Type 2 Diabetes Care in Hilo & Across Hawaiʻi — Medicaid (QUEST) Accepted

Type 2 diabetes is a chronic condition in which the body cannot use insulin effectively, so blood sugar (glucose) runs too high over time. It is one of the most common conditions we manage in primary care, it is highly treatable, and in its early stages it is often preventable. More than 1 in 10 Americans live with diabetes, and 90 to 95 percent of those cases are type 2, according to the Centers for Disease Control and Prevention. At Ohana Care Clinic in Hilo, we take a steady, whole-person approach to diabetes for patients across Hawaiʻi.

What type 2 diabetes is

Glucose is the fuel your cells run on, and insulin is the hormone that moves glucose from your blood into those cells. In type 2 diabetes, the body’s cells stop responding well to insulin, a state called insulin resistance, and over time the pancreas cannot keep up. Glucose then builds up in the bloodstream. This usually develops gradually over years, which is why many people have prediabetes, a stage of higher-than-normal glucose, well before diabetes is diagnosed. That long lead time is also the opportunity: caught early, the trajectory can often be changed.

Why it matters

Persistently high blood sugar quietly damages blood vessels and nerves, which is why diabetes is a leading contributor to heart attack and stroke, kidney disease, vision loss, and nerve and foot problems. The encouraging reality is that good control dramatically lowers these risks. The goal of our care is not simply a lower number on a lab report; it is protecting your heart, kidneys, eyes, and nerves so you can keep doing the things that matter to you.

How we screen for and diagnose diabetes

Type 2 diabetes is often silent in its early years, so screening matters. The U.S. Preventive Services Task Force recommends screening adults ages 35 to 70 who are overweight or have obesity, and repeating that screening about every three years. Because diabetes appears at younger ages and lower body weights in Native Hawaiian, Pacific Islander, and other higher-risk communities, we often begin screening earlier. We diagnose diabetes with simple blood tests, most commonly the hemoglobin A1C, which reflects your average blood sugar over roughly three months, or a fasting glucose test.

How we treat and manage it

We build your plan around your life, not a template. For many people the foundation is everyday change that is realistic and sustainable, supported by medication when it is needed. Metformin is usually the first medication we consider, and a newer generation of medicines can also protect the heart and kidneys while improving glucose, which is why the American Diabetes Association now emphasizes choosing therapy based on each person’s whole health picture, not glucose alone. We set individualized A1C goals with you, monitor your heart, kidney, eye, and foot health over time, and adjust as life changes. Much of this ongoing management works well by telehealth, with in-person visits for exams and labs.

The mind-body connection

Diabetes and mental health are deeply linked, and this is where our clinic is different. Depression is roughly twice as common in people with diabetes, and untreated depression, stress, and poor sleep all make blood sugar harder to control. Because we integrate primary care and behavioral health under one roof, we screen for depression as part of diabetes care, as the American Diabetes Association recommends, and we treat the whole person rather than asking you to manage a medical condition and your emotional wellbeing in separate places.

Preventing diabetes and living well

If you have prediabetes, progression to diabetes is not inevitable. Structured lifestyle change has strong evidence for preventing or delaying type 2 diabetes, and we will help you find changes that fit your culture, your family, and your daily routine rather than handing you a generic list. For those already living with diabetes, the same supports, alongside the right medication and regular monitoring, make a full and active life entirely achievable.

Culturally grounded care

We care for the whole person, in the spirit of lōkahi — balance and harmony among the connected parts of life: the body, the mind and emotions, the spirit, the ʻohana (family), and our relationship with the ʻāina (land) and community. In a Native Hawaiian understanding of health, these are not separate, and neither is our care. To mālama (care for and protect) your wellbeing and to live pono (in balance and rightness), we listen to your whole story, welcome your ʻohana into the process, and honor the values and traditions that ground you. Offering kōkua (help given freely, with aloha) in a way that respects who you are is at the heart of how we practice.

Insurance and how we see you

We accept Medicare and Medicaid, including the Hawaiʻi QUEST Integration plans (AlohaCare, the Hawaiʻi Medical Service Association (HMSA), ʻOhana Health Plan, and UnitedHealthcare Community Plan), along with most commercial insurance, and we are accepting new patients in Hilo. Primary care works best as a partnership. Your first visit is in person at our Hilo clinic. We see patients in person for physical exams, vitals, and lab work, and we use telehealth for follow-up visits, medication management, and chronic-disease check-ins whenever it is clinically appropriate.

Common questions about type 2 diabetes

Can type 2 diabetes be reversed?

Type 2 diabetes can often be put into remission, especially when caught early, through sustained lifestyle change and weight loss, and some people reach normal blood sugars without medication. It is best thought of as a manageable, sometimes reversible condition that still needs ongoing monitoring.

What blood sugar or A1C number should I aim for?

A1C goals are individualized. Many adults aim for an A1C below 7 percent, but the right target depends on your age, other conditions, and risk of low blood sugar. We set your goal together rather than applying a single number to everyone.

Who should be screened for diabetes?

The U.S. Preventive Services Task Force recommends screening adults ages 35 to 70 who are overweight or have obesity, about every three years. We often screen earlier for people at higher risk, including many Native Hawaiian and Pacific Islander patients.

Can diabetes be managed by telehealth?

A great deal of diabetes care, including reviewing your glucose, adjusting medication, and follow-up visits, works well by telehealth. We use in-person visits in Hilo for physical exams, foot checks, and lab work.

References

American Diabetes Association Professional Practice Committee. (2026). Standards of care in diabetes—2026. Diabetes Care, 49(Supplement 1). https://diabetesjournals.org/care/issue/49/Supplement_1

U.S. Preventive Services Task Force. (2021). Prediabetes and type 2 diabetes: Screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-for-prediabetes-and-type-2-diabetes

Centers for Disease Control and Prevention. (n.d.). National diabetes statistics report. Retrieved June 29, 2026, from https://www.cdc.gov/diabetes/php/data-research/index.html

Papa Ola Lōkahi. (n.d.). Native Hawaiian health. Retrieved June 29, 2026, from https://www.papaolalokahi.org/

This page is general health education from Ohana Care Clinic, written by George Mackel, MSN, APRN, NP-C, PMHNP-BC, CARN-AP. It is not a substitute for a personal evaluation by a qualified clinician who knows your situation, and reading it does not create a provider–patient relationship. If you think you may have a medical condition, reach out to us or another licensed provider. In an emergency, call 911.

George Mackel, MSN, APRN, NP-C, PMHNP-BC, CARN-AP — President & Owner