Medical Management of Type 1 Diabetes Book

A Word About This Guide ix

Contributors to the Sixth Edition xi

Acknowledgments xiii

Diagnosis and Classification/Pathogenesis 1

Highlights 2

Diagnosis and Classification 5

Criteria for Diagnosis 5

Risk of Developing Type 1 Diabetes 6

Distingrnshing Type 1 Diabetes from Other Forms 7

Clinical Presentation of Type 1 Diabetes 11

Conclusion 11

Pathogenesis 13

Pathophysiology of the Clinical Onset of Type 1 Diabetes 13

Progression of Metabolic Abnormalities During Onset 14

Clinical Onset of Diabetic Symptoms and Metabolic Decompensation 15

Genetics and Immunology of Type 1 Diabetes 17

Conclusion 21

Diabetes Standards and Education 23

Highlights 24

Philosophy and Goals 27

Glycemic Control and Complications: A Summary of Evidence 27

Dysglycemia and Complications from Population-Based Data 28

Goals of Treatment 30

Clinical Goals 32

Conclusion 35

Patient Self-Management Education 37

General Principles 37

Self-Management Education Process 39

Content of Diabetes Self-Management Education 44

Additional Topics of Importance for Type 1 Diabetes 48

Incorporating Patient Education in Clinical Practice 49

Conclusion 50

Tools of Therapy 53

Highlights 55

Insulin Treatment 59

Insulin Preparations 59

Treating Newly Diagnosed Patients 62

Insulin Regimens 65

Alternative Insulin Delivery Systems 74

Optimizing Blood Glucose Control 74

Common Problems in Long-Term Therapy 78

Insulin Allergy 78

Special Considerations 79

Conclusion 82

Treatment with Amylin Analog Pramlintide 85

Monitoring 88

Patient-Performed Monitoring 88

Glucose Sensors 90

Ketone Testing 92

Physician-Performed Glucose Monitoring 93

Other Monitoring 95

Conclusion 95

Nutrition 98

Nutrition Recommendations 98

Nutrition Therapy for Type 1 Diabetes 100

Additional Nutrition Considerations 109

The Process of Medical Nutrition Therapy 113

Practical Approaches to Nutrition Counseling 115

Conclusion 117

Exercise 122

Glycemic Response to Exercise 122

Potential Benefits of Exercise 123

Potential Risks of Exercise 124

Reducing Exercise Risks 125

Exercise Prescription 127

Aerobic Training 127

Strategies for Maintaining Optimal Glycemic Control with Exercise 130

Conclusion 131

Special Situations 133

Highlights 135

Diabetic Ketoacidosis 139

Presentation of DKA 139

Acute Patient Care 141

Other Important Considerations 145

Intermediate Patient Care 147

Preventive Care 148

Conclusion 148

Hypoglycemia 150

Pathophysiology 150

Mild, Moderate, and Severe Hypoglycemia 151

Common Causes of Hypoglycemia 153

Treatment 155

Hypoglycemia Unawareness 157

Hypoglycemia with Subsequent Hyperglycemia 158

Dawn and Predawn Phenomena 159

Conclusion 159

Pregnancy 161

Risk Factors 161

Maternal Metabolism During Pregnancy 162

Preconception Care and Counseling 162

Congenital Malformations: Risk and Detection 166

Maternal Glucose Control During Pregnancy 167

Nutrition Needs 169

Outpatient Care 169

Timing of Delivery 171

Labor and Delivery 172

Postpartum Care 173

Family Planning and Contraception 173

Conclusion 174

Surgery 176

General Principles 176

Major Surgery 176

Minor Surgery 177

Conclusion 177

Islet Transplantation 178

Psychosocial Factors Affecting Adherence, Quality of Life, and Well-Being: Helping Patients Cope 181

Highlights 182

Periods of Increased Emotional Distress 185

Maintaining Adherence 187

Diabetes Complications 188

Developmental Considerations in Children 189

Developmental Considerations in Adolescents 193

Adults 197

The Elderly 198

Emotional and Behavioral Disorders and Diabetes 199

Stress and Diabetes 200

Complications 203

Highlights 205

Retinopathy 209

Eye Examination 209

Clinical Findings in Diabetic Retinopathy 210

Evaluation 212

Treatment 214

Conclusion 216

Nephropathy 219

Clinical Syndrome 219

Natural History 219

Pathogenesis 221

Testing for Nephropathy 221

Management of Nephropathy 222

Hypertension 225

Other Aspects of Treatment 226

Dialysis and Kidney Transplantation 227

Conclusion 228

Neuropathy 230

Overview of Neuropathies 230

Distal Symmetric Sensorimotor Polyneuropathy 231

Late Complications of Polyneuropathy 232

Management of Distal Symmetric Polyneuropathy and Complications 234

Autonomic Neuropathy 235

Focal Neuropathies 239

Conclusion 240

Macrovascular Disease 242

Prevalence and Risk Factors 242

Assessment and Treatment 243

Symptoms and Signs of Atherosclerosis 246

Conclusion 248

Limited Joint Mobility 251

Detection and Evaluation 251

Conclusion 252

Abnormal Linear Growth 253

Subtle Growth Abnormalities 253

Determining Growth Rate 253

Conclusion 254