Howard A. Wolpert - Intensive Diabetes Management

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2016 by the American Diabetes Association, Inc. All Rights Reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including duplication, recording, or any information storage and retrieval system, without the prior written permission of the American Diabetes Association.

Printed in the United States of America
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The suggestions and information contained in this publication are generally consistent with the Standards of Medical Care in Diabetes and other policies of the American Diabetes Association, but they do not represent the policy or position of the Association or any of its boards or committees. Reasonable steps have been taken to ensure the accuracy of the information presented. However, the American Diabetes Association cannot ensure the safety or efficacy of any product or service described in this publication. Individuals are advised to consult a physician or other appropriate health care professional before undertaking any diet or exercise program or taking any medication referred to in this publication. Professionals must use and apply their own professional judgment, experience, and training and should not rely solely on the information contained in this publication before prescribing any diet, exercise, or medication. The American Diabetes Associationits officers, directors, employees, volunteers, and membersassumes no responsibility or liability for personal or other injury, loss, or damage that may result from the suggestions or information in this publication.

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American Diabetes Association
1701 North Beauregard Street
Alexandria, Virginia 22311

DOI: 10.2337/9781580406321

Library of Congress Cataloging-in-Publication Data

Names: Wolpert, Howard, 1958- , editor. | American Diabetes Association,
issuing body.
Title: Intensive diabetes management / [edited by] Howard Wolpert.
Description: 6th edition. | Alexandria : American Diabetes Association,
[2016] | Includes bibliographical references and index.
Identifiers: LCCN 2016014046 | ISBN 9781580406321 (alk. paper)
Subjects: | MESH: Diabetes Mellitus--therapy | Diet, Diabetic |
Insulin--administration & dosage | Patient Education as Topic | Self Care--methods
Classification: LCC RC660 | NLM WK 815 | DDC 616.4/62--dc23
LC record available at http://lccn.loc.gov/2016014046

eISBN: 978-1-58040-655-0

Contents

Highlights

Intensive Diabetes Management

Physiological Basis of Intensive Management Methods

Normal Fuel Metabolism

Regulation of Fuel Metabolism

Implications for Therapy

Bibliography

Highlights

Integrated Diabetes Management Team

Defining Team Members Roles

Team Communication

Conclusion

Bibliography

Highlights

Integration of the Team Approach

Diabetes Continuing Education

Assessment

Instruction

Environment

Planning

Content

Sequencing of Diabetes Education

Education Strategies

Motivation and Support

Action Planning

Evaluation

Documentation

Conclusion

Bibliography

Highlights

Psychosocial Assessment

Psychological Factors

Diabetes Management

Adherence Screening

Lifestyle Changes

Psychosocial Support System

Family System

Living with Others

PatientHealth Care Professional Relationship and Communication

Helping Patients with Long-Term Adherence

Conclusion

Bibliography

Highlights

Glycemic Goals of Intensive Management

Clinical Considerations

Patients with Type 2 Diabetes

Goal-Setting for Special Populations

Culture

Pregnancy

Children

Older Adult Patients

Conclusion

Bibliography

Highlights

Insulin Pharmacology

Insulin Timing and Action

Stability of Insulins

Insulin Absorption

Insulin Regimens

Multicomponent Insulin Regimens: General Points

Specific Flexible Multicomponent Insulin Regimens

Insulin Dose and Distribution

Initial Insulin Doses

Insulin Dose Distribution

Insulin Adjustments

Acute Adjustments

Pattern Adjustments

Injection Devices

Conclusion

Bibliography

Highlights

Insulin Infusion Pump Therapy

Benefits of CSII

Initial Dosage Calculations for Insulin Pump Therapy

Basal Insulin Dosage

Bolus Insulin Dosage

Insulin Dosage Adjustments

Diet

Exercise

Illness

Risks of CSII

Skin Infection

Unexplained Hyperglycemia and Ketoacidosis

Hypoglycemia

Wearing the Pump

Patient Education for CSII

Real-Time Continuous Glucose Monitoring

Conclusion

Bibliography

Highlights

Monitoring by the Patient

Blood Glucose

Ketone Monitoring

Monitoring by the Health-Care Team

A1CEstimated Average Glucose

Monitoring for Long-Term Complications

Retinal Examinations

Lipid Screening

Blood Pressure

Urinary Albumin Screening

Foot Examinations

Bibliography

Highlights

Goals of Medical Nutrition Therapy

Target Nutrition Recommendations

Strategies for Type 1 Diabetes

Strategies for Type 2 Diabetes

Glucose Monitoring and the Nutrition Plan

Blood Glucose Monitoring

Continuous Glucose Monitoring

Hypoglycemia

Omitting or Delaying Planned Meals or Snacks

Inappropriate Timing of Insulin Relative to Meals

Imbalance between Food and Meal-Related Insulin Dose

Inadequate Food Supplementation for Exercise

Consuming Alcohol on an Empty Stomach

Oral Treatment of Hypoglycemia

Facilitating Nutrition Self-Management

Meal-Planning Approaches for Intensified Management

Carbohydrate Counting

Adjusting Insulin for Protein and Fat

Weight Gain Associated with Intensive Management

Prevention

Bibliography

Kirstine Bell, RD, CDE, PhD
Research Fellow, University of Sydney, Australia

Ann Goebel-Fabbri, PhD
Past Senior Psychologist, Joslin Diabetes Center
Assistant Professor of Psychiatry, Harvard Medical School

Marilyn Ritholz, PhD
Senior Psychologist, Joslin Diabetes Center
Assistant Professor of Psychiatry, Harvard Medical School

Jo-Anne Rizzotto, MEd, RD, LDN, CDE
Director, Educational Services, Joslin Diabetes Center

Emmy Suhl, MS, RD, CDE, LD
Senior Nutritionist, Joslin Diabetes Center

Elena Toschi, MD
Staff Physician, Joslin Diabetes Center
Instructor in Medicine, Harvard Medical School

Howard Wolpert, MD
Senior Physician, Joslin Diabetes Center/Beth Israel Deaconess Medical Center
Associate Professor of Medicine, Harvard Medical School