FREQUENTLY ASKED QUESTIONS

GENERAL

What is Endocrine System & What is the role of an Endocrinologist?


The endocrine system is a series of glands that produce and secrete hormones that the body uses for a wide range of functions. These control many different bodily functions, including: Metabolism, Reproduction, Overall wellbeing Sexual development & Growth to name a few. Hormones are produced by various glands and sent into the bloodstream to the various tissues in the body. In the tissues and organs, these hormones send signals to tell them what they are supposed to do. When the glands do not produce the right amount of hormones (May produce too little = Hypo or may produce too much hormones = Hyper) As a result imbalance happens and diseases develop that can affect many aspects of life. Endocrinologist is a specialist who is trained to take care of these Hormone Imbalances. They are trained in 2 years of fellowship training after three years of residency in Internal Medicine after Medical school.




What services are offered by Capitol Endocrinology Inc?


Capitol Endocrinology is a referral based practice for which your primary care physician is required to send a referral with a clear question for help. Our intention is to address the condition and send you back to your primary care physician but sometimes your provider expects us to provide ongoing care for that specific condition. Ours is a 100% Endocrinology Consulting Practice and you are required to have a primary care Physician to address all other concerns. Our practice works most notably with all kinds of Diabetes Mellitus (Type 1, Type 2, LADA, MODY and Other types) and offer state of the art care including latest technology (Insulin Pumps & Continuous Glucose Monitoring, CGM) For Gestational Diabetes, we suggest you coordinate care with your OB-GYN with high risk pregnancy specialists. Obesity & Weight Issues, Thyroid disorders, Parathyroid and Calcium Disorders, Osteoporosis, Pituitary Disorders, Hypogonadism, Adrenal Disorders, PCOS and Hirsutism are some other areas of our expertise. We offer help if it's within the scope of the practice. depending upon complexity of the condition. but we may suggest you to seek help form a tertiary Care Center. We also care for patients with a wide range of other Metabolic and Endocrine disorders.




What are the factors that contribute to Endocrine Disorders? ?


Some of the factors that affect endocrine organs include puberty, aging, pregnancy, Stress, Environment, genetics and certain diseases and medications, including naturopathic medicine, herbal supplements, and prescription medicines such as opioids or steroids. Chronic diseases and other conditions may affect endocrine system function in several ways. After hormones produce their effects at their target organs, they are broken down (metabolized) into inactive molecules. The liver and kidneys are the main organs that break down hormones. The ability of the body to break down hormones may be decreased in people who have chronic heart, liver, or kidney disease. Other factors could be: Congenital (birth) or Genetic defects, Surgery, Radiation, or some Cancer Treatments, Traumatic Injuries, Cancerous and Non-Cancerous Tumors, Infection, Autoimmune destruction (when the immune system turns against the body's own organs and causes damage) Medications or supplements




How can I contact Capitol Endocrinology Inc.?


There are multiple ways to connect with us! You can call us at 530-677-0700. For any urgent concerns you can also text or call 916-622-0360 or email: capitolendo@gmail.com You may also send a message through your patient portal (Once we have replied you will receive an email notification)




How can I access my Patient Portal?


For new patients we will send an email with a link to the patient portal when we have scheduled your first appointment. That is so long as you have provided us with an up to date email. For existing patients you can access our patient portal by visiting: health.healow.com/Capitolendocrinology




What if I can't access Patient Portal?


Please contact our office if you are unable to access the patient portal so that we can provide you with a temporary password for you to access your account.




What services can I access on Patient Portal?


Patient portal is a great way to contact and connect with our office to send a message or question, request a refill, request a lab or Imaging order, or view your visit summary from previous visits. These features may be updated from time to time. Please check back here for updates.





PRESCRIPTIONS

How do I obtain prescription refills?


First suggestion is to call your pharmacy where your original prescription was filled to request a refill of your medication. If needed, they will contact our office if any questions or clarifications. Second option is to request a refill through your patient portal. You will receive an email notification once we have responded. Third option is to contact our office phone at 530-677-0700 and leave a message requesting a refill. In order for us to respond in a timely manner we need your medication Name / Dosage / Instructions, your preferred pharmacy and any changes to your insurance coverage. Please specify if you want 30 day or 90 day supply. Please allow us up to 2 business days to authorize your refill request




How do I obtain mail order prescriptions


If you prefer to use a mail order pharmacy, please provide us with the name and fax number of your mail order pharmacy and we will fax the prescription for you. Please coordinate with the mail order pharmacy to assure your medication is on the way. If you are going to be out of your medication before your mail order prescription arrives, please call the clinic at 530-677-0700. We can either call a smaller prescription to a local pharmacy or give you samples if they are available.




What if my medication is too expensive and not covered?


You could obtain a “Medication Formulary” list from your insurance and bring with you to every office visit. This will help us know what medications your insurance prefers. If your medication is not covered please contact our office and we may suggest an alternative medication if this is appropriate. If an alternative is not appropriate then we can process a prior authorization request for your medication. Prior authorizations, if approved, often help with coverage and help to lower the cost. Prior authorizations may take 3-7 days therefore we request you to be patient and work with our office




Do you offer samples of medications?


COVID-19 CHANGE: We understand the economic hardship at this time, however we prefer to avoid medication samples at this time to avoid COVID-19 exposure. See below for exception. If available, we can provide a short supply of SAMPLES (usually limited to 2 weeks) in the following situations: To cover for the time needed to switch to an alternative medication and to cover for the time needed while trying to obtain prior authorization for a medication. Please note that samples are not consistently stocked therefore patient's shouldn’t rely on samples to receive their medications




Do you offer in office injections?


We provide testosterone injections, Vitamin B12 and Prolia injections in-office for those patients we deem necessary to receive these various injections.





LAB

What if I need a Lab order?


COVID-19 CHANGE: We suggest that all non-urgent lab work be delayed due to COVID-19 Precautions Routinely, you can request labs by way of your patient portal. You can also call our office and we can mail your lab order or fax your lab order to your preferred lab




Is there a lab we prefer?


We prefer Quest or Lab corp. You can check out the following websites to find the lab draw station closest to you based on your town or zip code: QUEST LABCORP However if it is difficult for you to get to these labs then you can go to hospital lab closest to you or lab that’s convenient for you. Please make sure you provide our info to your lab (usually all info including our fax no. is on the Lab requisition form that’s given to you at the time of visit and you take that to get the testing) This is important because we need the report at the time of your visit




Fasting or No Fasting?


Do I need to Fast for the lab testing or Any preferred time of the day when labs to be done? All specialty labs to be done after at least 8 hours of fasting, between 7 – 8 am in fasting state HbA1C and Thyroid testing does not need to be done in a fasting state Do I have to fast if I am having an A1c test? NO, you do not have to fast when you are having an A1c test. This test shows your “average” blood sugar level over a 2-3 month period. Do I have to fast if I am having a lipid test? YES, you must fast for at least eight hours. This means you may drink water and take any current medications, but you should not eat or drink anything else during this period of time.





IMAGING

What if I need an Imaging Order? (ie. Ultrasound, Bone Density, X-Rays, CT Scan or MRI etc)


You can request an imaging order by sending us a message on your patient portal. You can also call our office and we can mail your imaging order or we can fax your order to your preferred diagnostic imaging location (i.e.. Sutter, Mercy, Marshall, etc.)





CGM

What if I dont know how to start my DEXCOM CGM?


Please refer to section Diabetes Technology > NEW START CGM We have provided the quick start videos here as well for your reference. Quick Start Videos: Dexcom G6 - Inserting the Sensor and Attaching the Transmitter




What if I need to upgrade DEXCOM reciever from G5 to G6?


Please refer to this instruction video below to update your Dexcom receiver from G5 to G6. You should already have received an authorization code from Dexcom and if you still need an authorization code please contact Dexcom customer service at (888) 738-3646.




What if I dont know how to use my Freestyle Libre CGM?


Check out the online tutorial: Freestyle Libre CGM https://www.freestylelibre.co.uk/libre/help/tutorials.html Freestyle libre customer service phone#: (855)-632-8658 If you are still having trouble with your CGM please call our office at 530-677-0700 and we can set up a telemedicine visit to review the instructions for your CGM and how to get started.




What if I need refills on my DEXCOM or FREESTYLE Libre Sensors?


Please call the medical supply company or pharmacy where you receive your Dexcom or Freestyle libre sensors from and request a refill. They will send us a request if they need any additional information. If you are still having trouble with getting your sensors then please contact our office at 530-677-0700




How do I upload my CGM?


For more information please refer to the section "Diabetes Technology" and choose "Upload my continuous glucose monitor"





INSULIN PUMP

What if I need a refill on my Insulin Pump Supplies?


Please call the medical supply company or pharmacy where you receive your insulin pump supplies and request a refill from them. They will send us a request if they need any additional information. If you are still having trouble with insulin pump supplies then contact our office at 530-677-0700




How do I upload my Insulin Pump from home?


For more information please refer to the section "Diabetes Technology" and choose "Upload my insulin pump" Below we have provided links to instructions on how to upload your insulin pump from home. It is important to upload your insulin pump the day prior to your scheduled telemedicine (video) visit and will allow your provider to review the insulin pump data.





COVID -19

COVID-19 as it relates to Capitol Endocrinology Inc.


COVID-19 as it relates to Capitol Endocrinology Are we still offering appointments? YES, we are offering telemedicine visits which allow you to stay at home and connect with your providers by way of video or phone at your scheduled appointment time. How can I schedule a telemedicine visit? Please contact our office and request a telemedicine visit. Call us at 530-677-0700. For any urgent concerns you can also text at 916-622-0360 or email: capitolendo@gmail.com Can I schedule same day telemedicine visits? YES. We do offer same day telemedicine visits. This will be available on first come first serve basis as spots are limited.  Are we offering in-office visits? We had temporarily put that on hold but offering it again now. Are we offering injections (Testosterone, Prolia, Vitamin B12)? Not at this time. We have temporarily stopped administering in-office injections. Please schedule a telemedicine visit to discuss alternative options with your provider.




COVID-19 Symptoms & Prevention (Source ADA)


COVID-19 Symptoms and Prevention (source: ADA) Is COVID-19 different from the seasonal flu? COVID-19 is proving to be a more serious illness than seasonal flu in everyone, including people with diabetes. All of the standard precautions to avoid infection that have been widely reported are even more important when dealing with this virus. Recommended safety precautions are the same as for flu, such as frequent hand washing and covering coughs and sneezes with a tissue or your elbow. The CDC does not recommend the use of face masks by people who are not infected. We encourage people with diabetes to follow the guidance of the CDC and to review how you manage sick days—preparing for a sick day can make it easier What are the symptoms and warning signs I should be watching out for—and what do I do if I think I’m developing them? Pay attention for potential COVID-19 symptoms including fever, dry cough and shortness of breath. If you feel like you are developing symptoms, call your doctor.
When you call: Have your glucose reading available Have your ketone reading available Keep track of your fluid consumption (you can use a 1-liter water bottle) and report Be clear on your symptoms (for example: are you nauseated? Just a stuffy nose?) Ask your questions on how to manage your diabetes What are the emergency warning signs—and what should I do if I’m experiencing them? If you develop emergency warning signs for COVID-19 get medical attention immediately. In adults, emergency warning signs include: Difficulty breathing or shortness of breath Persistent pain or pressure in the chest New confusion or inability to arouse Bluish lips or face What should I do to prevent the spread of COVID-19 in my home—and what do I do if someone in my household has the virus? For people with underlying health conditions, including diabetes, healthy family members in the household should conduct themselves as if they were a significant risk to them. For example, they should be sure to wash their hands before feeding or caring for them. If possible, a protected space should be made available for vulnerable household members, and all utensils and surfaces should be cleaned regularly. If a member of your household is sick, be sure to give them their own room, if possible, and keep the door closed. Have only one family member care for them, and consider providing additional protections or more intensive care for household members over 65 years old or with underlying health conditions. Learn more about how to keep your home safe here.




COVID -19 & Diabetes (Souce: ADA)


Staying Healthy During COVID-19 The CDC has determined that COVID-19 (coronavirus) is a serious public health threat—and older adults and people with serious chronic medical conditions, including diabetes, are at a higher risk of getting very sick from it. We have resources to help keep you healthy We encourage people with diabetes to follow the guidance of the CDC and to review how you manage sick days—preparing for a sick day can make it easier Are people with diabetes more likely to get COVID-19? People with diabetes are not more likely to get COVID-19 than the general population. The problem people with diabetes face is primarily a problem of worse outcomes, not greater chance of contracting the virus. In China, where most cases have occurred so far, people with diabetes had much higher rates of serious complications and death than people without diabetes—and generally we believe that the more health conditions someone has (for example, diabetes and heart disease), the higher their chance of getting serious complications from COVID-19. While the death toll is likely to rise as the virus spreads, we expect the death rate—the number of people who die from the virus as a percentage of the total number of people who contract the virus—to go down as we get better at detecting and treating this specific virus. Do people with diabetes have a higher chance of experiencing serious complications from COVID-19? People with diabetes do face a higher chance of experiencing serious complications from COVID-19. In general, people with diabetes are more likely to experience severe symptoms and complications when infected with a virus. If diabetes is well-managed, the risk of getting severely sick from COVID-19 is about the same as the general population. When people with diabetes do not manage their diabetes well and experience fluctuating blood sugars, they are generally at risk for a number of diabetes-related complications. Having heart disease or other complications in addition to diabetes could worsen the chance of getting seriously ill from COVID-19, like other viral infections, because your body’s ability to fight off an infection is compromised. Viral infections can also increase inflammation, or internal swelling, in people with diabetes. This is also caused by above-target blood sugars, and both could contribute to more severe complications. Do I need to worry about DKA (diabetic ketoacidosis)? When sick with a viral infection, people with diabetes do face an increased risk of DKA (diabetic ketoacidosis), commonly experienced by people with type 1 diabetes.
DKA can make it challenging to manage your fluid intake and electrolyte levels—which is important in managing sepsis. Sepsis and septic shock are some of the more serious complications that some people with COVID-19 have experienced. If your blood sugar has registered high (greater than 240 mg/dl) more than 2 times in a row, check for ketones to avoid DKA Are the risks different for people with type 1 and type 2 diabetes? In general, we don’t know of any reason to think COVID-19 will pose a difference in risk between type 1 and type 2 diabetes. More important is that people with either type of diabetes vary in their age, complications and how well they have been managing their diabetes. People who already have diabetes-related health problems are likely to have worse outcomes if they contract COVID-19 than people with diabetes who are otherwise healthy, whichever type of diabetes they have. Will COVID-19 impact my access to insulin and other diabetes supplies? Leading manufacturers are reporting that COVID-19 is not having an impact on their current manufacturing and distribution capabilities for insulin and other supplies at this time. We are continuing to monitor the situation and will provide updates should anything change. If you are struggling to pay for insulin or know someone who is, the ADA has resources to help—visit InsulinHelp.org.





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