Medical Management of Type 2 Diabetes Book

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