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To Teach, To Learn, To Live: The Complete Diabetes Education Guide for Health Care Professionals Diabetes Mellitus . . . . . . 5 Diagnosis. . . . . . 5 Signs and Symptoms. . . . . . 6 Type 1 Diabetes . . . . . . 6 Variation . . . . . . 7 Incidence. . . . . . 7 Risk Factors. . . . . . 8 Screening. . . . . . 8 Diagnosis. . . . . . 8 Signs and Symptoms . . . . . . 8 Treatment. . . . . . 8 Prevention. . . . . . 9 Type 2 Diabetes. . . . . . 9 Development of Type 2 Diabetes—Summary . . . . . . 11 Variations. . . . . . 13 Incidence. . . . . . 13 Risk Factors. . . . . . 14 Screening. . . . . . 14 Diagnosis . . . . . . 15 Signs and Symptoms . . . . . . 15 Treatment. . . . . . 15 Prevention. . . . . . 15 Prediabetes. . . . . . 15 Incidence. . . . . . 16 Risk Factors. . . . . . 16 Screening. . . . . . 17 Diagnosis. . . . . . 17 Signs and Symptoms . . . . . . 17 Treatment. . . . . . 17 References. . . . . . 20 Chapter 2 - Complications of Diabetes. . . . . . 23 Cost of Complications . . . . . . 26 Prevention of Complications . . . . . . 26 A1C. . . . . . 27 Blood Pressure . . . . . . 29 Cholesterol. . . . . . 30 Long-Term Complications of Diabetes. . . . . . 33 Macrovascular Disease. . . . . . 33 Risk Factors. . . . . . 34 Screening . . . . . . 35 Treatment. . . . . . 35 Prevention . . . . . . 35 Microvascular and Neurovascular Disease. . . . . . 37 Nephropathy. . . . . . 37 Neuropathy . . . . . . 40 Retinopathy. . . . . . 45 Acute Complications of Hyperglycemia . . . . . . 48 Diabetic Ketoacidosis (DKA) . . . . . . 48 Risk Factors . . . . . . 49 Signs and Symptoms . . . . . . 49 Diagnosis. . . . . . 49 Treatment. . . . . . 49 Prevention . . . . . . 50 Hyperglycemic, Hyperosmolar, Non-ketosis . . . . . . 52 Risk Factors . . . . . . 52 Signs and Symptoms . . . . . . 52 Treatment. . . . . . 53 Prevention . . . . . . 53 References. . . . . . 55 Chapter 3 - Diabetes Education. . . . . . 59 The Diabetes Health Care Team . . . . . . 63 The Diabetes Educator. . . . . . 66 Challenges Facing the Diabetes Educator. . . . . . 66 Resources . . . . . . 67 Responsibilities of the Diabetes Educator. . . . . . 67 The Diabetes Education Program. . . . . . 69 Challenges to Diabetes Education. . . . . . 70 Assessment . . . . . . 71 Communication. . . . . . 82 Program Content . . . . . . 82 Presentation. . . . . . 83 Empowerment. . . . . . 89 Self-Management. . . . . . 89 Flexible Educational Strategies. . . . . . 90 The Aboriginal Client . . . . . . 90 The Client from Another Culture . . . . . . 90 The Older Adult . . . . . . 91 The Child or Adolescent Client . . . . . . 92 The Client with Disabilities . . . . . . 92 The Client Who Speaks a Foreign Language . . . . . . 93 The Client with Low Literacy Skills . . . . . . 93 The Deaf or Hearing Impaired Client . . . . . . 93 Strategies to Prevent or Minimize Communication Barriers . . . . . . 94 Evaluation. . . . . . 96 Follow-up . . . . . . 97 References . . . . . . 99 Chapter 4 - Managing Diabetes: Lifestyle . . . . . . 101 Individualizing the Management Plan. . . . . . 104 Monitoring Glycemic Status . . . . . . 106 Self-Monitoring of Blood Glucose . . . . . . 106 Glycosated Hemoglobin Monitoring . . . . . . 111 Urine Glucose Monitoring . . . . . . 111 Record Keeping. . . . . . 112 Nutrition Therapy. . . . . . 113 Calories . . . . . . 114 Macronutrients. . . . . . 115 Carbohydrate . . . . . . 115 Fat . . . . . . 119 Protein. . . . . . 119 Vitamins and Minerals . . . . . . 120 Alcohol. . . . . . 120 Nutritional Concerns. . . . . . 122 Obesity. . . . . . 122 Description . . . . . . 122 Treating Obesity. . . . . . 123 Maintaining Weight Loss. . . . . . 125 Celiac Disease . . . . . . 125 Description. . . . . . 125 Screening . . . . . . 126 Treatment. . . . . . 126 Gastroparesis . . . . . . 126 Description. . . . . . 126 Treatment . . . . . . 127 Physical Activity . . . . . . 127 Aerobic Exercise . . . . . . 128 Resistance Training . . . . . . 129 Physical Activity Precautions . . . . . . 130 Barriers to Physical Activity. . . . . . 131 Treating Depression . . . . . . 132 Managing Stress. . . . . . 133 Treating Sleep Disorders. . . . . . 134 Insomnia. . . . . . 135 Apnea. . . . . . 136 Restless Leg syndrome. . . . . . 136 References. . . . . . 138 Chapter 5 - Managing Diabetes: Medication. . . . . . 143 OHA Therapy. . . . . . 146 Classes of OHAs. . . . . . 147 Alpha-Glucosidase Inhibitor . . . . . . 147 Biguanide . . . . . . 148 Insulin Secretagogues. . . . . . 150 Insulin Sensitizers. . . . . . 152 Diet and Plant-Based Remedies. . . . . . 154 Insulin Therapy. . . . . . 155 Type 1 Diabetes . . . . . . 155 Type 2 Diabetes . . . . . . 156 Types of Insulin. . . . . . 159 Rapid-Acting Insulin. . . . . . 159 Regular Insulin . . . . . . 160 Intermediate-Acting Insulin. . . . . . 161 Premixed Insulin. . . . . . 161 Long-Acting Insulin. . . . . . 162 Factors Affecting Insulin Absorption. . . . . . 163 Storage of Insulin . . . . . . 165 Insulin Delivery Systems . . . . . . 166 Syringes and Pens. . . . . . 166 Insulin Pumps. . . . . . 169 Insulin Requirements . . . . . . 172 Total Daily Dosage . . . . . . 172 Basal/Bolus Insulin Ratio. . . . . . 173 Basal Insulin. . . . . . 173 Bolus Insulin. . . . . . 174 Injection Regimens. . . . . . 174 Insulin Dosage Adjustment . . . . . . 178 Patterned Approach. . . . . . 179 Adjusting Insulin for Carbohydrate Intake. . . . . . 180 Adjusting Insulin for Blood Glucose That Is Not at Target. . . . . . 180 Insulin Adjustment for CSII. . . . . . 180 Hypoglycemia . . . . . . 180 Risk Factors. . . . . . 182 Prevention. . . . . . 183 Treatment. . . . . . 184 On the Horizon. . . . . . 187 References. . . . . . 189 Chapter 6 - Diabetes in Pregnancy. . . . . . 193 Managing the Pregnancy Complicated by Diabetes. . . . . . 197 Monitoring Glycemic Status. . . . . . 197 Checking for Ketones. . . . . . 198 Record Keeping. . . . . . 198 Nutrition Therapy . . . . . . 198 Physical Activity . . . . . . 199 Insulin Therapy. . . . . . 200 Fetal Growth Monitoring. . . . . . 204 Labour and Delivery. . . . . . 204 Postpartum. . . . . . 205 The Pregnancy Complicated by Pre-existing Diabetes. . . . . . 205 Pre-Conception. . . . . . 206 Type 1 Diabetes. . . . . . 207 Type 2 Diabetes. . . . . . 208 Gestational Diabetes Mellitus . . . . . . 211 Incidence. . . . . . 211 Risk Factors. . . . . . 211 Screening. . . . . . 212 Diagnosis. . . . . . 212 Management of GDM/IGT of Pregnancy . . . . . . 212 Postpartum . . . . . . 213 References. . . . . . 215 Chapter 7 - Diabetes in Special Groups . . . . . . 219 Aboriginal People. . . . . . 222 Risk Factors. . . . . . 222 Screening. . . . . . 223 Education and Treatment. . . . . . 223 Prevention. . . . . . 224 Children and Adolescents. . . . . . 224 Type 1. . . . . . 226 Type 2. . . . . . 226 Secondary Diabetes. . . . . . 227 Long-Term Complications . . . . . . 228 Acute Complication. . . . . . 229 Monitoring Glycemic Status . . . . . . 229 Education . . . . . . 229 Nutrition Therapy. . . . . . 231 Physical Activity . . . . . . 232 Treatment . . . . . . 232 Making the Transition to Adult Care. . . . . . 237 Inmates in Correctional Facilities . . . . . . 237 Screening. . . . . . 238 Monitoring Glycemic Status. . . . . . 238 Education . . . . . . 238 Nutrition Therapy and Physical Activity . . . . . . 239 Treatment. . . . . . 239 Older Adults. . . . . . 240 Screening . . . . . . 241 Complications. . . . . . 241 Monitoring Glycemic Status. . . . . . 243 Education . . . . . . 244 Nutrition Therapy. . . . . . 245 Physical Activity . . . . . . 246 Treatment. . . . . . 247 Prevention. . . . . . 250 References. . . . . . 251 Chapter 8 - Acute Care of Diabetes. . . . . . 255 Acute/Critical Illness. . . . . . 258 Coronary Disease and Myocardial Infarction . . . . . . 259 Diabetic Ketoacidosis . . . . . . 261 Hyperglycemic, Hyperosmolar, Non-ketosis . . . . . . 264 Hypoglycemia . . . . . . 266 Lactic Acidosis. . . . . . 268 Surgery. . . . . . 269 Labour and Delivery. . . . . . 271 References. . . . . . 274 Chapter 9 - Diabetes and Daily Life . . . . . . 277 Costs of Diabetes Care . . . . . . 280 Discrimination. . . . . . 280 Driving. . . . . . 282 Drugs. . . . . . 286 Alcohol . . . . . . 286 Tobacco . . . . . . 288 Illegal Substances. . . . . . 288 Exercise . . . . . . 289 Medication Interactions. . . . . . 290 Sick Days . . . . . . 290 Travel . . . . . . 292 Blood Glucose That Is Not at Target . . . . . . 295 Causes of Hypoglycemia . . . . . . 295 Causes of Hyperglycemia. . . . . . 296 Causes of Variable Blood Glucose. . . . . . 298 References. . . . . . 299 Chapter 10 - Case Studies. . . . . . 301 Appendices. . . . . . 319 Appendix A - Comparison of Type 1 and Type 2 Diabetes . A-1 Appendix B - Antihypertensive Drugs . A-2 Appendix C - Lipid-Lowering Drugs . A-4 Appendix D - Standardized Questionnaires for Depression and Anxiety Disorders . A-5 Appendix E - The Mini-Mental State Exam . A-10 Appendix F - Diabetes Education Checklist . A-12 Appendix G - Sample Diabetes Patient Care Plan . A-16 Appendix H - Calculation of Daily Calorie Requirement . A-17 Appendix I - Calculation of Percentage of Body Fat . A-18 Appendix J - Calculation of Daily Carbohydrate Requirement . A-19 Appendix K - Fiber Content of Selected Foods . A-19 Appendix L - Glycemic Index and Glycemic Load of Selected Foods . A-20 Appendix M - Calculation of Body Mass Index . A-21 Appendix N - Calories Burned Per Hour of Physical Activity . A-22 Appendix O - Antiobesity Agents . A-22 Appendix P - Carbohydrate and Insulin Adjustments for Exercise . A-23 Appendix Q - Management of Hyperglycemia in Type 2 Diabetes . A-24 Appendix R - Oral Antihyperglycemic Agents . A-25 Appendix S - Calculation of Insulin-to-Carbohydrate Ratio . A-28 Appendix T - Calculation of Insulin Sensitivity Factor . A-29 Appendix U - Calculation of Insulin Requirements When Starting Pump Therapy. A-30 Appendix V - Types of Insulin and Action Profiles . A-31 Appendix W - Patterned Approach to Insulin Dosage Adjustment . A-32 Appendix X - DKA protocol – BC Children’s Hospital . A-34 Appendix Y - Effects of Various Medications on Blood Glucose . A-36 Appendix Y - Abbreviations . A-38 Glossary. . . . . . A-39 | |||||||||
