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.
Diabetes resulting in high blood sugar (glucose) levels can gradually lead to complications over time. Although the complications from diabetes are serious, the good news is that we can do a lot to prevent these problems. Possible diabetes complications include:
Over time, high blood sugar damages the blood vessels, organs, and nerves. You can stay healthy and prevent or reduce the risk of diabetes complications by controlling your blood sugar, blood pressure, and lipids (cholesterol and triglycerides). You can also reduce your risk by making healthy lifestyle choices, taking certain medications, and having routine screening and monitoring tests.
We will work with you to set your treatment goals. Treatment goals will include keeping your blood sugar (glucose), blood pressure, and lipids (cholesterol and triglycerides) as close to normal as possible, most of the time. Studies have shown that this reduces the chance of developing diabetes complications. If your results are above the target ranges, we will discuss adjusting your treatment plan.
Hemoglobin A1c (A1c) or estimated average glucose (eAG) is a blood test that measures your average blood sugar over the past 2 to 3 months. We recommend a hemoglobin A1c blood test at least every year, and possibly more often if we are adjusting your treatment plan.
The target for many people with diabetes is an A1c below 7 percent or an eAG below 150. If you are older than 65 or have additional health conditions, we may recommend an A1c below 8 percent or eAG below 180. Talk with us about your personal target for A1c and eAG.
For most people with diabetes, the target blood pressure is at or below 139/89. Lower blood pressure means less stress on your heart and blood vessels, eyes, and kidneys. Ask us about the blood pressure goal that is best for you.
It is important to have your blood pressure checked at least once a year and possibly more often. In addition, consider taking your own blood pressure at home with an automatic blood pressure monitor.
We recommend a blood test for lipids every year. Lower LDL cholesterol and triglyceride (blood fat) levels reduce your risk for hardening of the arteries, heart attack, and stroke. Your lipid results are reported in milligrams per deciliter of blood (mg/dL). Target ranges for most people with diabetes:
|Total cholesterol||Less than 200 mg/dL|
|Triglycerides||Less than 150 mg/dL|
|LDL cholesterol||Less than 100 mg/dL|
|HDL cholesterol||More than 40 mg/dL for men, more than 50 mg/dL for women|
For some people with diabetes and heart disease, we aim for LDL cholesterol below 70 mg/dL. Ask us about your lipid targets.
Studies have shown certain medications protect you from heart attack, stroke, and kidney damage when you have diabetes. We recommend these medications even if your blood pressure and lipids are in the target ranges because of the protective benefit. We will discuss which medications are best for you. Common types of preventive medications when you have diabetes include:
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 a support group for people with diabetes. It is also important to get support from friends and family members.
Routine screening tests look for early signs of complications before you may notice any symptoms. Finding complications early means you can have treatments to cure the problem or prevent it from progressing.
We recommend a blood test every year, or more often, to monitor hemoglobin A1c (average blood sugar) and lipids (cholesterol and triglycerides).
We recommend having your blood pressure checked at least once a year, or possibly more often if your blood pressure is above target.
A yearly urine test for microalbumin (tiny amounts of protein) is recommended for most people with diabetes. If protein is found in your urine, it may mean the kidneys are not working as well as usual, and we will discuss treatments to protect your kidneys. If you already take medication to protect your kidneys, a urine microalbumin test may not be necessary.
It is important to have your eyes examined every 1-2 years, even if your eyesight is good. This type of eye screening exam looks at the health of tiny blood vessels that supply the retina (thin layer of nerves that lines the back of the eye).
How often to have an eye screening depends on your type of diabetes or the recommendation of your eye specialist. A typical screening schedule is:
|Type of diabetes||When to get your eyes screened|
|Type 1||Every year.|
|Type 2||Every 1 to 2 years.|
|Women planning pregnancy||We recommend a complete eye exam before pregnancy.|
We will check the nerves in your feet at an appointment each year.
Visit your dentist at least every 6 months to 1 year for routine dental care and cleaning. This helps keep your gums healthy and prevents gum disease and infections that may cause high blood sugar.
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.