My Doctor Online
The Permanente Medical Group

Risk Factors

Factors that increase your risk of developing diabetes include:

• Being overweight. 
  
• Having a parent, brother, or sister with type 2 diabetes. 
  
• Being of Native American, Latino, African American, or Asian/Pacific Islander ancestry. 
  
• Giving birth to a baby weighing more than 9 pounds. 
  
• Gaining too much weight during pregnancy. 
  
• Gestational diabetes. 
  
• Prediabetes.
• High blood pressure. 
  
• Low levels of good cholesterol (HDL). 
  
• High triglycerides. 
  
• Polycystic ovarian syndrome (PCOS). 
  

Symptoms and Complications

Symptoms

Diabetes can cause:

• Extreme tiredness. 
  
• Extreme thirst. 
  
• Frequent urination, especially at night. 
  
• Blurry vision or a change in vision. 
  
• Increased hunger. 
  
• Unintentional weight loss. 
  
• Sores or cuts that heal slowly. 
  
• Numbness or tingling in your feet. 
  
• Frequent infections of skin, gums, bladder, or vagina. 
  

However, many people with diabetes do not have any symptoms. This is why it is important for people with diabetes to frequently check their blood sugar to get a sense of how things are going inside the body.

Complications

Left untreated, diabetes can lead to serious health problems. Examples include:

• Eye damage. This can lead to loss of vision.
  
• Nerve damage. This can cause loss of sensation and chronic pain.
  
• Kidney damage. It can cause a rise in blood pressure and kidney failure.
  
• Stomach issues. Symptoms include chronic nausea and digestion problems
  
• Blood vessel damage. This can cause circulation problems, such as stroke and heart attacks. It can also cause pain in the feet and make it difficult to walk or for men to get an erection. 
  

Diagnosis

If you have diabetes symptoms, we may order a fasting blood glucose test. Before this blood test, you will need to fast overnight for 12 hours. 

Typically, we recommend a fasting blood glucose test at least every 5 years. Even without symptoms, we may test you every year if you have any of these risk factors:

• High blood pressure or high cholesterol
  
• Prediabetes
  
• Gestational diabetes
  
• Giving birth to a baby weighing more than 9 pounds
  

Your test result is reported in milligrams of sugar (glucose) per deciliter of blood (mg/dL).

We may order other blood tests that measure average blood sugar over several months.

Routine Monitoring Tests

Our goal is to keep your blood sugar, blood pressure, and cholesterol at healthy levels. Controlling these reduces the chance of complications like heart attack and stroke. We will monitor your levels regularly. If your test results reveal any problems, we will adjust your treatment plan.

In addition, we may conduct other tests:

• Diabetes eye exam
  
• Foot examination
  
• Kidney function test
  

If you have gestational diabetes, you may need to test your blood sugar frequently. This will reduce the risk of health problems for you and your baby.

Hemoglobin A1C and eAG (blood sugar)

We may order a hemoglobin A1C and estimated average glucose (eAG) blood test. This test measures your average blood sugar during the past 2 to 3 months. This tells us if your diabetes is under control. We recommend repeating the test at least twice a year. If we adjust your medication, we may test more frequently.   

We'll discuss your personal target for A1C and eAG. Typical ranges are:

Blood pressure and lipid tests

Blood pressure

Most people with diabetes should keep their blood pressure below 139/89. Lower blood pressure means less stress on the heart, blood vessels, eyes, and kidneys. Ask us about the blood pressure target that is best for you.

Lipids (cholesterol and triglycerides)

Keep your cholesterol and triglycerides in a healthy range. This will reduce your risk of heart problems including heart attack and stroke. Most people with diabetes should be on statin medications to manage cholesterol. Check with your doctor to see if statins are right for you.

Medication

Most people with diabetes benefit from medication that helps to control blood sugar. We may recommend other medications to manage blood pressure and cholesterol levels. If you are pregnant, or plan to be, talk to us. Controlling blood sugars early in pregnancy helps prevent birth defects.

Lifestyle Changes and Management

Healthy lifestyle habits can help you manage your blood sugar and prevent complications. You may need less medication and feel better overall. 

Healthy habits for people with type 1 and type 2 diabetes include:

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

Learn about managing diabetes and make changes one step at a time. Many people find it helpful to enroll in a diabetes class or join a support group for people with diabetes. Also ask for support from friends and family members.

Healthy Eating and Healthy Weight

Healthy eating and weight management help control blood sugar. You and your family benefit when you manage your diabetes. You can do this by paying special 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.

When you eat. Don't skip or delay meals. Eating regular meals will keep blood sugar under control. 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. Include:

• Vegetables and fruits
  
• Whole grains
  
• Lean protein
  
• Nonfat or low-fat dairy products

Physical Activity

Be physically active on most days

Get 30 minutes or more of physical activity on most days. Physical activity helps to:

• Control blood sugar
  
• Keep your blood pressure down
  
• Keep cholesterol and triglycerides in a healthy range
  
• Improve your mood
  
• Give you more energy
  
• Reduce the risk of heart disease and stroke
  

If you are just beginning to exercise, talk with us. We can help you choose activities that are right for your fitness level. Remember to:

• Do something you enjoy.
  
• Start out slowly, for 5 to 10 minutes each day, and gradually do more.
  
• Listen to your body. Stop right away if you feel dizzy, short of breath, sick, or are in pain.
  
• Drink plenty of water before, during, and after exercise.
  
• Wear shoes and socks that fit well.
• Make exercise a part of your daily schedule.

Self-Monitoring

You can keep yourself healthy by checking your blood sugar and blood pressure. It's also important to check your feet every day so you can treat any cracks or injuries. We recommend you keep a log of this information.

Check your blood sugar. We will talk to you about your personal blood sugar targets and how often you should check your blood sugar. Here are the goals for most people with diabetes: 

We may modify your targets if you are pregnant or to fit lifestyle and health goals.

Monitor your blood pressure. Check your blood pressure with an automated blood pressure monitor. Tell us if your blood pressure is frequently outside your target range so we can adjust your treatment plan. 

Managing blood sugar during exercise

If you have type 1 diabetes:

• Check your blood sugar before exercising.
  
• Eat a carbohydrate snack if necessary.
  
• While you are exercising, watch for symptoms of low blood sugar.
  
• Carry a fast-acting sugar source with you. Try glucose tablets or fruit juice.
  
• Wear a MedicAlert bracelet to identify you as a person with diabetes.
  

You may need to test your urine for ketones before exercising. We may ask you to do this if you have type 1 diabetes and your blood sugar is above 250 mg/dL. We can prescribe ketostix for testing your urine at home. If your urine contains moderate or high ketones in your urine, don't exercise. This is a sign that your body does not have enough insulin. Contact us right away to discuss treatment.

Managing stress and mood

Chronic stress can get in the way of managing diabetes. Stress can:

• Increase blood sugar and blood pressure. 
  
• Make it harder to stick to a healthy eating and exercise plan.  
  
• Make it more difficult to remember to check blood sugar and take medications.
  

Learn and practice these techniques to cope with stress:

• Deep breathing
  
• Physical activity
  
• Muscle relaxation
  
• Meditation
  
• Support from family or friends
  
• Making time for activities you enjoy
  

Coping with feelings and mood. 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, or hopeless. This may indicate depression. Behavioral treatments and medications can help. 

Prevention

You can protect your health and help prevent type 2 diabetes by:

Exercising for 30 to 60 minutes every day. Physical activity decreases insulin resistance, helping your body to balance your blood sugar. Walking for 30 minutes 3 times per week reduces the chance of developing diabetes.

Losing weight. 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. Choose smaller portions. Include a variety of vegetables, fruits, and whole grains in your diet. Limit your intake of sugary foods and alcohol.

Your Care with Me

As your hospital medicine physician, my first contact with you will be either in the Emergency Department or in your hospital room.  Together we will go over your medical history and medications you are currently taking, perform a physical examination, and come up with a treatment plan.

While you are in the hospital

I will work closely with your bedside nurse and patient care coordinator each day of your stay to improve your health and to plan for a safe return home. We will also inform your family members of your care plan. If you are having symptoms that concern you when you are in the hospital, please inform me or one of the hospital staff immediately.

If specialty care is needed during your hospital stay, I may contact one of my specialty colleagues and discuss your care with them.

If I prescribe medications

During your hospital stay, we will work together to monitor and assess how your medications are working and make adjustments over time. Before you leave, we will go over each new medication, how to take it, and when/if to stop the medication. At the time of discharge, all medications can be picked up at the discharge pharmacy. 

After you are discharged from the hospital, you will have a follow up visit with your primary care clinician. You may also receive a follow up phone call from one of the hospital staff to see how you are doing once you are at home.

If you are having symptoms that concern you and you are not currently in the hospital:

• You may contact your personal physician, who will evaluate your health and symptoms.
• If you have urgent concerns or issues or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice and make an appointment with your doctor if needed.  
• If you are experiencing an emergency, call 911 or go to the nearest Emergency Room.

Coordinating 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 that allows all of the doctors and clinicians involved in your care to stay connected on your health status and 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.

This applies especially to your primary care physician, who will be notified electronically when you are hospitalized, and may review the care you are receiving while in the hospital. Upon discharge, your doctor will receive a summary of your care in the hospital, including some tests or imaging results that may still be pending.

Care After Hospital Discharge

If you require further testing and medications, or are having symptoms after leaving the hospital, we recommend that you contact your primary care physician.
You can also call the Appointment and Advice line. Our call centers are open every day of the year around the clock. If you need advice, we will transfer you to one of our skilled advice nurses (RNs). They can help you determine when you need to be seen and in what location. The advice nurse can often start your treatment by telephone depending on the situation and has access to your electronic medical record.

If refills are needed in the future after you leave the hospital, you can:

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

If further lab testing or imaging is needed 

For lab tests that are needed after discharge, 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. Your primary care physician will follow up on these results unless your condition needs immediate attention. In addition, you can view most of your laboratory results online, along with any comments that your primary care physician may have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, I will make an electronic referral to the appropriate department and they will contact you for an appointment.

If Surgery or a Procedure is a Treatment Option

Occasionally, a procedure and/or surgery can be postponed until you are healthier and have recovered from your hospitalization. Then I will refer you to the appropriate service and they will follow up with you once you are discharged from the hospital.

If you are considering a procedure or surgery, please take a moment to go to the “Tools & Classes” tab above and select the “Prepare for Your Procedure - Emmi” link. There you can watch videos about different procedures.

Convenient Resources for You

As your specialist, I have a goal 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 at any time that is most convenient for you. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages to your primary care physician and specialist.
• Manage your prescriptions.
• View your past visits and test results. View your preventive services to see whether you are due for a routine screening or updated immunization.
• Manage your family’s health by setting up access to act on their behalf. Learn how to coordinate care for the ones you love.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures of common conditions we take care of in the hospital.
• 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 every 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.