My Doctor Online The Permanente Medical Group

Treatment Goals

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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.

Blood sugar

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.

Blood pressure

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.

Lipids (cholesterol and triglycerides)

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: 

For some people with diabetes and heart disease, we aim for LDL cholesterol below 70 mg/dL. Ask us about your lipid targets.

Preventive Medications

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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:

• Aspirin, 81 mg daily, reduces your risk for heart attack and stroke by decreasing the chance of a sudden blockage in an artery. We usually recommend aspirin for people with diabetes who are over 40 years of age. We may recommend aspirin for younger people with additional risk factors like family history of heart attack, high blood pressure, or high cholesterol or those who smoke.
• ACE inhibitors or ARBs lower blood pressure, reduce your chance of having a heart attack or stroke, and protect your kidneys. We usually recommend ACE inhibitors or ARBs for people with diabetes who are over age 55 or those who have additional risk factors such as high blood pressure or protein in their urine.
• Statins lower cholesterol and triglycerides (blood fats) and may decrease inflammation inside your arteries, reducing the chance of having a heart attack or stroke. We usually recommend statins for people with diabetes who are over age 40, even when your LDL cholesterol is below 100.

Lifestyle Changes

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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:

• Eating healthy foods and maintaining a healthy weight
• Being physically active on most days
• Managing stress and depression
• Monitoring your blood sugar
• Quitting smoking
• Taking care of your feet

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 and Monitoring

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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.

Blood sugar and lipids

We recommend a blood test every year, or more often, to monitor hemoglobin A1c (average blood sugar) and lipids (cholesterol and triglycerides).

Blood pressure

We recommend having your blood pressure checked at least once a year, or possibly more often if your blood pressure is above target.

Kidney screening

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.

Eye screening

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:

Nerve screening

We will check the nerves in your feet at an appointment each year. 

Dental exams

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.

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.
• 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.

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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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