expert type icon EXPERT

Dr. Robert R. Kimmel , MD

Endocrinology-Diabetes

Dr. Robert R. Kimmel MD is a top Endocrinology-Diabetes in Puyallup, . With a passion for the field and an unwavering commitment to their specialty, Dr. Robert R. Kimmel MD is an expert in changing the lives of their patients for the better. Through their designated cause and expertise in the field, Dr. Robert R. Kimmel MD is a prime example of a true leader in healthcare. As a leader and expert in their field, Dr. Robert R. Kimmel MD is passionate about enhancing patient quality of life. They embody the values of communication, safety, and trust when dealing directly with patients. In Puyallup, WA, Dr. Robert R. Kimmel MD is a true asset to their field and dedicated to the profession of medicine.
Dr. Robert R. Kimmel, MD
  • Puyallup, WA
  • Saint Louis University
  • Accepting new patients

My husband feels anxious due to his diabetes medication. What should we do to manage it?

Anxiety due to medications for diabetes usually results from low blood sugar (hypoglycemia) or blood sugar level that is decreasing too rapidly (even if not actually low). Hypoglycemia, READ MORE
Anxiety due to medications for diabetes usually results from low blood sugar (hypoglycemia) or blood sugar level that is decreasing too rapidly (even if not actually low). Hypoglycemia, usually defined as blood sugar below 70 mg/dL, can result from too much insulin, sulfonylurea (like glipizide, glyburide, glimeperide), or meglitinide (like repaglinide (Prandin), nateglinide (Starlix)) and SGLT2 inhibitors (like Jardiance, Farxiga, Invokana). On the other hand, some anti-diabetic medications are less likely to cause low blood sugar. These include DPP4 inhibitors (like Januvia, Onglyza, Tradjenta), GLP1 receptor agonists (like Byetta, Bydureon, Trulicity, Ozempic and Victoza) as well as acarbose (Precose) and metformin. However, even these drugs can cause low blood sugar when taken in combination or as overdose. Lows also can occur when diabetic medications are not adjusted for exercise or significant decrease in food intake. Combining diabetic medications with alcohol is especially dangerous since alcohol inhibits the ability of the liver to make glucose fast enough in response to a low. Determining the cause of anxiety due to medications for diabetes requires a bit of detective work, so it would be best not to "go it alone" and to discuss your blood sugar patterns with your health care provider. Your doctor will find it most helpful if you check blood sugars upon arising and at bedtime, before and 2 hours after eating, any any time you feel anxiety, apprehension, rapid heart rate, sweating, excessive hunger, unusual fatigue or sleepiness, lightheadedness, sudden or profound weakness.

How should diabetes be treated in patients who have had it for a long time?

I would first determine whether your mother is still making insulin. If so, there may be new medications or combinations that would help. Otherwise she would be limited to insulin READ MORE
I would first determine whether your mother is still making insulin. If so, there may be new medications or combinations that would help. Otherwise she would be limited to insulin or drugs that can lower blood sugar but don't depend on insulin. I would make sure she is doing everything possible in the way of lifestyle changes such as diet, exercise, weight and stress control. Also, I would make sure she has no occult infection that may be causing high sugar levels due to insulin resistance. Finally I would make sure she is not on drugs like cortisone or prednisone, and numerous others, which can increase insulin requirements dramatically.

Are my insulin injections permanent?

Answer: Starting on insulin does not have to be a one-way street. Patients can often work down and off of insulin, depending on the reason for starting insulin, how long the person READ MORE
Answer: Starting on insulin does not have to be a one-way street. Patients can often work down and off of insulin, depending on the reason for starting insulin, how long the person has had diabetes, the type of diabetes, and how difficult it has been to control blood sugars. Individuals who cannot make insulin will not be able to stop insulin unless they receive and new pancreas. This group includes those individuals with established Type 1 diabetes, following pancreatic resection or destruction and many adults with latent autoimmune diabetes.

Stopping insulin is sometimes possible if an individual has not had diabetes for more than 10 years and blood sugars haven't been too high for too long. Taking strong measures to reduce insulin resistance, such as losing weight, increasing exercise, treating infections, addressing the causes of chronic stress and pain, treating sleep apnea and, if possible, getting off of medications such as steroids If a patient is on basal insulin and doesn't need mealtime coverage, taking these measures will reduce, and sometimes eliminate, the need for injecting insulin.