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A Word About This Guide vii
Contributors to the Seventh Edition ix
Acknowledgments xi
Diagnosis and Classification 1
Highlights 2
Definition of Diabetes 5
Diagnosis of Diabetes 6
Classification of Diabetes 6
Type 1 diabetes 7
Type 2 diabetes 9
Other specific types of diabetes 9
Stage of disease 10
Screening for Diabetes 10
Categories of Increased Risk for Diabetes 11
Gestational Diabetes Mellitus 12
Metabolic Syndrome 13
Evaluation and Classification of Patients Before Treatment 14
Pathogenesis 49
Highlights 20
Genetic and Environmental Factors 21
Insulin Resistance 22
Sites of insulin resistance 22
Mechanisms of insulin resistance 23
The Fat Cell as an Endocrine Organ 24
Defects in Insulin Secretion 25
Factors modulating insulin secretion 25
Physiological consequences of defective insulin secretion 26
Conclusion 26
Management 29
Highlights 30
Therapeutic Objectives and Plan 35
MNT Effectiveness, Process, and Goals 39
Energy balance and weight loss 41
Carbohydrate 43
Protein 46
Fat 46
Sodium 47
Alcohol 48
Vitamins and minerals 48
Exercise 51
Potential benefits of exercise 51
Precautions and considerations 53
The exercise prescription 54
Pharmacologic Intervention 57
Available agents 58
Insulins 67
Long-term combinations of oral agents with insulin 78
Adjusting insulin dosage in long-term type 2 diabetes 79
Assessment of Treatment Efficacy 83
Office methods 84
Self-monitoring 87
Special Therapeutic Situations 91
Highlights 92
Diabetes in Pregnancy 95
Diabetes in Youth 97
Differentiation of type 1 and type 2 diabetes in youth 97
Screening for type 2 diabetes in youth 97
Treating type 2 diabetes in youth 98
Diabetes in Hospitalized and Critically Ill Patients 101
Major Acute Complications 104
Hyperosmolar hyperglycemic state 104
Hypoglycemia 105
Infection 106
Detection and Treatment of Chronic Complications 109
Highlights 110
Rationale for Optimizing Glycemic Control in Type 2 Diabetes 115
Accelerated Macrovascular Disease 117
Diabetes as a cardiovascular risk factor 118
Screening for cardiovascular disease 119
Importance of modifying vascular risk factors 119
Treatment of cardiovascular disease 126
Diabetic Retinopathy 127
Stages of diabetic retinopathy 129
Prevention of vision loss from retinopathy 129
Treatment of retinopathy 130
Diabetic Renal Disease 131
Clinical presentation of nephropathy 132
Conditions that influence renal function 132
Prevention and treatment of diabetic renal disease 133
Diabetic Foot Problems 135
Causes of diabetic foot problems 135
Prevention of foot problems 136
Treatment of foot problems 137
Diabetic Neuropathies 139
Diagnosis and treatment of neuropathy 140
Autonomic neuropathy 142
Other varieties of diabetic neuropathy 147
Behavior Change Strategies 155
Highlights 156
Influences on Behavior Change 157
Strategies for Behavior Change 158
Diabetes Self-Management Support 160
Redesigning Practice to Support Behavior Change 161
Summary 161
Index 163
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