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The Permanente Medical Group

Insulin

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Most people with type 1 diabetes need to inject insulin. Insulin is a hormone made by the pancreas, but it can also be injected. Insulin helps glucose (sugar) move from the blood into the cells. In the cells it is made into energy. Without enough insulin, too much sugar remains in the blood.

If you have type 1 diabetes, your body does not make its own insulin. This means that insulin injections are essential for life.

Insulin injections can also be a good option for people with type 2 diabetes. If you have type 2 diabetes, we may recommend insulin when:

• Your blood sugar levels are high.
  
• Oral medications do not control your blood sugar.
  
• Insulin is the best choice for your medical condition. 
• You experience side effects from oral medications. 

Two types of insulin

There are 2 types of insulin:

• Mealtime insulin keeps blood sugar from rising too high after a meal. It includes aspart, lispro, and regular insulin.
  
• Background insulin provides a constant level of insulin. This type of insulin includes neutral protamine Hagedorn (NPH), glargine, and detemir.

Insulin injections

Insulin is injected just under the skin. We will teach you how to do this. The needles are very short and thin. Most people do not feel discomfort and are surprised at how easy the injections are. If you have concerns about injecting insulin, talk to us. 

Medications for Type 2 Diabetes

There are several types of oral pills used to treat type 2 diabetes. For some people, one medication will be enough to control their blood sugar. Others may need a combination of medications as well as insulin injections. We will discuss which medications will work best for you.

Metformin

Glipizide (Glyburide)

Adjusting Your Diabetes Medications and Insulin

We will discuss your personal blood sugar targets with you and tell you how often to 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 your lifestyle and health goals.

Record your test results to keep track of your blood sugar patterns. Tell us if your blood sugar is out of range. We may need to adjust your medications.

If you have diarrhea and vomiting, or are intentionally fasting, we may tell you not to take medications or insulin. Call us if you are sick or intend to fast. 

Hemoglobin (Hb) A1C

We may order a hemoglobin (Hb) A1C blood test. This test measures your average blood sugar over several months. The goal is to keep the HbA1C within a normal range, usually below 7 percent.

Medications to Prevent Diabetes Complications

We may recommend medication to prevent heart attack or stroke. Medication can also protect you against kidney damage.

Statins

Statins lower cholesterol and triglycerides. They may also reduce the chance of heart attack or stroke. We usually recommend statins for people over 40 who have diabetes. Statins are helpful even when your bad cholesterol (LDL) is below 100.

Aspirin (81 mg daily)

A low dose of aspirin reduces the chance of a sudden blockage in an artery. This can prevent heart attack and stroke. We usually recommend aspirin for people over 40 who have diabetes and an increased risk of stroke or heart attack. Risk factors include:

• Cigarette smoking
  
• High blood pressure
  
• High cholesterol
  
• Family history of heart disease

ACE inhibitors and ARBs

We may prescribe an ACE inhibitor or ARB. ACE stands for angiotensin converting enzyme inhibitor. ARB stands for angiotensin receptor blocker. These medications:

• Lower blood pressure.
  
• Reduce your chance of having a heart attack or stroke.
  
• Protect your kidneys.
  

We usually recommend these medications for people over 55 who have diabetes. We may also prescribe them if the person has an additional risk factor such as high blood pressure or protein in the urine.

Medications and Pregnancy

Medications that can cause birth defects include:

• ACE inhibitors
  
• ARBs
  
• Statins
  
• Some oral diabetes medications
  

These medications should not be taken by women who are pregnant or trying to get pregnant. 

Talk to us if you are thinking about having a baby. It is best to have your diabetes under good control before trying to get pregnant. 

Diabetes can complicate your pregnancy. It can risk your health and the health of your baby. If you are a woman of childbearing age (15 to 49) and are not planning to get pregnant, use an effective form of birth control.

Managing Your Medications

Taking medication is a new habit to work into your lifestyle. Here are some tips:

• Make a simple chart and post it in a place you will see it every day.
  
• Set an alarm or watch as a reminder.
  
• Create a routine for taking your medications, such as at mealtime or bedtime, or when checking your blood sugar.
  
• Use a pillbox with sections for each day of the week.
  
• Carry a list of medications with you in your purse or wallet.
  

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 non-urgent 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 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 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

As your personal physician 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.
• 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.
• 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.