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Online Medical Consultation for Diabetes

Diabetes is a disease that lasts a lifetime as there is currently no cure. It is a major medical problem, with an estimated 18 million Americans afflicted. Five million are not even aware that they have it. Diabetes is actually a number of different diseases involving problems with insulin levels. Under normal circumstances, the pancreas (located behind the stomach) releases insulin helping the body store and utilize fat and sugar obtained from food.

Diabetes develops when one of the following situations takes place -
• Pancreas produces no insulin.
• Pancreas produces insufficient quantities of insulin.
• The body responds inappropriately to insulin (insulin resistance).

The Role of Insulin in Diabetes

Blood glucose levels are closely regulated by insulin. It is constantly being released in small quantities by the pancreas. When the level of blood sugar rises to a specific level, the pancreas releases additional insulin which pushes more glucose into the cells causing blood glucose levels to go down.

To prevent blood sugar levels from becoming too low (hypoglycemia), the body alerts a person they should eat which releases some of the glucose stores, kept within the liver.

Those with diabetes either do not produce enough insulin or their body cells are insulin resistant, resulting in “high blood sugar”. The clinical definition of diabetes is a blood glucose level of 126 milligrams per deciliter (mg/dL) or greater after fasting overnight.

Types of Diabetes

Type 1 –This kind of diabetes happens when insulin producing cells in the pancreas are destroyed by the immune system. These diabetic patients produce no insulin. They must use injections of insulin to control blood sugar levels. Type 1 is most prevalent in people under 20 but it can occur at any age.

Type 2 – With type 2 diabetic patients produce insulin. However, their pancreas does not secrete enough or else their body is resistant to it. In this type, glucose cannot enter into the body cells. “Adult onset” is another name for type 2 diabetes, and it is the most common type in the U.S. While the majority of cases can be prevented, it remains the number one cause of serious complications, related to diabetes, including chronic kidney failure, blindness and non-traumatic amputations, in people over the age of 40.

Gestational – Triggered by pregnancy, gestational diabetes causes hormonal changes affecting the normal functioning of insulin. It develops in about four percent of pregnancies.

Symptoms of Diabetes

Type 1 diabetes symptoms can be sudden and severe. Consult a doctor, as soon as possible if you experience:
• Increased thirst
• Increased hunger
• Frequency of urination
• Dry mouth
• Weakness or feeling tired
• Unexplained weight loss
• Blurry vision
• Labored breathing
• Loss of consciousness (in rare cases)

Symptoms of Type 2 diabetes can be very similar to the above list. Often, there are no apparent symptoms or they develop very gradually. Other symptoms include -
• Sores or cuts that heal slowly
• Itching of the skin
• Recent gain in weight
• Yeast infections
• Tingling/numbness of the feet and/or hands
• Erectile dysfunction

Management of Diabetes

As mentioned above, diabetes can only be controlled not cured. Keys to managing diabetes are:
• Following a balanced meal plan
• Regular exercise
• Using diabetes medication exactly as prescribed by your doctor
• Home monitoring of both blood sugar and blood pressure levels.
• Routine visits to your doctor and having blood tests as ordered 

Clinical Trial Online Disease Management of Diabetes

In August 2012, the Palo Alto Medical Foundation conducted a clinical trial, and the results were published in an American medical journal. The purpose of the study was to determine the effectiveness of an online management system which supports uncontrolled type 2 diabetics.

A year long randomized trial of 415 individuals, with poorly controlled type 2 diabetes with the following intervention methods:
• Wireless uploaded home glucose meter readings
• Detailed diabetes status reports, specific to each subject
• Nutrition/exercise journal
• Insulin records
• Online messaging with team of health care professionals
• Online advice by nursing care manager/dietitian
• Medication management, including online prescriptions
• Personalized educational videos/texts, provided electronically by health team.

Significantly lowered plasma glucose concentrations were noticed at the six month mark. At 12 months, differences were not remarkable but more subjects had improved diabetic control beyond twelve months. The researchers concluded that a multidisciplinary health team, led by a registered nurse, can effectively manage diabetic patients who take advantage of an online management program dealing with specific diseases including diabetes.


Tang PC et al. (2013). Research and applications online disease management of diabetes: Engaging and Motivating Patients Online With Enhanced Resources-Diabetes (EMPOWER-D), a randomized controlled trial.

JMIA,20(3): 526-534.

UMMC (2011) Type 2 diabetes.

WebMD (2013). Diabetes basics.


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