Jaypee Brothers
In Current Chapter
In All Chapters
X
Clear
X
GO
Normal
Sepia
Dark
Default Style
Font Style 1
Font Style 2
Font Style 3
Less
Normal
More
A Practical Guide to Diabetes Mellitus
Nihal Thomas, Jachin Velavan, Nitin Kapoor, Senthil Vasan K
CHAPTER 1:
Physiology
PANCREAS
Functional Anatomy
Synthesis of Insulin
Insulin Receptor
Mechanism of Action of Insulin
Effects of Insulin
Effect on Carbohydrate Metabolism (Fig. 1.4)
Effect on Lipid Metabolism
Effect on Protein Metabolism
Effect on Potassium Transport
Effect on General Growth and Development
Glucose Transporters
Major Factors Regulating Insulin Secretion
The Incretin Effect
GIP
GLP-1
GLP-1 in the Pancreas: Insulin Secretion and β cell Mass
GLP-1 in the Periphery: Gut Motility and Insulin Sensitivity
GLP-1 in the CNS: Control of Appetite and Weight
Properties and Biological Actions of GIP and GLP-1
Substances with Insulin-like Activity
DIABETES MELLITUS
Type 1 Diabetes
Type 2 Diabetes
Consequences of Disturbed Carbohydrate Metabolism
Consequences of Disturbed Lipid Metabolism
Consequences of Disturbed Protein Metabolism
Consequences of Disturbed Cholesterol Metabolism
Further Complications
SELF-ASSESSMENT
CHAPTER 2:
Introduction and Overview of Glycemic Disorders
INTRODUCTION
EPIDEMIOLOGY AND EVOLUTION
Asian Indian Phenotype and its Characterization
Thrifty Genotype versus Phenotype Hypotheses
PATHOGENESIS
Type 1 Diabetes Mellitus
Genetic Factors
Autoimmunity
Role of Islet Autoantibody Testing in Clinical Practice
Environmental Factors
Type 2 Diabetes Mellitus
Genetic Factors
Environmental Factors
Fetal and Neonatal Programming/Epigenetic Effects
Role of Obesity and Inflammation
CLASSIFICATION
HISTORY TAKING IN DIABETES
Demographic Data
Chief Complaints
Diabetic History
Past Medical and Surgical History
Family and Personal History
DIAGNOSIS OF DIABETES MELLITUS
CONCEPT OF PREDIABETES
Diagnosis of Impaired Fasting Glycemia and Impaired Glucose Tolerance
CONCEPT OF “THE METABOLIC SYNDROME”
Clinical Context
Study Highlights
Clinical Implications
SCREENING FOR DIABETES
SUMMARY OF RECOMMENDATIONS FOR ADULTS WITH DIABETES
Glycemic Control Targets
Lipids
Key Concepts in Setting Glycemic Goals
GLYCOSYLATED HEMOGLOBIN
SELF-ASSESSMENT
CHAPTER 3:
Practical Medical Nutritional Therapy
GOALS OF NUTRITION THERAPY
MAINTENANCE OF BODY WEIGHT
MACRONUTRIENTS
CARBOHYDRATE
Recommended Intake
Simple Carbohydrate
Complex Carbohydrate
Benefits of Increasing Dietary Fiber
Glycemic Index of Foods
Low GI Foods (< 55)
Medium GI Foods (55–69)
High GI Foods (> 70)
Methods to Lower GI of the Meal
Glycemic Load
PROTEIN
Role of Protein in Diabetic Diet
Recommended Daily Allowance for Protein
Sources
FAT
Recommendations for Fat Intake
Visible Sources of Fat
Invisible Sources of Fat
Composition of Commonly used Oils
Recommended Oils
Recommended Quantity of Oil
Sources of Trans Fat in Diet
Omega-3 Fatty Acids
MICRONUTRIENTS
NON-NUTRITIVE SWEETENERS
ALCOHOL AND DIABETES
FENUGREEK
FOOD EXCHANGES
MEAL PLANNING
Step 1: Assessment has Four Components
Step 2: Identify the Areas for Dietary Intervention
Step 3: Formulation of Meal Plan
Determine the Calorie Requirement
Distribution of Carbohydrate Load through Small Frequent Meals
Healthy Snack Options (Midmorning and Evening)
Plate Method
Nutritional Management of Nephropathy
Nutritional Management of Cardiovascular Disease
Nutritional Management of Type 1 Diabetes Mellitus
Step 4: Monitoring Progress
CARBOHYDRATE COUNTING
SELF-ASSESSMENT
CHAPTER 4:
Exercise
INTRODUCTION
PHYSIOLOGICAL CHANGES OCCURRING DURING EXERCISE
CLINICAL IMPLICATIONS OF THE EFFECTS OF EXERCISE IN DIABETES
BENEFITS OF EXERCISE IN PATIENTS WITH DIABETES
POTENTIAL ADVERSE EFFECT OF EXERCISE IN PATIENTS WITH DIABETES
Cardiovascular
Microvascular
Metabolic
Musculoskeletal
Recommendations
EXERCISE PRESCRIPTION
Medical Evaluation
Exercise History
Motivation/Psychosocial Issues
Patient Education
Avoiding Complications
Timing of Exercise
Realistic Plan for the Individual
Tips to Start a Walking Program
Exercise in Children
TYPES OF PHYSICAL ACTIVITY
Strengthening Exercises
Aerobic Exercises
Flexibility (stretching) Exercises
Endurance Exercises
Non-weight Bearing Exercises
PRACTICAL CONSIDERATIONS (Fig. 4.8)
How Much Exercise?
Which is the Best Exercise?
How Much Calories Do I Burn with Various Exercise?
SELF-ASSESSMENT
CHAPTER 5:
Counseling
INTRODUCTION
STEPS IN COUNSELING
Rapport-building
Identifying Counseling Goals
Assessment of Patient's Level of Coping
Stage
Previous Knowledge about Disease
Age
Sex
Socioeconomic Status
Family/Peer Support
Patient Typing
Practical Considerations
Counseling Intervention
Types of Counseling Interventions
Models of Behavior Change
Follow-up
Counseling Caregivers and Family Members
Basic Health Education
Individual Casework for “Caregiver Stress”
Family Therapy
CONCLUSION
CASE STUDIES
Case 1
Discussion
To Assess Previous Knowledge
Socioeconomic Status
Assumptions for Mapping
Case 2
Discussion in Brief
ACKNOWLEDGMENT
SELF-ASSESSMENT
CHAPTER 6:
Oral Antidiabetic Agents
ROLE OF ORAL ANTIDIABETIC AGENT THERAPY IN TYPE 2 DIABETES MELLITUS
BIGUANIDES
Adverse Effects of Biguanide Therapy
Dose
Therapeutic Application
Contraindications
SULFONYLUREAS
Available Agents
Glibenclamide
Glipizide
Gliclazide
Glimepiride
Glimepiride versus other Sulfonylureas
Therapeutic Applications of Glimepiride
MEGLITINIDE
Mechanism
Available Agents and Dosing
Therapeutic Application
Disadvantages
ALPHA-GLUCOSIDASE INHIBITORS
Available Agents
Clinical Use
Contraindications
Precautions
THIAZOLIDINEDIONES
Therapeutic Applications
Adverse Effects
Contraindications
Available Agents
Recent Controversies
INCRETIN EFFECT
Glucagon-like Peptide-1 Analogs and Dipeptidyl Peptidase Inhibitors
Dipeptidyl Peptidase Inhibitors
Mechanism of Action of DPP-IV Inhibitors
Available Agents
Sitagliptin
Vildagliptin
Saxagliptin
Linagliptin
HYDROXYCHLOROQUINE IN DIABETES
SODIUM-GLUCOSE COTRANSPORTER 2 INHIBITORS
Mechanism of Action of Sodium-Glucose Cotransporter 2 Inhibitors
Available Agents
Canagliflozin
Dapagliflozin
Empagliflozin
Ipragliflozin
Therapeutic Application
BROMOCRIPTINE
GUIDELINES FOR INITIATING ORAL ANTIDIABETIC AGENTS
American Diabetes Association: Standards of Medical Care in Diabetes 2015 (Flowchart 6.3)
SELF-ASSESSMENT
CHAPTER 7:
Parenteral Therapeutic Agents
PATHOPHYSIOLOGY AND THE BASIS FOR INSULIN REPLACEMENT REGIMENS
HISTORY
SOURCES OF INSULIN
CLASSIFICATION OF INSULIN
Basal Insulins
Bolus or Mealtime Insulins
Premixed Insulin
INDICATIONS FOR INSULIN THERAPY
THERAPEUTIC REGIMENS
Augmentation Therapy
Replacement Therapy
Dosing
ORAL MEDICATIONS PLUS INSULIN
INSULIN ANALOGS
Standard Insulin versus Insulin Analogs
Problems with Regular Insulin
TYPES OF INSULIN ANALOGS
Rapidly-acting Analogs
Insulin Lispro
Insulin Aspart
Insulin Glulisine
Long-acting Analogs
Insulin glargine
Insulin Detemir
Insulin Degludec
Insulin Degludec Plus
GLUCAGON LIKE PEPTIDE-1 ANALOGS
Incretin Effect
Exenatide
Dosage
Common Dosage in Practice
Adverse Effects
Drug Safety
Drug-Disease Contraindications
Liraglutide
AMYLIN ANALOGS
Pramlintide
SELF-ASSESSMENT
CHAPTER 8:
Insulin Therapy—Practical Aspects
INTRODUCTION
INSULIN SYRINGES
Reuse and Disposal of Syringes
Syringe Alternatives
Insulin Storage
Resuspension of Insulin
Sites for Insulin Administration
Lifted Skin Fold Technique
Mixing of Insulin
Split-Mix and Multiple Dose Regimens
FACTORS THAT AFFECT RATE OF ABSORPTION OF INSULIN
Site for Injection
Temperature
Exercise
Needle Length
COMPLICATIONS OF INSULIN THERAPY
Hypoglycemia
Weight Gain
Lipoatrophy/Lipohypertrophy
Somogyi Effect
Symptoms
Recommendations
Dawn Phenomenon
Recommendations
Pain
BARRIERS TO INSULIN THERAPY
Patient Barriers
System Barriers
Provider Barriers
Special Population
Children
Pregnancy
Elderly Patients
Clients with Vision, Hearing, or Dexterity Impairment
SICK DAY MANAGEMENT
Sick Day Guidelines
Other Instructions
ALTERNATIVE METHODS OF INSULIN DELIVERY
Insulin Pens
Reusable Insulin Pens
Disposable Insulin Pens (Prefilled Pens/Single Use only)
Advantages of Insulin Pen Devices over Conventional Insulin Syringes
Who Benefits from Pen Devices?
Limitations of Pen Devices
DETERMINING EFFECTIVENESS OF SELF-INJECTION EDUCATION
Insulin Pump: Continuous Subcutaneous Insulin Infusion
Components of Insulin Pump Therapy (Figs. 8.8 and 8.9)
Example:
Basal Insulin
Bolus Insulin
Client Selection for Continuous Subcutaneous Insulin Infusion
Proposed Clinical Characteristics of Suitable Insulin Pump Candidates
Type 1 Diabetes Mellitus
Type 2 Diabetes Mellitus
Benefits of CSII
Risks of CSII
Special Consideration with CSII Therapy
Training Clients on CSII
DOSE ADJUSTMENT FOR NORMAL EATING
What is DAFNE?
What are the Benefits of DAFNE?
SELF-ASSESSMENT
CHAPTER 9:
Blood Glucose Monitoring
INTRODUCTION
SELF-MONITORING OF BLOOD GLUCOSE
Benefits of Self-monitoring of Blood Glucose
Frequency of Self-monitoring of Blood Glucose
Bedside Monitoring
Barriers for Self-monitoring of Blood Glucose
Record Keeping
Self-monitoring of Blood Glucose Devices
Glucometers
Issues to be Considered in Glucose Meter Selection
Calibration Code
International Diabetes Federation's (IDF) Recommendations for Glucose Monitoring in Diabetes
Training on Self-monitoring of Blood Glucose
Client Education Guide Self-monitoring of Blood Glucose
CONTINUOUS GLUCOSE MONITORING SYSTEM
Components
Continuous Glucose Monitor
Cable
Glucose Sensor
Com-station
Beneficial Scenarios
Limitations
Warnings/Precautions
SELF-ASSESSMENT
CHAPTER 10:
Peripheral Neuropathy
INTRODUCTION
DEFINITION
WHO Definition of Neuropathy in Diabetes
RISK FACTORS
CLASSIFICATION
PATHOGENESIS
Metabolic Hypothesis
Immune Hypothesis
Microvascular Hypothesis
Neurotrophic Hypothesis
Oxidative Stress Hypothesis
CLINICAL PRESENTATION
Symmetric Polyneuropathies
Proximal Motor Neuropathy
Cranial Neuropathies
Limb Mononeuropathies
Diabetic Truncal Mononeuropathy
Asymmetric Lower Limb Motor Neuropathy (Diabetic Amyotrophy)
Chronic Inflammatory Demyelinating Polyneuropathy
Assessment of DSPN
Nylon Monofilament Test
QST–Quantitative Sensory Testing
Electrophysiology
Proximal Motor Neuropathy
MANAGEMENT
General Management
Small Fiber Neuropathy
Large Fiber Neuropathy
Medical Management of DSPN
Management Aimed at Pathogenesis
Management Aimed at Symptoms
Deep-seated Pain
Nonpharmacological Treatment of Diabetic Neuropathy
Transcutaneous Electrical Nerve Stimulation
Electrical Spinal Cord Stimulation
Percutaneous Electrical Nerve Stimulation
Magnetic Field Therapy
Low-intensity Laser Therapy
Monochromatic Near-infrared Treatment (MIT)
Electroacupuncture
Exercise
Psychological Therapy
Focal Neuropathies
Mononeuropathy
Entrapment Neuropathy
CONCLUSION
SELF-ASSESSMENT
CHAPTER 11:
Feet, Foot Care and Neuroarthropathy
INTRODUCTION
ULCERATION
Etiology of Foot Ulceration
Pathobiology of Foot Ulceration
Structural Deformity and Limited Joint Mobility
Evaluation of a Foot Ulcer in Diabetes
Classification of Diabetic Foot Ulcers
Treatment of Foot Ulcer in Diabetes
Role of Debridement
Role of Antibiotics
Role of Amputation
History of Previous Ulceration and Amputation
Prevention
NEUROARTHROPATHY
Investigations (Table 11.2)
Plain Radiography
Bone Scan (Fig. 11.13)
MRI (Good Sensitivity and Specificity)
Portable Infrared Dermal Thermometry
Joint Aspiration
Synovial Biopsy
Treatment
Nonsurgical Therapy
Surgical Therapy
Medical Therapy
PERIPHERAL ARTERY OCCLUSIVE DISEASE
Diabetes Maintenance Therapy for Vascular Disease Prevention
Blood Glucose Control
Blood Pressure Control
Blood Lipid Control
Antiplatelet Therapy
Miscellaneous Treatment
SELF-ASSESSMENT
INTRODUCTION
WOUND ASSESSMENT
WOUND CLEANSING
Cleansing Solutions
Nontoxic Wound Cleansers
DEBRIDEMENT
Types of Debridement
Choice of Dressings
SELF-ASSESSMENT
CHAPTER 12:
Therapeutic Footwear
INTRODUCTION
FOOT INJURY MECHANISM DUE TO SENSORY NEUROPATHY
FOOT INJURY MECHANISM DUE TO MOTOR AND SENSORY NEUROPATHY
FOOT EXAMINATION FOR SELECTING APPROPRIATE FOOT ORTHOTICS
Test for Protective Sensation
Intrinsic Muscle Strength
Plantar Pressure Assessment
SELECTION OF FOOTWEAR
The Low-risk Foot Patients (~ 85%)
Microcellular Rubber
The Moderate-risk Foot Patients (~ 15%)
Footwear Prescription
Microcellular Rubber Sandal
Footwear Management for Ulcers and Deformities
Hindfoot Ulcers
The High-Risk Foot Patients
SUMMARY
ACKNOWLEDGMENT
SUGGESTED READING
SELF-ASSESSMENT
CHAPTER 13:
Hypertension
DEFINITIONS
HYPERTENSION AND AGE
HYPERTENSION AND THE VASCULAR SYSTEM
PATHOPHYSIOLOGY
SECONDARY HYPERTENSION
Renovascular Hypertension
Primary Hyperaldosteronism
MANAGEMENT OF HYPERTENSION
Screening and Initial Evaluation
Target Blood Pressure
Nonpharmacologic Therapy of Hypertension
Pharmacotherapy of Hypertension
ANTIHYPERTENSIVE DRUGS (SEE TABLE 13.6)
PRINCIPLES IN MANAGEMENT OFHYPERTENSION (SEE FLOWCHART 13.2)
SELF-ASSESSMENT
CHAPTER 14:
Nephropathy
INTRODUCTION
DEFINITIONS
RISK FACTORS
CLASSIFICATION
SURVIVAL IN PATIENTS WITH DIABETIC NEPHROPATHY
PATHOGENESIS OF NEPHROPATHY
PATHOLOGY
Screening
Clinical Presentation
DIFFERENTIATING FROM OTHER CAUSES OF KIDNEY DISEASES
Decline of Glomerular Filtration Rate without Proteinuria
Absence of Retinopathy
Sudden and Rapid Onset of Proteinuria
Macroscopic Hematuria and/or Red Blood Cells Casts in Urine
Presence of Systemic Symptoms
MANAGEMENT
Prevention is Better than Cure!
Renin-Angiotensin-Aldosterone System Blockade
Control of Hypertension
Dietary Restriction
Lifestyle Modification
Lipid Lowering
WHAT SHOULD BE DONE WHEN THE GFR HAS BEGUN TO DECLINE?
AVOIDANCE OF FURTHER INJURY
SUPPORTIVE TREATMENT FOR THE CHRONIC KIDNEY DISEASE PATIENT
Lifestyle Modifications
Control of Dyslipidemia
Phosphate Binders and Vitamin D Analogs
Treatment of Anemia
Avoidance of Fluid Overload, Hyperkalemia and Metabolic Acidosis
INVESTIGATIONS
RENAL REPLACEMENT THERAPY
NORMOALBUMINURIC CHRONIC KIDNEY DISEASE IN DIABETES
NEWER/EXPERIMENTAL THERAPY FOR DIABETIC NEPHROPATHY
CONCLUSION
SELF-ASSESSMENT
CHAPTER 15:
Macrovascular Complications in Diabetes
EPIDEMIOLOGY
DIABETES MELLITUS AND CARDIOVASCULAR DISEASE
Screening for Coronary Artery Disease in Diabetes
Resting ECG
Noninvasive Stress Testing
Exercise ECG
Stress Myocardial Perfusion Imaging
Stress Echocardiography
Computed Tomography
Cardiac Magnetic Resonance Imaging
Catheterization, Angiography, and Coronary Arteriography
Lifestyle Management
Weight Reduction
Medical Nutrition Therapy
Physical Activity
Blood Pressure
Tobacco
Antiplatelet Agents
Glycemic Control
Coronary Revascularization Considerations in Diabetes
Percutaneous Coronary Intervention
Coronary Artery Bypass Grafting
CABG versus PCI
Revascularization versus Optimal Medical Therapy
DIABETIC DYSLIPIDEMIA
Primary Prevention in Individuals with Diabetes
Pharmacological Management of Dyslipidemia
Bile Acid-Binding Resins
Statins (Hydroxymethylglutaryl-Coenzyme A Reductase Inhibitors)
Ezetimibe
Omega 3 Fatty Acids
Fibrates
Niacin
Cholesterylester Transfer Protein Inhibitors
INTRODUCTION
Risk for Stroke in a Patient with Diabetes
Primary and Secondary Stroke Prevention Strategies in Diabetics
Diabetes in the Setting of Acute Ischemic Stroke
Other Special Considerations in a Diabetic Patient with a Stroke
Carotid Atherosclerotic Disease
Antiplatelet Agents
SELF-ASSESSMENT
CHAPTER 16:
Ocular Disease and Retinopathy
INTRODUCTION
CORNEAL CHANGES
LENS AND CATARACT
DIABETES AND GLAUCOMA
ORBITAL INVOLVEMENT
NEURO-OPHTHALMIC MANIFESTATIONS OF DIABETES
Cranial Neuropathies
Autonomic Dysfunction
Optic Neuropathies
DIABETIC RETINOPATHY
Epidemiology
Risk Factors
CLASSIFICATION AND FEATURES OF DIABETIC RETINOPATHY (Flowchart 16.1)
Nonproliferative Diabetic Retinopathy
Mild NPDR
Moderate NPDR (Fig. 16.2A)
Severe NPDR (Fig. 16.2B)
Very Severe NPDR
Proliferative Diabetic Retinopathy (Figs. 16.2C and D)
Clinically Significant Macular Edema
PATHOLOGY AND IMPLICATIONS OF THE FEATURES OF DIABETIC RETINOPATHY
Complications of Diabetic Retinopathy
MANAGEMENT OF DIABETIC RETINOPATHY (Flowchart 16.3)
Mild and Moderate NPDR
Severe and Very Severe NPDR
Clinically Significant Macular Edema
Proliferative Diabetic Retinopathy
Screening Protocol for Diabetic Retinopathy
Referral to Ophthalmologist
OPHTHALMOSCOPY
Procedure
Fundus Findings of Diabetic Retinopathy
Microaneurysms
Hard Exudates
Hemorrhages
Soft Exudates (Cotton Wool Spots)
Venous Beading
Intraretinal Microvascular Abnormalities
Neovascularization
Tractional Retinal Detachment (Fig. 16.2F)
RECORDING OF FUNDUS FINDINGS
SELF-ASSESSMENT
CHAPTER 17:
Autonomic Neuropathy
INTRODUCTION
EPIDEMIOLOGY OF DAN
PATHOGENESIS
CLINICAL MANIFESTATIONS OF DAN
Cardiovascular Autonomic Neuropathy (CAN)
Clinical Manifestations
Prognostic implications of CAN
Evaluation of CAN
Treatment of CAN
Gastrointestinal (GI) Autonomic Neuropathy
Clinical Manifestations
Evaluation of GI Autonomic Neuropathy
Treatment
Genitourinary Autonomic Neuropathy
Clinical Manifestations
Evaluation of Genitourinary Autonomic Neuropathy
Treatment
Metabolic Manifestations of DAN
Sudomotor and Peripheral Microvascular Manifestations of DAN
Clinical Manifestations
Evaluation
Treatment
Miscellaneous Manifestations of DAN
CURRENT GUIDELINES FOR THE DIAGNOSIS OF DAN
MANAGEMENT IMPLICATIONS OF DAN
CONCLUSION
SELF-ASSESSMENT
CHAPTER 18:
Infections in Diabetes
INTRODUCTION
Predisposing Factors
Host Factors
Organism Specific Factors
Infections with an Increased Prevalence in Patients with Diabetes
Head and Neck
Genitourinary
Skin and Soft Tissue
Pulmonary
Abdominal
Infections Unique to Patients with Diabetes
Head and Neck
Urinary Tract
Skin and Soft Tissue
SPECIFIC INFECTIONS
Head and Neck Infections
Rhinocerebral Mucormycosis
Malignant Otitis Externa
Periodontal Infections
Pulmonary Infections
Urinary Tract Infections
Bacteriuria and Cystitis in Women
Acute Pyelonephritis
Emphysematous Pyelonephritis
Abdominal and Gastrointestinal Infections
Emphysematous Cholecystitis
Enteric Pathogens
Skin and Soft Tissue Infections
Intertrigo
Dermatophyte (Tinea) Infections
Pyomyositis
Synergistic Necrotizing Cellulitis
Fournier's Gangrene
Diabetic Foot Infections
Melioidosis
Immunizations Recommended in Diabetes
CONCLUSION
Common Infections and Suggested Antimicrobial Therapy (Tables 18.3 to 18.5)
SELF-ASSESSMENT
CHAPTER 19:
Hyperglycemic Emergencies
INTRODUCTION
PRECIPITATING FACTORS
PATHOPHYSIOLOGY OF DKA AND HHS
CLINICAL RECOGNITION, ESTABLISHING ADIAGNOSIS AND ASSESSMENT OF COMORBIDITIES
History in Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State
Physical Findings in DKA and HHS
DIAGNOSTIC EVALUATION AND LABORATORY STUDIES
Urine
Blood and Plasma
Other Tests
CLINICAL MANAGEMENT OF DKA AND RECOGNITION OF COMPLICATIONS
Fluid Resuscitation
Choice of Fluids
Insulin Therapy
Electrolyte Correction
Potassium
Correction of Acid-Base Balance
Phosphate Replacement
Treatment of Concurrent Infection
COMPLICATIONS
SPECIAL SITUATIONS
Diabetic Ketoacidosis in Children and Adolescents
Diabetic Ketoacidosis with Pregnancy
Diabetic Ketoacidosis in Patients with End-stage Renal Disease/Hemodialysis
USE OF INPATIENT STANDARD MANAGEMENT PROTOCOLS IN DIABETIC KETOACIDOSIS
CLINICAL MANAGEMENT OF HYPEROSMOLAR HYPERGLYCEMIC STATE
PROGNOSIS
SELF-ASSESSMENT
CHAPTER 20:
Hypoglycemia
CLINICAL CLASSIFICATION OF HYPOGLYCEMIA
PATHOPHYSIOLOGY OF COUNTER-REGULATION
CAUSES
CLINICAL RECOGNITION OF HYPOGLYCEMIA
History
Physical Examination
Laboratory Studies
CLINICAL MANAGEMENT OF HYPOGLYCEMIA (Flowchart 20.1)
LONG-TERM MANAGEMENT
RECURRENT HYPOGLYCEMIA
CONSEQUENCES
SELF-ASSESSMENT
CHAPTER 21:
Pregnancy and Diabetes
INTRODUCTION
TERMINOLOGY
Gestational Diabetes Mellitus
Pregestational Diabetes
Overt Diabetes
GESTATIONAL DIABETES MELLITUS
Pathophysiology
Mechanisms of Insulin Resistance
Gestational Diabetes and MODY
Screening for Gestational Diabetes Mellitus
Whom to Screen?
When to Screen?
Diagnostic Testing
Other Methods of Diagnosing Diabetes in Pregnancy
Maternal and Fetal Complications in Gestational Diabetes Mellitus
PREGESTATIONAL DIABETES
Fetal Effects
Unexplained Fetal Demise
Preconceptional Counseling
MANAGEMENT
Medical Management of Gestational Diabetes Mellitus (Flowchart 21.1)
Medical Nutrition Therapy
Physical Activity
Pharmacological Therapy
Hypoglycemia in Pregnancy
Obstetric Management of Gestational Diabetes Mellitus
Antepartum Management
Postpartum Management
FUTURE RISKS IN MOTHER
CONCLUSION
SUGGESTED READING
SELF-ASSESSMENT
CHAPTER 22:
Diabetes in Childhood and Adolescence
INTRODUCTION
EPIDEMIOLOGY
DIAGNOSIS
CLASSIFICATION
CLINICAL FEATURES
Type 1 Diabetes
Type 2 Diabetes
Pancreatic Diabetes Mellitus
Maturity Onset Diabetes of the Young
Lipodystrophic Diabetes
Generalized Lipodystrophy
Familial Partial Lipodystrophy
Acquired Lipodystrophy
Mitochondrial Diabetes
Others
APPROACH TO DIAGNOSIS
MANAGEMENT
Diet
Exercise
Management of Exercise: Principles
Appropriate Management by Age
Infants (< 1 Year)
1–3 Years
Preschoolers and Early School-Aged Children (3–7 Years)
School-aged Children (8–11 Years)
Adolescents
Transitional Care of Childhood Diabetes: The Problems of the Emerging Adult
Insulin Management
Blood Glucose Monitoring
Peer Support
Glycemic Control
CHRONIC COMPLICATIONS
Growth Retardation
Nephropathy
Hypertension
Dyslipidemia
Retinopathy
Foot Care
Psychological Aspects
Associated Autoimmune Conditions
ACUTE COMPLICATIONS
Hypoglycemia
Diabetic Ketoacidosis
SICK DAY MANAGEMENT
TYPE 2 DIABETES IN CHILDREN
Prediction of Development of Type 1 Diabetes Mellitus
CONCLUSION
SELF-ASSESSMENT
CHAPTER 23:
Diabetes in the Elderly
DIABETES IN THE OLDER ADULT: HOW IS IT DIFFERENT?
Issues to be Considered in Management of Diabetes in the Older Adults
MANAGEMENT OF DIABETES IN THE ELDERLY
Diabetes Education for the Patient and Family/Caregiver
Nutrition in the Elderly with Diabetes
Physical Activity in the Elderly with Diabetes
Pharmacotherapy
Hypoglycemia in the Elderly
SELF-ASSESSMENT
CHAPTER 24:
Secondary Diabetes and Other Specific Types
CLASSIFICATION OF SECONDARY DIABETES
Disorders of the Pancreas
Chronic Pancreatitis
Fibrocalculous Pancreatic Diabetes
Malnutrition Related Diabetes Mellitus
Acute Pancreatitis
Pancreatectomy
Cystic Fibrosis
Primary Hemochromatosis and Secondary Hemochromatosis
Pancreatic Cancers
Endocrinopathies
Cushing's Syndrome
Growth Hormone Excess
Hyperthyroidism
Pheochromocytoma
Primary Hyperparathyroidism
Primary Hyperaldosteronism (Conn's Syndrome)
Pancreatic Neuroendocrine Tumors
Lipodystrophies
Drug and Chemical Induced Diabetes
CHRONIC COMPLICATIONS IN SECONDARY DIABETES
Clinical Considerations—Why is Knowledge about Secondary Diabetes Important?
Management
OTHER SPECIFIC TYPES OF DIABETES
Genetic Defects of Beta-cell Function
Maturity-onset Diabetes of the Young
Mitochondrial DNA Defects
Proinsulin/Insulin Conversion Defect and Aberrant Insulin Synthesis
Defects in Insulin Action: Severe to Extreme Insulin Resistance
Infectious Diseases
Other Uncommon Autoimmune Mediated Diabetes
Genetic Syndromes with a Higher Propensity to Develop Diabetes
SELF-ASSESSMENT
CHAPTER 25:
Perioperative Care
METABOLISM AT REST
METABOLIC CHALLENGE OF SURGERY
PREOPERATIVE MANAGEMENT OF DIABETIC PATIENTS
Preoperative Assessment
Evaluation of End-organ Damage
LEVEL OF GLYCEMIC CONTROL
CLASSIFICATION OF THE TYPE OF SURGERY
MANAGEMENT OF DIABETES DEPENDS ON
CHOICE OF ANESTHESIA
PREMEDICATION
INTRAOPERATIVE ANESTHETIC MANAGEMENT OF DIABETIC PATIENTS
Aims of Management
Monitoring under Anesthesia
General Principles of Management
POINT OF CARE GLUCOSE MEASUREMENTS
MAJOR SURGERY REGIMEN
MANAGEMENT OF DIABETIC PATIENTS UNDER DIFFERENT MODES OF ANESTHESIA
In General Anesthesia
In Regional Techniques
PROBLEMS TO BE ANTICIPATED IN A DIABETIC PATIENT UNDER ANESTHESIA
Hypoglycemia
Treatment
Hyperglycemia
Treatment
Diabetic Ketoacidosis
Treatment
EMERGENCY SURGERY IN THE DIABETIC PATIENT
SPECIAL CLINICAL SCENARIOS
POSTOPERATIVE MANAGEMENT OF DIABETIC PATIENTS
Blood Glucose Monitoring and Control
Surgical Wound Management
SUMMARY
SELF-ASSESSMENT
CHAPTER 26:
Obesity with Diabetes
DEFINITION OF OBESITY
EPIDEMIOLOGY OF OBESITY AND ITS IMPACT ON DIABETES
ETIOPATHOGENESIS OF OBESITY
EVALUATION OF OBESITY
Investigations to be done in a Patient of Obesity
MANAGEMENT
Prevention
Lifestyle Management
Drugs
Metformin in Obesity
Liraglutide in the Management of Obesity
Bariatric and Metabolic Surgery
Mechanisms by which Bariatric Procedures Help Glycemic Control
CONCLUSION
SELF-ASSESSMENT
CHAPTER 27:
Laboratory and Analytical Methods
INTRODUCTION
LABORATORY ERRORS
PREANALYTICAL, ANALYTICAL AND POSTANALYTICAL ERRORS
Control of Preanalytical and Postanalytical Errors
At the Test Selection
At the Phlebotomy
At Transport
At the Laboratory
At the Reporting (Postanalytical)
Control of Analytical Errors
Quality Control
Internal Quality Control
External Quality Control/Assurance
ROLE OF LABORATORY IN DIABETES MANAGEMENT
AVAILABLE ASSAYS
Plasma Glucose
Preanalytical Considerations
Methods and Analytical Considerations
Recommended Results
Oral Glucose Tolerance Test
Glycated Hemoglobin (GHb, HbA1c)
Preanalytical Considerations
Methods and Analytical Considerations
Recommended Results
Serum Creatinine
Methods and Analytical Considerations
Recommended Results
Lipid Profile
Serum Cholesterol
Serum Triglycerides
High-Density Lipoprotein Cholesterol
Low-Density Lipoprotein Cholesterol
Urinary Albumin Excretion
Preanalytical Considerations
Methods and Analytical Considerations
Recommended Results
OTHER TESTS OF RELEVANCE
Ketone Bodies in Urine
Fructosamine
Assay Method
Insulin and C-Peptide
Normal Range
Islet Cell Antibodies
Assay
SELF-ASSESSMENT
CHAPTER 28:
Recent Advances
DRUGS WHICH POTENTIATE INSULIN SECRETION
Newer Glucagon-Like Peptide-1 Analogs
Albiglutide
Dulaglutide
Taspoglutide
Lixisenatide
Newer Dipeptidyl Peptidase 4 Inhibitors
INSULIN RECEPTOR ACTIVATORS
NEWER PEROXISOME PROLIFERATOR-ACTIVATED RECEPTOR AGONISTS
NEW HEPATIC TARGETS FOR GLYCEMIC CONTROL IN DIABETES
ADVANCES IN INSULIN THERAPY
Oral Insulin
Inhaled Insulin
Buccal Insulin
Bionic Pancreas to Replace Insulin Pumps
A New Dawn for Young People with Diabetes
IMMUNOTHERAPY FOR TYPE 1 DIABETES
Immunomodulators
Humanized anti-CD3 Monoclonal Antibodies
Rituximab
Thymoglobulin
Recombinant Human Glutamic Acid Decarboxylase (rhGAD65)
Miscellaneous
STEM CELL THERAPY
SELF-ASSESSMENT
CHAPTER 29:
In-hospital Management of Diabetes
INTRODUCTION
EFFECTS OF HYPERGLYCEMIA IN HOSPITALIZED PATIENTS AND BENEFITS OF GLYCEMIC CONTROL
WHICH PATIENT SHOULD WE ADMIT?
AIMS AND TARGETS
Goals for Blood Glucose Levels*
THE DIABETES INPATIENT TEAM
THE PARADOX: BARRIERS TO GLYCEMIC CONTROL IN HOSPITAL
COMMON ERRORS IN MANAGEMENT
Glucose Monitoring
GLUCOSE CONTROL
General Recommendations
Recommendations in Specific Situations
The Patient on Oral Agents and who is not Eating
The Patient on Oral Agents and who is Eating
The Insulin-Treated Patient who is not Eating
The Insulin-Treated Patient who is Eating
Patients on Glucagon-like Peptide-1 Analogues
Some Peculiar Clinical Situations
DIABETES MANAGEMENT IN THE CRITICALLY ILL PATIENTS
SELF-ASSESSMENT
CHAPTER 30:
Integrating Systems
INTRODUCTION
DISEASE PREVENTION
PREVENTION AND ITS IMPORTANCE
In the Hospital
In the Community
INTEGRATED DIABETES CLINICS
FUNCTIONARIES OF AN INTEGRATED DIABETES CLINIC AND THEIR ROLE (Fig. 30.1)
Physician
Diabetes Educator
Dietician
Physiotherapist
Foot Care Technician
Ophthalmologist
Laboratory Quality Control
Essential Pharmacy Services
Outreach Activities
IMPROVING FOOT CARE FOR PEOPLE WITH DIABETES MELLITUS: AN INTEGRATED CARE APPROACH
DIABETES SUPPORT GROUPS
Steps for Starting a Diabetes Support Group
Meeting Scheme
After Session
INTRODUCTION
TELEHEALTH CLASSROOM SETUP
Communication Media
Software
DESKTOP CONFERENCE: WEB-BASED LEARNING METHOD
Multipoint Control Unit
Live Streaming to Desktop/Laptop
Archiving the Lectures
Telepresence
REQUIREMENTS FOR QUALITY TRANSMISSION
Image
Audio
Lighting
Positioning of the Camera
ADMINISTRATIVE CHALLENGES AND ISSUES
Impact of Telemedicine on Diabetes and Health
CONCLUSION
SUGGESTED READING
SELF-ASSESSMENT
Final Evaluation
MULTIPLE CHOICE QUESTIONS
Single Best Response Type:1 to 75
Case Analysis: 76 to 78
Case Analysis: 79 to 81
Case Analysis: 82 to 84
Case Analysis: 85 to 87
Case Analysis: 88 to 90
Extended Matching Types: 91 to 95
Extended Matching Types: 96 to 100
Extended Matching Types: 101 to 105
Extended Matching Types: 106 to 110
Multiple True or False:111 to 120
ANSWER KEYS
Answers to Self-Assessment
CHAPTER 1: PHYSIOLOGY
CHAPTER 2: INTRODUCTION AND OVERVIEW OF GLYCEMIC DISORDERS
CHAPTER 3: PRACTICAL MEDICAL NUTRITIONAL THERAPY
CHAPTER 4: EXERCISE
CHAPTER 5: COUNSELING
CHAPTER 6: ORAL ANTIDIABETIC AGENTS
CHAPTER 7: PARENTERAL THERAPEUTIC AGENTS
CHAPTER 8: INSULIN THERAPY—PRACTICAL ASPECTS
CHAPTER 9: BLOOD GLUCOSE MONITORING
CHAPTER 10: PERIPHERAL NEUROPATHY
CHAPTER 11: FEET, FOOT CARE AND NEUROARTHROPATHY
CHAPTER 12: THERAPEUTIC FOOTWEAR
CHAPTER 13: HYPERTENSION
CHAPTER 14: NEPHROPATHY
CHAPTER 15: MACROVASCULAR COMPLICATIONS IN DIABETES
CHAPTER 16: OCULAR DISEASE AND RETINOPATHY
CHAPTER 17: AUTONOMIC NEUROPATHY
CHAPTER 18: INFECTIONS IN DIABETES
CHAPTER 19: HYPERGLYCEMIC EMERGENCIES
CHAPTER 20: HYPOGLYCEMIA
CHAPTER 21: PREGNANCY AND DIABETES
CHAPTER 22: DIABETES IN CHILDHOOD AND ADOLESCENCE
CHAPTER 23: DIABETES IN THE ELDERLY
CHAPTER 24: SECONDARY DIABETES AND OTHER SPECIFIC TYPES
CHAPTER 25: PERIOPERATIVE CARE
CHAPTER 26: OBESITY WITH DIABETES
CHAPTER 27: LABORATORY AND ANALYTICAL METHODS
CHAPTER 28: RECENT ADVANCES
CHAPTER 29: INHOSPITAL MANAGEMENT OF DIABETES
CHAPTER 30: INTEGRATING SYSTEMS
Appendices
1:
Dietary Recommendations
CHANGE PROPORTIONS OF FOOD → CONTROL DIABETES
Cereal Exchange
Pulse Exchange
Nonvegetarian Exchange
Vegetable Exchange
Fruit Exchange
Nuts and Oil Seeds
Milk Exchange
Fat Exchange
Foods to Avoid
Free Foods
2:
A Quick Guide for Choosing Footwear, MCR Add-ons and Braces
3:
Evidence in Medicine
4:
Diabetes Case Record
5:
Patient Handouts and Educational Material
WHAT IS DIABETES MELLITUS?
WHAT ARE THE SYMPTOMS OF DIABETES MELLITUS?
WHAT DOES THE MANAGEMENT OF DIABETES MELLITUS INVOLVE?
HOW OFTEN SHOULD ONE CHECK BLOOD SUGARS?
Monitoring Blood Sugar Control
WHAT ARE THE TABLETS UTILIZED IN TREATING DIABETES MELLITUS?
WHAT ARE THE SYMPTOMS OF A LOW BLOOD SUGAR (“HYPOGLYCEMIC ATTACK”)?
WHEN SHOULD INSULIN BE USED?
HOW SHOULD INSULIN BE ADMINISTERED?
WHAT EXTRA ATTENTION DOES THE FEET REQUIRE IN DIABETES MELLITUS?
CONCLUSION
THE IMPORTANCE OF FOOT CARE IN DIABETES MELLITUS
INDEX
TOC
Index
×
Chapter Notes
Save
Clear