Medical Management of Type 1 Diabetes

by Kaufman, Francine R.

• ISBN13: 9781580404563
• ISBN10: 1580404561
• Edition: 6th
• Format: Paperback
• Copyright: 2012-05-29
• Publisher: American Diabetes Association

Summary

New insulins and administration protocols, advanced carbohydrate counting, ground-breaking developments in insulin pump therapy and continuous glucose monitoring, and emphasis on continuing patient care have increased the odds of positive outcomes for patients with type 1 diabetes. The challenge for health care professionals is helping patients maximize their chances of reaching these outcomes by developing individualized, flexible, and responsive treatment plans.

Author Biography

Francine R. Kaufman, MD, is a distinguished professor emerita of pediatrics and communications at the Keck School of Medicine and the Annenberg School of Communications at the University of Southern California. She was also the head of the Center for Endocrinology, Diabetes, and Metabolism at Children's Hospital Los Angeles until 2009, when she became the chief medical officer and VP of global clinical, medical, and health affairs for Medtronic Diabetes. In 2003, she was the president of the American Diabetes Association.

Table of Contents

A Word About This Guide	p. ix
Contributors to the Sixth Edition	p. xi
Acknowledgments	p. xiii
Diagnosis and Classification/Pathogenesis	p. 1
Highlights	p. 2
Diagnosis and Classification	p. 5
Criteria for Diagnosis	p. 5
Risk of Developing Type 1 Diabetes	p. 6
Distingrnshing Type 1 Diabetes from Other Forms	p. 7
Clinical Presentation of Type 1 Diabetes	p. 11
Conclusion	p. 11
Pathogenesis	p. 13
Pathophysiology of the Clinical Onset of Type 1 Diabetes	p. 13
Progression of Metabolic Abnormalities During Onset	p. 14
Clinical Onset of Diabetic Symptoms and Metabolic Decompensation	p. 15
Genetics and Immunology of Type 1 Diabetes	p. 17
Conclusion	p. 21
Diabetes Standards and Education	p. 23
Highlights	p. 24
Philosophy and Goals	p. 27
Glycemic Control and Complications: A Summary of Evidence	p. 27
Dysglycemia and Complications from Population-Based Data	p. 28
Goals of Treatment	p. 30
Clinical Goals	p. 32
Conclusion	p. 35
Patient Self-Management Education	p. 37
General Principles	p. 37
Self-Management Education Process	p. 39
Content of Diabetes Self-Management Education	p. 44
Additional Topics of Importance for Type 1 Diabetes	p. 48
Incorporating Patient Education in Clinical Practice	p. 49
Conclusion	p. 50
Tools of Therapy	p. 53
Highlights	p. 55
Insulin Treatment	p. 59
Insulin Preparations	p. 59
Treating Newly Diagnosed Patients	p. 62
Insulin Regimens	p. 65
Alternative Insulin Delivery Systems	p. 74
Optimizing Blood Glucose Control	p. 74
Common Problems in Long-Term Therapy	p. 78
Insulin Allergy	p. 78
Special Considerations	p. 79
Conclusion	p. 82
Treatment with Amylin Analog Pramlintide	p. 85
Monitoring	p. 88
Patient-Performed Monitoring	p. 88
Glucose Sensors	p. 90
Ketone Testing	p. 92
Physician-Performed Glucose Monitoring	p. 93
Other Monitoring	p. 95
Conclusion	p. 95
Nutrition	p. 98
Nutrition Recommendations	p. 98
Nutrition Therapy for Type 1 Diabetes	p. 100
Additional Nutrition Considerations	p. 109
The Process of Medical Nutrition Therapy	p. 113
Practical Approaches to Nutrition Counseling	p. 115
Conclusion	p. 117
Exercise	p. 122
Glycemic Response to Exercise	p. 122
Potential Benefits of Exercise	p. 123
Potential Risks of Exercise	p. 124
Reducing Exercise Risks	p. 125
Exercise Prescription	p. 127
Aerobic Training	p. 127
Strategies for Maintaining Optimal Glycemic Control with Exercise	p. 130
Conclusion	p. 131
Special Situations	p. 133
Highlights	p. 135
Diabetic Ketoacidosis	p. 139
Presentation of DKA	p. 139
Acute Patient Care	p. 141
Other Important Considerations	p. 145
Intermediate Patient Care	p. 147
Preventive Care	p. 148
Conclusion	p. 148
Hypoglycemia	p. 150
Pathophysiology	p. 150
Mild, Moderate, and Severe Hypoglycemia	p. 151
Common Causes of Hypoglycemia	p. 153
Treatment	p. 155
Hypoglycemia Unawareness	p. 157
Hypoglycemia with Subsequent Hyperglycemia	p. 158
Dawn and Predawn Phenomena	p. 159
Conclusion	p. 159
Pregnancy	p. 161
Risk Factors	p. 161
Maternal Metabolism During Pregnancy	p. 162
Preconception Care and Counseling	p. 162
Congenital Malformations: Risk and Detection	p. 166
Maternal Glucose Control During Pregnancy	p. 167
Nutrition Needs	p. 169
Outpatient Care	p. 169
Timing of Delivery	p. 171
Labor and Delivery	p. 172
Postpartum Care	p. 173
Family Planning and Contraception	p. 173
Conclusion	p. 174
Surgery	p. 176
General Principles	p. 176
Major Surgery	p. 176
Minor Surgery	p. 177
Conclusion	p. 177
Islet Transplantation	p. 178
Psychosocial Factors Affecting Adherence, Quality of Life, and Well-Being: Helping Patients Cope	p. 181
Highlights	p. 182
Periods of Increased Emotional Distress	p. 185
Maintaining Adherence	p. 187
Diabetes Complications	p. 188
Developmental Considerations in Children	p. 189
Developmental Considerations in Adolescents	p. 193
Adults	p. 197
The Elderly	p. 198
Emotional and Behavioral Disorders and Diabetes	p. 199
Stress and Diabetes	p. 200
Complications	p. 203
Highlights	p. 205
Retinopathy	p. 209
Eye Examination	p. 209
Clinical Findings in Diabetic Retinopathy	p. 210
Evaluation	p. 212
Treatment	p. 214
Conclusion	p. 216
Nephropathy	p. 219
Clinical Syndrome	p. 219
Natural History	p. 219
Pathogenesis	p. 221
Testing for Nephropathy	p. 221
Management of Nephropathy	p. 222
Hypertension	p. 225
Other Aspects of Treatment	p. 226
Dialysis and Kidney Transplantation	p. 227
Conclusion	p. 228
Neuropathy	p. 230
Overview of Neuropathies	p. 230
Distal Symmetric Sensorimotor Polyneuropathy	p. 231
Late Complications of Polyneuropathy	p. 232
Management of Distal Symmetric Polyneuropathy and Complications	p. 234
Autonomic Neuropathy	p. 235
Focal Neuropathies	p. 239
Conclusion	p. 240
Macrovascular Disease	p. 242
Prevalence and Risk Factors	p. 242
Assessment and Treatment	p. 243
Symptoms and Signs of Atherosclerosis	p. 246
Conclusion	p. 248
Limited Joint Mobility	p. 251
Detection and Evaluation	p. 251
Conclusion	p. 252
Abnormal Linear Growth	p. 253
Subtle Growth Abnormalities	p. 253
Determining Growth Rate	p. 253
Conclusion	p. 254
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