Type 2 Diabetes in Adults of All Ages 2e by Fox, Charles -- Read -- Imperial Library of Trantor

Index

Cover Half Title Page Title Page Copyright Page Contents Preface 1 Introduction 2 Getting to grips with diabetes

When you first find out you have diabetes Structured patient education programmes DESMOND DESMOND topics covered at the newly diagnosed patients’ session X-PERT Coming to terms with diagnosis What happens next? Older people Teenagers and young adults Self-help groups Routine check-ups The nine vital health checks you need every year if you have diabetes (NICE) Diabetes UK’s fifteen healthcare essentials Living the life you choose

3 Caring for your own diabetes

Goals for managing diabetes How can you achieve these goals? Traditional approach Diabetes today – cornerstones of management Becoming your own expert Can you take time off from diabetes? Alternative and complementary therapies Bitter gourd or bitter melon

4 Diabetes: some background

Insulin history Type 1 diabetes Type 2 diabetes Risk factors for Type 2 diabetes Non-insulin treatments for Type 2 diabetes Young people with Type 2 diabetes Principles of treatment for Type 2 diabetes Maturity-onset diabetes of the young (MODY) Latent autoimmune diabetes in the adult (LADA) How common is diabetes? Can you catch diabetes? Does eating too much sweet food cause diabetes?

5 How your body works

Phases in glucose metabolism How insulin works Insulin Insulin and blood glucose What happens to the carbohydrates in the food? Your body doesn’t realize it has diabetes Diabetes, insulin deficiency and insulin resistance

6 Regulation of blood glucose

Where does the glucose in your blood come from? Counter-regulating hormones that increase blood glucose levels Effects of insulin The liver Body reserves during fasting and hypoglycaemia Liver and muscle stores Glucagon Glucagon injections Effects of glucagon Adrenaline Effects of adrenaline Cortisol Effects of cortisol Growth hormone The effects of growth hormone

7 High blood glucose levels

Insulin resistance – not enough insulin to do the job? Early need for insulin in Type 2 diabetes What to do about a high blood glucose level Diet alone Anti-diabetes tablets Symptoms of persistently high blood glucose Insulin treatment Hyperosmolar hyoiglycaemic state (HHS) Ketoacidosis Blurred eyesight and diabetes

8 Nutrition

What is our food made of? Aims of nutritional management Absorption of carbohydrates Glycaemic index Factors that raise the blood glucose level more quickly Factors that raise the blood glucose level more slowly Carbohydrates Glycaemic index, high and low Emptying the stomach How is the emptying of the stomach affected? Gastoparesis Taking fluids with food Dietary fibre Sugar content of our food Dietary fats Food rules of thumb Food choices and diabetes Potatoes Bread Cereal Rice Pasta Pizza Fruit and berries Vegetables Milk Meat and fish Salt Herbs and spices Mealtimes ‘Special’ foods Branded ‘diabetic’ food? ‘Fast food’ Vegetarian and vegan diets Party-time Religious fasting days Ramadan: the fasting month Sweeteners Free from sugar? Intense sweeteners Sweeteners without energy Nutritive sweeteners Fructose Polyols

9 Weight control

What is ‘overweight’? Is weight always a problem? Definitions of central obesity Metabolic syndrome Acanthosis nigricans Fatty change in the liver Polycystic ovary syndrome (PCOS) Weight loss: the benefits to your health Exercise and weight loss Are low carbohydrate diets useful? Are conventional low fat diets useful? Partial meal replacement diets Using the glycaemic index (GI) in dietary planning for weight reduction Group therapy Drugs for weight loss Silbutramine (Reductil) Rimonabant (Acomplia) Orlistat (Xenical) Weight loss: summary points Bariatric surgery

10 Exercise

What happens during exercise? The effects of exercise on the blood glucose level Planning and maintaining exercise Exercise and mood Ways of introducing exercise into your daily life Exercise and insulin resistance Benefits of exercise: research findings Exercise and its effects on blood sugar Exercise and muscle strength Buy a pedometer Classification of pedometer-determined physical activity in healthy adults

11 Monitoring

The blood glucose testing dilemma NICE guidelines for blood glucose monitoring Do you need to monitor at all? NICE blood glucose guidelines How many tests should you take? If you are on diet and exercise, metformin, gliptin, glitazone or GLP-1 treatment If you are on sulphonylureas Blood glucose self-monitoring guidelines If you are on insulin Acting on the results Persistently high or low readings Isolated high or low readings Are some things forbidden? Urine tests How to take blood tests Lancets for blood glucose tests Does continuous finger-pricking cause loss of feeling? Why take blood tests? Sources of error when measuring blood glucose Borrowing someone else’s finger-pricking device Alternative site testing Does the meter show the correct value? Which meter? Self-monitoring around mealtimes Self-monitoring around mealtimes if you are not taking insulin Self-monitoring around mealtimes if you are taking insulin Self-monitoring around mealtimes: what it means for you Continuous glucose monitoring Ketones

12 Glycosolated haemoglobin (HbA1c)

HbA1c New way of expressing HbA1c What level should HbA1c be? Relationship between HbA1c and blood glucose Why check your HbA1c? HbA1c goals For how long do blood glucose levels affect HbA1c? How often should you check your HbA1c? Can your HbA1c be ‘too good’? Can the HbA1c measurement give false information? Fructosamine People with an abnormal haemoglobin

13 Tablets for lowering blood sugar

Nine Key Points Tablet treatments for diabetes Biguanides (metformin) When should you not use metformin? Available metformin preparations Who should not take metformin? Side effects Evidence for using metformin to manage your diabetes Other uses for metformin Sulphonylureas When should you take a sulphonylurea, and how much? Commonly used sulphonylureas in the UK When should you not use a sulphonylurea? Who should not take sulphonylureas? Side effects Evidence for using a sulphonylurea to manage your diabetes Gliptins When should you not use a gliptin? Who should not take gliptins? Side effects Evidence for using a gliptin to manage your diabetes Glitazones (insulin sensitizers) When should you not use a glitazone? Who should not take glitazones? Side effects Evidence for using glitazones to manage your diabetes Postprandial glucose regulators (PPGRs) When should you avoid PPGRs? Side effects of PPGRs Who should not take PPGRs? Evidence for using a PPGR to manage your diabetes Alpha-glucosidase inhibitors Who should avoid taking acarbose? Side effects of acarbose What is the evidence for using acarbose to treat Type 2 diabetes? Sodium-glucose transporter-2 (SGLT-2) inhibitors GLP-1 agonists Exenatide Liraglutide Once weekly exenatide Oral treatment pathways for blood glucose: what is the best form of treatment?

14 Insulin treatment

Animal and human insulin Production of human insulin Methods of slowing the action of insulin Units and insulin concentrations Short- and rapid-acting insulin Basal insulin New basal insulins Research findings: Levemir Research findings: Lantus Pre-mixed insulin Twice-daily treatment Multiple injection treatment Research findings: multiple injections Injections before meals (bolus insulin) When should you take your pre-meal dose? Can regular insulin injections be taken just before a meal? Timing your injections What do I do if my premeal glucose is too high or too low? Can I skip a meal? Bedtime insulin When should the long-acting injection be taken? Mixing insulins Depot effect How accurate is your insulin dose? Insulin absorption Factors influencing the insulin effect What if you forget to take your insulin? Forgotten pre-meal injection (multiple injection treatment) Forgotten bedtime injection multiple injection treatment) What if you take the wrong type f insulin? At bedtime During the day Having a lie in at weekends Staying awake all night Shift work Safe use of insulin and insulin passports

15 Administering Insulin

Injection technique Taking the pain out of injections Research findings: injection technique Is it best to inject into fat or into muscle? Recommended injection sites In the tummy or the thigh? Is it necessary to disinfect the skin? Storage of insulin Syringes Injections with syringes Pen injectors Replacing pen needles Different pens for daytime and night-time insulin Air in the cartridge or syringe How to get rid of air in the insulin cartridge Insulin on the pen needle Used needles and syringes Insulin pumps What is an insulin pump and why should you use one in Type 2 diabetes? What do the studies about using pumps in Type 2 diabetes say? What’s the conclusion? New methods of insulin delivery Inhaled insulin Nasal insulin

16 Changing insulin requirements

Moving on to insulin Combination therapy – basal insulin combined with other treatments Insulin and metformin Insulin and other tablets Insulin and GLP-1 agonists Treatment with insulin alone Premixed insulin Splitting the evening dose of mixed insulin Why do blood glucose results vary from day to day? Food intake Skin temperature Exercise Depth of insulin injection Site of injection Illness Stress Blood glucose goals Managing your insulin doses Keeping good records What to do if your blood glucose level is high

17 Side effects and problems with insulin treatment

Key concerns patients have about insulin treatment Insulin and weight gain Does insulin increase appetite? Hypoglycaemia Why do patients with Type 2 diabetes have to take such large amounts of insulin? Insulin resistance syndrome Reducing the insulin dose Problems at the injection sites Lipohypertrophy Redness at injection sites Stinging after injection injections Bruising after injection injections Insulin antibodies

18 Hypoglycaemia

Stages of hypoglycaemia Blood glucose levels and symptoms of hypoglycaemia Symptoms of hypoglycaemia related to adrenaline production Symptoms of hypoglycaemia from the brain Research findings: effects of low blood glucose Severe hypoglycaemia What caused your hypoglycaemia? Seizures Hypoglycaemia unawareness Driving and insulin Tips for safe driving Rebound phenomenon Too little food or too much insulin? Night-time hypoglycaemia Symptoms indicating night-time hypoglycaemia Taking the wrong type of insulin Can you die from hypoglycaemia?

19 Treating hypoglycaemia

Which dose of insulin contributed to your hypoglycaemia? Practical instructions Treatment of hypoglycaemia (as recommended by DAFNE) How many glucose tablets are needed to treat hypoglycaemia? Timing and hypoglycaemia Hypoglycaemia just before you eat Hypoglycaemia 45–60 minutes before your next meal Hypoglycaemia 1–2 hours before your next meal Helping someone with diabetes who is not feeling well Glucose Should you always eat when you feel hypoglycaemic? Fructose After hypoglycaemia Research findings: recovery from hypoglycaemia Learning to recognize the symptoms of hypoglycaemia

20 Stress

Stress in daily life Stress Research findings: stress and HbA1c levels

21 Coping with sickness

What to do if your blood glucose is high Illness and need for insulin Nausea and vomiting Insulin treatment while you are ill (excluding gastroenteritis) Gastroenteritis How do different illness affect blood glucose? The signs that tell you when to go to hospital Wound healing Surgery Drugs that affect blood glucose Teeth Gingivitis Having a tooth out Vaccinations

22 Type 2 diabetes and younger people

Why me? Type 2 diabetes and lifestyle Are the symptoms any different in younger people? What can be done? Is treatment with insulin inevitable in time? What does the future hold? Type 2 diabetes in young people who are not overweight Finding out more Useful resources

23 Smoking

The risks How do I stop? Willpower Counselling services Complementary therapies Nicotine replacement therapy Buproprion Passive smoking Snuff

24 Alcohol and other substances

Alcohol and the liver Why is it dangerous to drink too much if you have diabetes? Basic rules for people taking insulin Units of alcohol Dieting and weight loss Illegal drugs Benzodiazepines Cannabis

25 Sexual problems and Type 2 diabetes

Problems with your erection Depression Adequate investigation of any medical problems Medical treatment of erectile dysfunction Tablets Local agents Mechanical devices What happens if nothing works? What about women? Menstruation Fertility Contraception The Pill Interuterine devices and implants Contraceptive methods Staying healthy

26 Pregnancy and diabetes

Preparing for pregnancy Glucose control Research findings: diabetes and pregnancy Blood pressure control Cholesterol During the pregnancy Gestational diabetes Delivery Feeding your baby

27 Social and employment issues

Social life Eating out Diabetes ID Being a parent with diabetes Adoption Diabetes and work The Disability Discrimination Act Fitness for employment Telling your colleagues Discrimination, and what to do about it Shift work Guidelines for safe shift-working for people on insulin Diabetes and the Armed Forces Driving and diabetes To consider while driving

28 Travelling with diabetes

Travelling with insulin Names of insulin abroad Passing through time zones when on insulin Multiple injection treatment Two-dose treatment Safety rules for flying within the US Vaccinations Ill while abroad? Diarrhoea Problems with travel sickness Extra documentation Diabetes equipment you may need on the trip

29 Psychological aspects of Type 2 diabetes

Common responses to the diagnosis of Type 2 diabetes Need for information Psychological support Handling the diagnosis of diabetes: what your health professional should do Group/peer support Support from partners and other family members Anxiety and Type 2 diabetes Research findings: anxiety and Type 2 diabetes Depression and Type 2 diabetes Issues to come to terms with following a diagnosis of diabetes Diabetes and underlying psychiatric illness Schizophrenia Research findings: depression and Type 2 diabetes Diabetes and severe psychosis Type 2 diabetes and eating disorders Can psychological interventions help? Taking control

30 Complications of the cardiovascular system

What are macrovascular complications? Blood glucose levels What is the evidence for the link between high blood glucose and macrovascular complications? What can I do about it? Blood pressure What is the evidence for a link between higher blood pressure and amacrovascular complications? What can I do about it? Cholesterol levels What is the evidence for a link between blood fats and macrovascular complications? What can I do about it? Heart and large blood vessel diseases Insulin resistance What’s the evidence for the link between insulin resistance and macrovascular complications? What can I do about it? Who needs aspirin treatment? New cardiovascular risk markers Helping yourself

31 Microvascular complications

Complications affecting the eyes (retinopathy) Treatment Disturbed vision at unstable blood glucose levels Glasses Contact lenses Complications affecting the kidneys (nephropathy) Stages of kidney damage Complications affecting the nerves (neuropathy) Treatment: loss of sensation Treatment: pain due to nerve damage The autonomic nervous system Problems with the autonomic nervous system Avoiding complications: the evidence

32 Problems with feet

Why do foot problems happen? Minimizing the risks of foot problems The major complications of diabetes causing foot problems Treating foot ulcers Foot care rules Looking after your feet: first aid measures Charcot foot

33 Associated diseases

Insulin resistance Features of the metabolic syndrome Problems associated with insulin resistance Polycystic ovarian syndrome Non-alcoholic steatohepatitis Acanthosis nigricans Maturity onset diabetes of the young (MODY) Causes of secondary diabetes Hormonal causes Cushing’s syndrome Acromegaly Pancreatic disease and pancreatitis Haemachromatosis

34 Diabetes in later life

Best possible blood glucose levels Glucose-lowering drugs: which is best for you? Metformin Sulphonylureas Gliptins and GLP-1 analogues Pioglitazone Insulins Management of other risk factors if you are older Aspirin therapy Blood pressure control Reducing cholesterol in older adults Management of erectile dysfunction if you’re older Diabetes foot care Diabetes in a care home General rules

35 Support and information

What care should you be getting from your primary care team? Finding help from other sources Diabetes UK Publications Living with diabetes Diabetes UK holidays Diabetes UK family weekends Local Diabetes UK groups Parent support groups Insurance Joining Diabetes UK Other useful organizations Institute of Diabetes for Older People (IDOP) International Society for Pediatric and Adolescent Diabetes (ISPAD) Juvenile Diabetes Research Foundation (JDRF) International Diabetes Federation (IDF) Diabetes Ireland British Heart Foundation National Kidney Federation (NKF) RNIB The Stroke Association Practical and financial support Claiming benefits Prescription advice Reimbursed accessories Diabetes and the Internet Using the Internet

36 Outcome studies in Type 2 diabetes

What is an ‘outcome study’? Outcome studies looking at the effects of controlling blood glucose UKPDS What did it show? What does the UKPDS tell us? Ten year follow-up of survivors of the UKPDS What does the UKPDS follow-up study tell us? Two contrasting studies published in 2008 What did these two studies tell us? Effects of the ACCORD study Veterans Diabetes Trial Conclusions from all blood glucose studies Outcome studies looking at control of blood pressure UKPDS UKPDS 30-year follow-up study ADVANCE BP ACCORD-BP Swedish National Register blood pressure study HOPE What did it show? What does this mean? ASCOT What did it show? What does this mean? Studies looking at the effects of reducing cholesterol levels Heart Protection Study What did it show? What does this mean? CARDS What did it show? What does this mean? A study which tries to correct all risk factors: the Steno-2 study What did it show? What does this mean?

37 Research and new developments

No new drugs Very strict food restriction cures diabetes Other research Looking ahead

Glossary Finding out more Index

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