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Diabetes Consults

Diabetes is a chronic condition in which the body does not properly process food into energy. When we eat food (particularly carbs) the body turns it into glucose (sugar), the substance our body uses as energy. Central to this process is insulin, a hormone made by the pancreas to help cells absorb glucose. In people with diabetes, the body either does not produce enough insulin or uses it inefficiently. This causes the blood sugar, or blood glucose levels, to either get too high (hyperglycemia) or too low (hypoglycemia).

If you have diabetes, your doctor may recommend a number of at-home remedies to help you manage your symptoms and keep the condition's progression at bay. These include:

Eating healthy foods: This means staying away from salt, sugar, and unhealthy fats. Aim to have a large portion of your food intake come from veggies (especially leafy green ones), fruits, and other natural sources. This will help you reach and stay at a healthy weight, keep your blood sugar in a good range, and help to prevent cardiovascular problems, such as blood vessels and heart disease.

Get plenty of physical activity: Exercising, like proper nutrition, is good advice for everyone. If you're a diabetic, it can help keep you at a healthy weight, keep your heart and lungs healthy, and may even help your body regulate blood sugar.

Be consistent with your medicine: Follow all instructions given by your health care provider.

Test your blood sugar consistently: Glucose monitoring will not only help you keep track of how well the above steps are working, but it can also help you catch any complications such as diabetic ketoacidosis, which can be deadly if not treated.

Treatment for diabetes involves keeping a close eye on your blood sugar levels and keeping them in the target range set by your doctor through a combination of diet, exercise, and medication.

Your doctor may recommend you check your blood glucose levels daily. An instrument called a glucometer is used to check the blood sugar by dabbing a sample of your blood on a strip of paper. A newer device, known as a continuous glucose monitor (CGM), can be attached to your body and can measure your blood sugar every few minutes for up to a week at a time.

Monitoring your glucose gives you and your doctor a better idea of your body's changing need for insulin. For some people with type 2 diabetes, diet and exercise may be enough to control your diabetes. Others will need medication, which may be either an oral drug or insulin. There are a variety of oral drugs that a doctor may choose to prescribe, that each works in different ways. Insulin may be administered either as a shot, an insulin pen, or have an insulin pump.

Diabetes is a serious illness that you cannot treat on your own. You will want to see a doctor, and possibly build a team of health professionals, to help with your diabetes management. While there is no cure for diabetes, in some cases type 2 diabetes can be reversed. This means that the disease is in remission and your blood sugar levels can stay in a healthy range without needing medication. The key to this is often weight loss. Consult your health care team to figure out what method is best for you.

The exact cause of type 1 is unknown, though risk factors may include: family history, environment, presence of autoantibodies, and geography. Risk factors for type 2 diabetes may include:

  • Being overweight
  • Inactivity
  • Family history
  • Race/ethnicity
  • Age
  • High blood pressure
  • Low HDL ("good cholesterol") or high triglyceride levels

A diabetes care plan is a written document detailing the specific needs of diabetic students for the faculty and staff. It includes information such as what foods and medicines they take, when to take them, how much, and how the medicine is administered. Children and students with diabetes should have a care plan on file at their schools.

Possible complications from diabetes include:

  • Cardiovascular disease
  • Kidney disease
  • Eye damage
  • Nerve damage
  • Foot problems
  • Skin conditions

There are four main kinds of diabetes. They are:

Prediabetes: This is when your blood sugar is too high, but not high enough for your doctor to diagnose it as diabetes. It can, however, make you more likely to get type 2 diabetes and heart disease. More than a third of all people in the United States have prediabetes, though most are unaware of it. Exercising more and losing weight can lower the risk of it progressing.

Type 1 diabetes: Also known as insulin-dependent diabetes, type 1 diabetes is an autoimmune condition. It occurs when your body attacks your pancreas with antibodies causing the organ to stop producing insulin.

Type 2 diabetes: With type 2 diabetes, the pancreas usually produces some insulin, but it either doesn't produce enough, or the body doesn't use it correctly. About 90% of people who have diabetes have type 2. People who are obese (more than 20% over their target body weight) are at higher risk of type 2 diabetes.

Gestational diabetes: Pregnancy often causes some amount of insulin resistance. When it gets bad enough to become diabetes it is known as gestational. Gestational diabetes occurs in about 2%-10% of pregnancies and it usually goes away after birth. However, about 10% of women who have gestational diabetes get type 2 later on.

Diabetes can cause complications that affect foot health. Some of these complications are:

Nerve damage (neuropathy)

Untreated diabetes can damage nerves in the legs and feet. When nerves in those parts of the body are damaged, they may be unable to feel heat, cold, or trauma. This leads to infections, muscle weakening, and diabetic ulcers. If left untreated, these foot problems can be severe and threaten the safety of the limb. Podiatrists can help with wound care and preventative medicine to maintain foot health. This may save the foot from amputation.

Peripheral Vascular Disease

Diabetes can reduce blood flow to your feet, which makes it more difficult for infections and cuts to heal and increases the risk of developing gangrene or ulcers. Gangrene is a type of tissue death caused by a lack of circulation. Podiatrists can prescribe antibiotic medication to help the infection, but if left untreated, gangrene can lead to amputation.

Podiatrists can help create a foot care plan that keeps your feet healthy and free from infection. If you have a cut or blister that isn’t healing, or if you have chronic foot pain, talk to a doctor right away.

Podiatrists on Sesame offer affordable new patient consultations to talk you through your foot health and treatment plans that might be right for you. Sesame uses a direct-to-patient model, which means you book directly with the doctor you want to see and pay an upfront price with no insurance needed. Foot care can help prevent serious infection or disease. Talk to a doctor today to get the care you need.

Hemoglobin A1c Lab Tests, also called A1c, HbA1c, or glycated hemoglobin is a test that measures the average amount of blood sugar (also called glucose) attached to your hemoglobin over the past three months. Hemoglobin is a protein in your red blood cells that carries oxygen throughout your body. Doctors generally recommend getting an HbA1c every three months if you are managing a chronic condition like diabetes. That's because three months is the average lifespan of a red blood cell.

An HbA1c test is generally used by doctors to check for diabetes or prediabetes in adults. If you have already been diagnosed with diabetes, an HbA1c can help you and your doctor evaluate and manage your condition.

Diagnostic HbA1c tests are used to determine blood sugar levels - the critical factor in diabetes diagnosis. The results of an A1c test are given as percentages. These correspond to your blood sugar levels.

- Below 5.7%: A1c levels that are below 5.7% indicate healthy blood sugar levels. This means you are not currently at risk of developing diabetes.

- Between 5.7-6.4%: This range indicates prediabetes, a serious health condition. Prediabetes requires immediate treatment to manage blood sugar levels and prevent the development of Type 2 diabetes.

- 6.5% or higher (after 2 separate tests): Blood sugar levels higher than 6.5% indicate that you have developed diabetes. Doctors will order two separate A1c tests to conclusively test dangerous blood sugar levels. If both tests come back with blood sugar levels at over 6.5%, they will begin treating you for diabetes.

For individuals already managing diabetes, doctors will aim to keep blood sugar levels under 7%. Blood sugar levels over 7% may require an adjustment in your treatment plan.

A1c tests are usually performed by your primary care provider. To diagnose prediabetes or diabetes, the test is performed by taking a sample of blood via a needle inserted in the arm. If your doctor suspects that you may be at risk for diabetes, they will usually order two separate A1c tests to be performed on different days. Once the blood has been drawn, it will be sent to a lab for analysis. It may take a day or two before you get your results back.

If you have been diagnosed with diabetes and are undergoing an A1c test to manage your condition, your provider can draw blood via a prick of the finger. This drawn blood will be put in a vial and tested in the office that day. This means you will usually get your results on the same day as your appointment.

Sesame is able to prescribe a wide range of common medications for conditions like infections, diabetes, asthma, hypertension, high cholesterol, and more. However, we are unable to prescribe controlled substances and medications that are at risk for abuse.

If you are looking for medication for a mental health condition, are in stable condition, and do not need psychiatric care, book an online mental health medication visit on Sesame to discuss treatment options with a licensed health care provider.

If you have been referred to a psychiatrist or are in need of psychiatric care, book an online psychiatrist appointment to talk about your concerns and the best treatment plan for you.

Please note that prescriptions are always at the discretion of your provider. Provider appointments are designed to evaluate your condition and craft a treatment plan that works for you. If your appointment does not result in a prescription, your appointment is non-refundable.

Sesame does not accept insurance for provider appointments - however, you can pay with cash, credit, debit, or even your FSA or HSA card since visits and prescriptions on Sesame are considered health expenses.

However, Sesame clinicians can assist with insurance prior authorization specifically for patients who book a weight management service through Sesame’s online weight loss program.

Sesame video diabetes consults are available 24/7 in all 50 states and can be booked whenever you need to talk to a health care provider about diabetes concerns.
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