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Type 2 diabetes: symptoms, goals and telehealth follow-up in Puerto Rico

Type 2 diabetes is a long-term condition in which blood sugar stays too high. If you already have a diagnosis and it is stable, you can do your follow-up by video: the doctor reviews your numbers and medications, gives you lab orders and, if appropriate, renews your prescriptions. Foot exams and eye exams still need to be done in person.

Can we help by telehealth? Yes, we can help by telehealth.

Is this an emergency?

This is not an emergency service. Call 911 or go to the nearest emergency room if you have:

  • Very low blood sugar with confusion, fainting, seizures or inability to swallow
  • Fruity-smelling breath, fast deep breathing, vomiting that will not stop or stomach pain with high blood sugar
  • Blood sugar that stays at 300 mg/dL or higher
  • Chest pain, shortness of breath, weakness on one side of the body or trouble speaking
  • A foot wound with fever, pus, a bad smell or skin turning dark

Help lines:

Warning signs: when to go to the ER

Book a visit

Type 2 diabetes symptoms

Type 2 diabetes symptoms often take several years to develop, and some people notice none at all. That is why most diagnoses come from a blood test. Common symptoms include:

  • Peeing often
  • Increased thirst and hunger
  • Losing weight without trying
  • Fatigue
  • Blurry vision
  • Frequent urinary tract or yeast infections
  • Cuts or sores that are slow to heal
  • Dark patches of skin on the neck, armpits or groin
  • Numbness or tingling in the hands or feet

Diabetes in Puerto Rico

In 2021, 14.4% of adults in Puerto Rico had diagnosed diabetes, the highest of any US state or territory (Colorado was lowest at 6.5%), according to a CDC analysis published in Preventing Chronic Disease.

Diabetes means many follow-up appointments. When yours is stable and what you need is a results review, a plan adjustment or a refill, a video visit can save you the trip.

How it is diagnosed: A1C and blood sugar

Diabetes is confirmed with blood tests, and a second test is usually done to confirm the diagnosis.

  • A1C: below 5.7% is normal; 5.7% to 6.4% is prediabetes; 6.5% or above indicates diabetes.
  • Fasting blood sugar: 99 mg/dL or below is normal; 100 to 125 mg/dL is prediabetes; 126 mg/dL or above indicates diabetes.
  • Random blood sugar: 200 mg/dL or above, with symptoms, indicates diabetes.

Goals and follow-up labs

For many people with diabetes the A1C goal is below 7%, but your own goal depends on your age and other conditions, and the doctor will discuss it with you. The CDC recommends an A1C test at least twice a year.

Follow-up also covers blood pressure (some people with diabetes aim for below 130/80), cholesterol, and blood and urine tests that check your kidneys. See also high blood pressure and high cholesterol.

Type 2 diabetes follow-up by telehealth

In a US$79 online doctor visit, the doctor can:

  • Review your glucose readings, lab results and how your medications are working.
  • Give you lab orders (A1C, kidney function, cholesterol) at no extra charge and go over the results with you at a later visit. See lab orders.
  • Renew diabetes prescriptions when appropriate. See prescription refills.
  • Talk through food, activity and weight, and how to plan your medications for hurricane season (medications and hurricanes).

Diabetes medications

Depending on your situation, treatment can include pills, injectable medicines or insulin, alongside changes in eating and activity. Some people with diabetes also need a statin for cholesterol. Insulin management is at the doctor's discretion, based on what is safe to assess by video.

If appropriate, the doctor can prescribe medication. We do not prescribe controlled substances. We also do not prescribe compounded (pharmacy-made) versions of GLP-1 type medicines.

When you need to be seen in person

Telehealth does not replace these, which need someone to examine you in person:

  • A full foot exam at least once a year, including a check of feeling and pulses. If you already have loss of feeling or have had foot ulcers, your feet should be checked at every visit.
  • A dilated eye exam at least once a year with an eye doctor.
  • Foot wounds or sores that are not healing, or a change in the color of a foot.
  • A new diagnosis with strong symptoms, or very high blood sugar that will not come down.
  • A specialist (endocrinologist, kidney specialist) when the doctor thinks one is needed.

Diabetes in children and teens

We see patients from 6 months old, but diagnosing and managing diabetes in children and teens needs a pediatric specialist. If your child is very thirsty, peeing a lot or losing weight for no reason, get them seen in person soon. If they are also vomiting, breathing fast or very drowsy, go to the emergency room.

Video visit: US$79 · Pay by card · See the price and what is included

Before you book

  • You must be physically in Puerto Rico during the visit (visitors and tourists are welcome).
  • We see patients from 6 months old. Patients under 21: a parent or legal guardian must be on camera for the whole visit.
  • Real-time video only; we do not do phone-call visits.
  • We do not prescribe controlled substances.

What we don't do by telehealth

Frequently asked questions

What are the first signs of diabetes?
Many people have no symptoms at first. When symptoms appear, the most common are peeing often, thirst and hunger, fatigue, blurry vision and losing weight without trying. A blood test is the only way to know.
Can you refill my diabetes medication by telehealth?
Yes, if your diabetes is stable and the doctor judges it appropriate after the visit. Have your current medications and most recent labs at hand. We do not prescribe controlled substances.
How often should I get an A1C test?
The CDC recommends at least twice a year. If your treatment changed or you are not at your goal, the doctor may order it more often.
Can visitors to Puerto Rico get diabetes help?
Yes. If you are physically in Puerto Rico during the visit, the doctor can see you, for example if you run short of a non-controlled medication while traveling. See our guide for visitors.
What should I do if my blood sugar goes very low?
Blood sugar below 70 mg/dL is considered low. If you feel shaky, sweaty, confused or dizzy, take something with sugar as you were taught. If the person faints or cannot swallow, call 911.

Sources

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