Intensive Diabetes Management

by Wolfsdorf, Joseph I.

• ISBN13: 9781580404587
• ISBN10: 1580404588
• Edition: 5th
• Format: Paperback
• Copyright: 2012-05-29
• Publisher: American Diabetes Association

Summary

Virtually all patients with diabetes-type 1 and type 2-can improve their glycemic control and overall health through diabetes management.

Author Biography

Joseph I. Wolfsdorf, MB, BCh, is Clinical Director and Associate Chief of the Division of Endocrinology, and Director of the Diabetes Program at Children's Hospital Boston. He is Professor of Pediatrics at Harvard Medical School.

Table of Contents

A Word About This Guide	p. viii
Contributors to the Fifth Edition	p. x
Acknowledgments	p. xi
Terminology of Intensive Diabetes Management	p. xii
Rationale for and Physiological Basis of Intensive Diabetes Management	p. 1
Highlights	p. 2
Intensive Diabetes Management	p. 5
Physiological Basis of Intensive Management Methods	p. 7
Normal Fuel Metabolism	p. 7
Regulation of Fuel Metabolism	p. 9
Implications for Therapy	p. 10
The Team Approach	p. 15
Highlights	p. 16
Concept of Team Management	p. 18
Integrated Diabetes Management Team	p. 20
Role Definition	p. 22
Team Communication	p. 24
Functional Considerations	p. 25
Diabetes Self-Management Education	p. 29
Highlights	p. 30
Integration of the Team Approach	p. 31
Diabetes Continuing Education	p. 32
Assessment	p. 32
Instruction	p. 34
Environment	p. 34
Planning	p. 34
Content	p. 35
Sequencing of Classes	p. 37
Approaches/Strategies	p. 37
Motivation and Support	p. 39
Action Planning	p. 39
Evaluation	p. 40
Documentation	p. 41
Conclusion	p. 41
Psychosocial Issues	p. 43
Highlights	p. 44
Assessing Patient Suitability for Intensification	p. 46
Practicing Behavior	p. 46
Psychological Status and Psychosocial Support System	p. 48
The Individual	p. 49
Assessing the Effect of Stress on Glycemic Control	p. 50
The Family System	p. 51
Assessing Coping Skills	p. 52
Assessment of Diabetes-Related Coping	p. 52
Identifying Psychosocial Resources	p. 54
Supporting and Maintaining Patients' Behavior Changes	p. 55
Adoption of New Therapies and Therapeutic Modalities	p. 56
Helping Patients with Long-Term Adherence	p. 57
Lifestyle Changes	p. 59
Potential Adverse Psychological Outcomes of Treatment	p. 61
Depression	p. 61
Eating and Body Image Disorders	p. 62
Fear of Hypoglycemia	p. 63
Needle Phobia	p. 64
Helping Patients Deal with Complications	p. 65
Conclusion	p. 66
Patient Selection and Goals of Therapy	p. 69
Highlights	p. 70
Patient Selection	p. 71
Patients with Type 1 Diabetes	p. 73
Patients with Type 2 Diabetes	p. 74
Goals of Therapy	p. 75
Glycemic Goals	p. 76
Modifying Glycemic Goals	p. 78
Weighing Benefits and Risks in Type 2 Diabetes	p. 79
Conclusion	p. 79
Multiple-Component Insulin Regimens	p. 85
Highlights	p. 86
Insulin Pharmacology	p. 88
Insulin Timing and Action	p. 88
Stability of Insulins	p. 90
Insulin Absorption	p. 91
Insulin Regimens	p. 93
Multiple-Component Insulin Regimens: General Points	p. 93
Specific Flexible Multiple-Component Insulin Regimens	p. 96
Other Insulin Regimens	p. 99
Insulin Dose and Distribution	p. 99
Initial Insulin Doses	p. 99
Insulin Dose Distribution	p. 100
Insulin Adjustments	p. 100
Acute Adjustments	p. 100
Pattern Adjustments	p. 101
Injection Devices	p. 105
Conclusion	p. 105
Insulin Infusion Pump Therapy	p. 109
Highlights	p. 110
Benefits of CSII	p. 115
Initial Dosage Calculations for Insulin Pump Therapy	p. 116
Basal Insulin Dosage	p. 117
Bolus Insulin Dosage	p. 118
Insulin Dosage Adjustments	p. 120
Diet	p. 120
Exercise	p. 121
Illness	p. 121
Risks of CSH	p. 122
Skin Infection	p. 122
Unexplained Hyperglycemia and Ketoacidosis	p. 124
Hypoglycemia	p. 126
Wearing the Pump	p. 127
Patient Education for CSII	p. 129
Sensor Augmented Pump Therapy	p. 131
The Future	p. 132
Summary and Conclusion	p. 133
Monitoring	p. 137
Highlights	p. 138
Monitoring by the Patient	p. 139
Blood Glucose	p. 139
Ketone Monitoring	p. 140
Record Keeping	p. 141
Monitoring by the Health Care Team	p. 142
A1C - Estimated Average Glucose	p. 143
Real-Time Continuous Glucose Monitoring	p. 144
Monitoring for Long-Term Complications	p. 1145
Retinal Examinations	p. 145
Lipid Screening	p. 145
Blood Pressure	p. 146
Urinary Albumin Screening	p. 146
Foot Examinations	p. 147
Nutrition Management	p. 149
Highlights	p. 150
Goals of MNT	p. 152
Target Nutrition Recommendations	p. 153
Strategies for Type 1 Diabetes	p. 158
Strategies for Type 2 Diabetes	p. 159
Glucose Monitoring and the Nutritional Plan	p. 162
Blood Glucose Monitoring	p. 162
Continuous Glucose Monitoring	p. 163
Hypoglycemia	p. 164
Omitting or Delaying Planned Meals or Snacks	p. 164
Inappropriate Timing of Insulin Relative to Meals	p. 165
Imbalance Between Food and Meal-Related Insulin Dose	p. 166
Inadequate Food Supplementation for Exercise	p. 166
Consuming Alcohol on an Empty Stomach	p. 167
Oral Treatment of Hypoglycemia	p. 169
Facilitating Nutrition Self-Management	p. 169
Meal-Planning Approaches for Intensified Management	p. 170
Carbohydrate Counting	p. 170
Weight Gain Associated with Intensive Management	p. 171
Prevention	p. 172
Index	p. 175
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