Christopher D. Saudek - The Johns Hopkins Guide to Diabetes: For Patients and Families

The Johns Hopkins Guide to Diabetes

A Johns Hopkins Press Health Book

Christopher D. Saudek, M.D., was Professor of Medicine at the Johns Hopkins University School of Medicine and Director of the Johns Hopkins Diabetes Center.

Richard R. Rubin, Ph.D., CDE, was Professor of Medicine and Pediatrics at the Johns Hopkins University School of Medicine and a staff member at the Johns Hopkins Diabetes Center and the Johns Hopkins Pediatric Diabetes Clinic. He also had a private practice specializing in counseling people with diabetes.

Thomas W. Donner, M.D., is Associate Professor of Medicine at the Johns Hopkins University School of Medicine and Director of the Johns Hopkins Diabetes Center.

For Patients and Families

Second Edition

Christopher D. Saudek, M.D.

Richard R. Rubin, Ph.D., CDE

Thomas W. Donner, M.D.

Note to the reader: This book is not meant to substitute for medical care of people with diabetes, and treatment should not be based solely on its contents. Instead, treatment must be developed in a dialogue between the individual and his or her physician. Our book has been written to help with that dialogue.

1997, 2014 Johns Hopkins University Press

All rights reserved. Published 2014

Printed in the United States of America on acid-free paper

9 8 7 6 5 4 3 2 1

First edition published as The Johns Hopkins Guide to Diabetes: For Today and Tomorrow, by Christopher D. Saudek, M.D., Richard R. Rubin, Ph.D., CDE, and Cynthia S. Shump, R.N., CDE

Johns Hopkins University Press

2715 North Charles Street

Baltimore, Maryland 21218-4363

www.press.jhu.edu

Library of Congress Cataloging-in-Publication Data

Saudek, Christopher D.

The Johns Hopkins guide to diabetes : for patients and families / Christopher D. Saudek, M.D., Richard R. Rubin, Ph.D., CDE, Thomas W. Donner, M.D. Second edition.

pages cm (A Johns Hopkins Press health book)

Includes index.

ISBN-13: 978-1-4214-1179-8 (hardcover : alk. paper)

ISBN-10: 1-4214-1179-2 (hardcover : alk. paper)

ISBN-13: 978-1-4214-1180-4 (pbk. : alk. paper)

ISBN-10: 1-4214-1180-6 (pbk. : alk. paper)

ISBN-13: 978-1-4214-1181-1 (electronic)

ISBN-10: 1-4214-1181-4 (electronic)

1. DiabetesTreatmentHandbooks, manuals, etc. I. Rubin, Richard R.

II. Donner, Thomas W. III. Title.

RC660.J536 2014

616.4'62dc23 2013015256

A catalog record for this book is available from the British Library.

are by Jacqueline Schaffer.

Special discounts are available for bulk purchases of this book. For more information, please contact Special Sales at 410-516-6936 or .

Johns Hopkins University Press uses environmentally friendly book materials, including recycled text paper that is composed of at least 30 percent post-consumer waste, whenever possible.

We dedicate this book to the memory of Christopher Saudek, brilliant scientist, caring clinician, and beloved friend.

We also dedicate this book to people with diabetes. They fight the daily battles great and small. Their courage and perseverance inspire us and teach not just about diabetes but about the human spirit.

The first edition of this book was published in 1997. Much has changed in the years since then, including diabetes care. Three years ago Christopher Saudek and Richard Rubin began working on a new edition reflecting the many advances in diabetes treatment since we wrote the first edition of The Johns Hopkins Guide to Diabetes. Tragically, that effort was interrupted by Chris Saudeks untimely death in October 2010. Last year Richard Rubin, with the encouragement of Chris Saudeks wonderful wife, Susan, decided to try again to bring to print the vision that he and Chris had shared. Richard asked Chriss successor as head of the Johns Hopkins Diabetes Center, Dr. Tom Donner, to join him.

The words you read in this edition of The Johns Hopkins Guide to Diabetes are those of Chris, Richard, and Tom, supplemented by the following faculty members and fellows at Johns Hopkins: Dr. Nestoras Mathioudakis, Assistant Professor of Endocrinology; Dr. Sharon Solomon, Associate Professor of Ophthalmology; Emily Loghmani, RD, CDE, nutritionist at the Diabetes Center; Drs. Shabina Ahmed, Ilias Spanakis, Reshmi Srinath, and Laila Tabatabai, all clinical fellows in endocrinology; and Dr. Kristin Arcara, clinical fellow in pediatric endocrinology. Others who contributed to the book are Shereen Arent, J.D., Executive Vice President, Government Affairs and Advocacy, American Diabetes Association, and Katie Hathaway, J.D., Managing Director, Legal Advocacy, American Diabetes Association.

This book retains the wisdom, humor, and eloquence that Chris Saudek brought to all his endeavors. We miss him and we are honored to offer you an opportunity to benefit from his gifts.

As we wrote the first edition of The Johns Hopkins Guide to Diabetes: For Today and Tomorrow, we included stories we had heard from our patients and other people. These vignettes gradually became a central element of the book, and it dawned on us that, like many teachers, we learn far more from our students than we teach them. This edition includes even more of these personal stories. We have also added take home messages to the end of each chapter.

We are sharing what we have learned, and we hope that its helpful. We know, however, that your truth will come from many sources, not only this book. You may jump into the primary literature, reading original research articles. You will almost certainly talk with people, too: family members, people with diabetes, and your health care professionals. We hope you read the diabetes magazines and keep your eyes open for information from many directions, including reliable resources on the Internet. You will need to sort through all these sources of information and figure out what works for you.

You know your own self best. You know how you feel, what you eat, how much you exercise, and how your blood glucose responds. No one else knows you in as much detail as you know yourself. But we provide another perspective, the perspective of professionals who have had lots of experience with diabetes. Actually, we provide three perspectives.

Chris Saudek was a clinically oriented academic physician. In addition to caring for people with diabetes on a daily basis, he was in charge of teaching medical students at Johns Hopkins about diabetes, contributed to various treatment advances, and held positions in professional diabetes organizations, including a year as president of the American Diabetes Association. It was his business to stay in touch with the literature. He tried to be sure that the information provided here was factually correct and that current research findings were accurately integrated into the text. Mainly, with some 25 years invested in clinical care, he cared for and about people with diabetes.

When Chris died, diabetes lost a hero. We have lost one of our giants, said Dr. Edward D. Miller, dean of the faculty of the Johns Hopkins University School of Medicine. He always tried to make things better for patients. His compassion and understanding of the human condition was unsurpassed. Ronald J. Daniels, president of Johns Hopkins University, who was also a patient of Dr. Saudeks, added that Chris was the best Hopkins had to offer. His death is a huge loss to Hopkins and to medicine in the U.S. and beyond. He was a gentle and caring soul and an absolutely gorgeous human being.