Feeling symptoms of hypoglycemia (low blood sugar)
• Engaging in physical activity
• Sick or have an infection 
• Taking steroid medications for another condition

Sickness and infection cause blood sugar levels to increase. Steroid medications and cortisone injections also cause blood sugar levels to increase.

Tips for Blood Sugar Monitoring

.

Preventing sore fingers. You can prevent sore fingers by pricking the sides of your fingers and staying away from fingertips and pads. Alternate the fingers used for checking so you use a different site each time. Use the lightest setting on your penlet (lancing device) that still allows you to get a small blood droplet. Be sure to change the lancet after each use. With repeated use, lancets can become dull and cause sore fingers.

Getting enough blood. If you have difficulty getting enough blood, shake your hand up and down or run warm water over your hand before you prick your finger. 

Safe use of lancets.  Do not share your lancets (needles) with others. Check with your city or municipality for the safest way to dispose of used lancets. Do not dispose of lancets in garbage or recycle bins.

Recording Your Blood Sugar Readings

.

We recommend keeping a blood sugar record when you are first diagnosed with diabetes or when starting a new medication, eating plan, or activity. Many people use a notebook or the logbook included with the meter to write down:

• Date and time
• Blood sugar readings
• Comments about medication, food, activity, sickness, or stress

Keeping records helps you see patterns or trends in your blood sugar readings. We can use this information to make decisions about your diabetes pills or insulin. You can also use blood sugar records to make decisions about eating, physical activity, or stress management.

You may prefer to keep records by downloading your blood sugar readings from the meter's memory to your personal computer. Your meter's manufacturer usually offers software for downloading blood sugar readings.

To ensure that your meter is working properly, you will want to calibrate your meter carefully following the manufacturer's instructions. Also, you will want to ensure that the battery is in good working order to get the most accurate results.

Your Care with Me

.

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.
• Seizures related to low blood sugar.
• Excessive thirst and/or urination. 

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. 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.

• 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. 

.

How We Coordinate Your Care

.

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.

.

Convenient Resources for You

.

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.

.