Conditions
Type 2 diabetes: symptoms, labs and video care in Puerto Rico
Type 2 diabetes is a long-term condition in which blood sugar stays too high. We care for it by video: the doctor reviews your readings and medications, gives you a lab order for your A1C and, if appropriate, prescribes and we send your prescription to your pharmacy. A refill of a medicine you already take is a US$49 follow-up visit.
Is it an emergency? Call 911.
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
- A very thirsty child who pees a lot and is also vomiting, breathing fast or very drowsy
Help lines
At a glance
Type 2 diabetes
Common symptoms
- Peeing often
- Increased thirst and hunger
- Losing weight without trying
- Fatigue
- Blurry vision
- Cuts or sores that are slow to heal
- Numbness or tingling in the hands or feet
- Other names
- Type 2 diabetes mellitus · High blood sugar
- Usual test
- A1C and fasting blood sugar
- Treatment
- Changes in eating and activity, pills, injectable medicines or insulin, as the medical evaluation indicates
- Possible complication
- Damage to the eyes, kidneys, nerves and feet, and a higher risk of heart disease
On this page(10)
What type 2 diabetes is
In type 2 diabetes, your body does not use insulin well and sugar (glucose) builds up in your blood. Over time, high blood sugar can damage the eyes, kidneys, nerves and feet, and it raises the risk of heart disease. Good control lowers that risk a lot.
It is very common in Puerto Rico: in 2021, 14.4% of adults 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.
Type 2 diabetes care by video
We evaluate, diagnose and treat; if needed, we give you a lab order for a lab near you. You see Dr. Diana Nieves Castro, MD, a general practice physician licensed in Puerto Rico (check her license) with several years of emergency-department experience. She sees adults and children of all ages, in English or Spanish, and can be your online primary care doctor for diabetes and the rest of your health.
In your visit, the doctor:
- Reviews your glucose readings, lab results and how your medications are working.
- Gives you a lab order for your A1C, kidney function and cholesterol, and goes over the results with you.
- Adjusts your eating, activity and medication plan. If appropriate, the doctor prescribes and we send your prescription to your pharmacy.
- Helps you keep your care plan on track as part of our chronic care, with clear prices and no membership. The service is run by a nonprofit.
Your doctor
Dr. Diana Nieves Castro, MD
General practice physician
Several years of emergency-department experience.
Founding Executive Director of The Health Initiative.
How to book your visit in 3 steps
Booking a diabetes visit is simple:
Request your visit.
Request a visit online 24/7 — we confirm your time by email or text. Choose Doctor visit, or Follow-up visit if you only need a refill of a medicine you already take, and pay by card at secure checkout. Book your visit.
Get your link.
We send you a secure video link. It works on your phone, tablet or computer. You need to be in Puerto Rico during the visit (visitors are welcome). Patients under 21 need a parent or legal guardian on camera with photo ID.
See the doctor.
The doctor evaluates, diagnoses and treats you. If appropriate, the doctor prescribes and we send your prescription to your pharmacy. If you need a test, we give you a lab order for a lab near you.
Price: a US$79 doctor visit, no membership
A doctor visit costs US$79, the same price for every age, with no membership and no insurance needed. You are charged when you request the visit, and you get a full refund if the visit can't happen. A doctor's note after your visit is included at no extra charge. See all prices.
If you only need a refill of a medicine you already take, choose the US$49 follow-up visit; anyone can book it. A review of lab results is also a US$49 follow-up visit, for existing patients. If a US$49 visit turns out to need a full visit, the doctor explains why and, with your consent, you pay the difference.
Video visit
Doctor visit
US$79
For a new problem, urgent care (non-emergencies), primary care, children, birth control, STIs, skin and acne, and visitors. Includes a doctor's note if you need one.
- You’re charged when you request the visit.
- Full refund if the visit can’t take place
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 (acanthosis nigricans)
- Numbness or tingling in the hands or feet
Treatment and when a lab test is ordered
Diabetes is confirmed with blood tests, and a second test is usually done to confirm it. If you have symptoms or risk factors, the doctor gives you a lab order. These are the ranges (see also how to read lab results):
- 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.
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 talks it through 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. The doctor also watches for fatty liver, which is common with type 2 diabetes.
Depending on your situation, treatment can include changes in eating and activity, pills, injectable medicines or insulin. Some people with diabetes also need a statin for cholesterol. The doctor adjusts the plan with you at each visit. Some medicines, such as insulin, can drop your blood sugar too low: learn the signs of low blood sugar.
Your care plan: eyes, feet and kidneys
Good diabetes care means keeping your checkups current. The doctor helps you stay on top of them:
- A dilated eye exam at least once a year with an eye doctor.
- A full foot exam at least once a year, including a check of feeling and pulses. Look at your feet every day and tell the doctor about any sore, change in color or ingrown toenail.
- Kidney tests in blood and urine, with your lab order.
- Medicines for hurricane season: plan ahead so you have enough medicine on hand.
Diabetes in children and teens
We see adults and children of all ages. If your child is very thirsty, peeing a lot or losing weight for no reason, the doctor evaluates them and gives you a lab order to check their blood sugar. For their safety, if they are also vomiting, breathing fast or very drowsy, take them to the emergency room.
When to go to the ER
For your safety, call 911 or go to the emergency room if you have any of these signs. See also when to go to the ER.
- 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
How we care for you
We evaluate, diagnose and treat; if needed, we give you a lab order for a lab near you.
We see adults and children of all ages. Patients under 21: a parent with patria potestad (parental authority) or a legal guardian is on camera for the whole visit and shows photo ID.
Real-time video visit. We send you a secure video link. It works on your phone, tablet or computer.
If appropriate, the doctor prescribes and we send your prescription to your pharmacy. We do not prescribe controlled substances.
You must be physically in Puerto Rico during the visit (visitors, tourists and cruise passengers are welcome).
In an emergency, call 911.
Frequently asked questions
What are the first signs of diabetes?
Can I get my diabetes medicine refilled by video?
How often should I get an A1C test?
Can visitors to Puerto Rico get diabetes care?
What should I do if my blood sugar goes very low?
About this page
Author: The Health Initiative
Medical care provided by Dr. Diana Nieves Castro, MD (PR license 24027)
Disclosure: Founding Executive Director of The Health Initiative
Published: 2026-09-30 · Updated: 2026-10-02
Sources (10)
- CDC, Preventing Chronic Disease 24_0221: prevalence of diagnosed diabetes among adults by state and territory, 2021 (opens in a new tab) (accessed 2026-09-30)
- CDC: Diabetes symptoms (opens in a new tab) (accessed 2026-09-30)
- NIDDK (NIH): Diabetes tests and diagnosis (opens in a new tab) (accessed 2026-09-30)
- NIDDK (NIH): Managing diabetes (opens in a new tab) (accessed 2026-09-30)
- CDC: Diabetes and chronic kidney disease (opens in a new tab) (accessed 2026-09-30)
- CDC: Diabetes and vision loss (opens in a new tab) (accessed 2026-09-30)
- NIDDK (NIH): Diabetes and foot problems (opens in a new tab) (accessed 2026-09-30)
- CDC: Low blood sugar (hypoglycemia) (opens in a new tab) (accessed 2026-09-30)
- CDC: Diabetic ketoacidosis (opens in a new tab) (accessed 2026-09-30)
- NAFLD & NASH: Symptoms & Causes (NIDDK, NIH) (opens in a new tab) (accessed 2026-10-02)