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Pancreas and Islet Transplantation in Type 1 Diabetes. Diabetes Care. 29(4): 935. April 2006.

Successful pancreas transplantation has been demonstrated to be effective in significantly improving the quality of life of people with diabetes, primarily by eliminating the acute complications commonly experienced by patients with type 1 diabetes (hypoglycemia, marked hyperglycemia, and ketoacidosis). This brief article presents the position statement of the American Diabetes Association (ADA) on pancreas and islet transplantation in patients with type 1 diabetes. The recommendations are based on an ADA technical review and recent extensive review on the subject (both of which are available from the ADA for readers seeking additional information). Pancreas transplantation eliminates the need for exogenous insulin, frequent daily blood glucose measurements, and many of the dietary restrictions imposed by diabetes. Pancreas-only and islet transplants require lifelong immunosuppression to prevent rejection of the graft and potential recurrence of the autoimmune process that might again destroy pancreatic islet beta cells. The recommendations state that pancreas transplantation should be considered an acceptable therapeutic alternative to continued insulin therapy in diabetic patients with imminent or established end-stage renal disease who have had or plan to have a kidney transplant because the successful addition of a pancreas does not jeopardize patient survival, may improve kidney survival, and will restore normal glycemia. The recommendations outline patient-selection considerations and the recent work on pancreatic islet transplants. 2 references.

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Physical Activity, Exercise and Type 2 Diabetes: A Consensus Statement from the American Diabetes Association. Diabetes Care. 29(6): 1433-1438. June 2006.

This consensus statement from the American Diabetes Association summarizes the most clinically relevant recent advances related to people with type 2 diabetes and the recommendations that follow from these advances. Topics include physical activity and the prevention of type 2 diabetes; the effects of structured exercise interventions on glycemic control and body weight in type 2 diabetes; physical activity, aerobic fitness, and risk of cardiovascular and overall mortality; recommended frequency of exercise; exercise for weight loss and weight maintenance; the role of resistance training; flexibility exercises (stretching); evaluation of the diabetic patient before recommending an exercise program; exercise in the presence of nonoptimal glycemic control, including managing hyperglycemia and hypoglycemia; and exercise in the presence of specific long-term complications of diabetes, notably retinopathy, peripheral neuropathy, autonomic neuropathy, and microalbuminuria and nephropathy. A final section offers specific recommendations in the areas of lifestyle measures for the prevention of type 2 diabetes, aerobic exercise, resistance exercise, and prevention of hypoglycemia. 70 references.

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Physical Activity. IN: Mensing, C., ed. Art and Science of Diabetes Self-Management Education. Chicago, IL: American Association of Diabetes Educators. pp. 298-319.

A lifestyle the incorporates sufficient physical activity aids in diabetes prevention and is extremely beneficial to general health. This chapter on physical activity is from a comprehensive text that serves as a resource for all health professionals, community professionals, and individuals who provide education to individuals with diabetes. The author reviews current physical fitness terminology, including health-related physical fitness; the role of physical activity in diabetes prevention and treatment; the effect of physical activity on diabetes management, including cardiovascular exercise, resistance exercises, and flexibility exercises; the physiological responses to physical activity, notably changes associated with blood glucose levels; hypoglycemia and physical activity; self-management strategies for safe physical activity, including adding carbohydrates, medication adjustments, and problem-solving; the four components of the exercise prescription, including intensity, mode, frequency, and duration; physical activity in special populations, including children and teens, and elderly adults; and medical considerations, including the need for preactivity medical exam and assessment, cardiovascular disease, neuropathy, nephropathy, and retinopathy. The author stresses that learning to overcome barriers that interfere with a more physically active lifestyle is a large part of diabetes self-management education. The chapter includes a list of key points, a summary of teaching strategies, case studies, suggested Internet resources, a glossary of key terms, and a list of references. 13 tables. 45 references.

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Products for Treating Low Blood Glucose. Diabetes Forecast. 59(1): RG60-RG62. January 2006.

For people with diabetes, a drop in blood glucose can occur when they take too much insulin or oral medications; eat too little food or inadequate nutrients to cover their insulin or oral medication; do not eat at the appropriate time; or get more physical activity than they prepared for. This section on products for treating low blood glucose is from a special issue of Diabetes Forecast that offers the annual guide to diabetes products and services. The author first reviews the physiology of hypoglycemia (low blood glucose), including the symptoms, the causes, and suggestions for how to prevent and treat low blood glucose reactions. In addition to juice and other carbohydrates, there are commercially-manufactured products that are available to treat low blood glucose. The author reviews three points to consider when purchasing these products: how quickly it works, the form it comes in, and costs. Specific products described include ExtendBar that provides a continuous glucose supply for up to 9 hours; Glucerna Shakes, weight-loss shakes, meal, and snack bars, that contains carbohydrates that are digested slowly to help minimize peaks in blood glucose; and Enterex Diabetic Drink, which offers complete and balanced nutrition with no sugar added for meal replacement. One chart briefly summarizes the products described. 1 table.

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Pumping Insulin. 4th ed. San Diego, CA: Torrey Pines Press/ Diabetes Mall. 2006. 332 p.

This book is a guide for using a smart insulin pump for diabetes control. The book consists primarily of figures, charts, examples, tables, and sidebars of tips that provide basic and advanced information about the use of an insulin pump. The authors caution that specific treatment plans, insulin dosages, and other aspects of health care for a person with diabetes must be based on individualized treatment protocols under the guidance of their own health care team. The book offers 27 chapters in six sections: getting ready; the essentials of pump training; how to set and adjust doses; troubleshooting; special considerations; and resource materials, including carbohydrate counting, references, a glossary, and a subject index. Specific topics covered include the benefits of pumping, high blood glucose complications also known as hyperglycemia, modeling the pancreas, patient selection issues, how to select an insulin pump, the features of different insulin pumps, carbohydrate counting, the glycemic index, recordkeeping, basal dosing, bolus dosing, lifestyle issues, control tools and tips, hypoglycemia and hypoglycemia unawareness, ketoacidosis, managing site and skin problems, exercise, children and teens using insulin pumps, pumps and type 2 diabetes, and using insulin pumps during pregnancy. 29 figures. 89 tables. 132 references.

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Smart Snacking. IN: Pediatric Diabetes: Health Care Reference and Client Education Handouts. Chicago, IL: American Dietetic Association. 2006. pp. 20-21.

This chapter on smart snacking is from a resource book that provides health-care professionals with practical, age-appropriate diabetes self-management and nutrition education materials for children and adolescents with type 1 and 2 diabetes. In this chapter, the author discusses the role of snacking in a diabetes meal plan for children, indications for addition of snacks or change in snacking patterns, special snacking considerations (school, weekends, camp, social events), and counseling suggestions. The author stresses that snacks play a key role in fulfilling the goals of medical nutrition therapy in children and adolescents with diabetes: to prevent hunger between meals, to assist in providing adequate energy for growth and development, and to help prevent hypoglycemia. The author recommends that the child be given some control over eating by starting with snacks, an approach that can be particularly useful if the caregiver providers reasonable limited choices. Snacks are also an easy way to incorporate fruits, vegetables, and calcium-rich foods into the diet. 4 references.

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Special Considerations in Older Adults with Diabetes: Meeting the Challenge. Diabetes Spectrum. 19(4): 229-233. Fall 2006.

This article addresses the special considerations in managing older adults with diabetes. The author stresses that thoroughness and vigilance are prime qualities that are needed in managing older adults with diabetes, especially in the areas of assessment and treatment. The author reviews the principles of diabetes care, functional impairment in diabetes and the role of comprehensive geriatric assessment, diabetes and cognitive performance, depression and diabetes, hypoglycemia in older patients, and the importance of goal-setting in this patient population. The major medical goals in managing older patients with diabetes are to achieve freedom from hyperglycemic symptoms, prevention of undesirable weight loss, avoidance of hypoglycemia and other adverse drug reactions, estimation of cardiovascular risk, screening for and preventing vascular complications, detection of cognitive impairment and depression, detection of functional disabilities, and achievement of a normal life expectancy for patients where possible. Patient-oriented goals include the maintenance of general well-being and good quality of life, the acquisition of skills and knowledge to adapt to lifestyle changes, and the encouragement of diabetes self care. 5 tables. 29 references.

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Standards of Medical Care in Diabetes 2006, Part 2: Diabetes Care. Practical Diabetology. 25(2): 8-34. 2006.

This second installment of the Standards of Medical Care in Diabetes (American Diabetes Association, 2006) covers diabetes care, including initial evaluation, management, glycemic control, self-monitoring of blood glucose (SMBG), glycosylated hemoglobin testing (HbA1c), medical nutrition therapy, weight management, diabetes self-management education (DSME), physical activity, psychosocial assessment and care, referral for diabetes management, intercurrent illness, hypoglycemia recommendations, and immunization recommendations. MNT issues covered include dietary carbohydrate, dietary protein, dietary fats, optimal macronutrient mix, fiber, reduced-calorie sweeteners, antioxidants, chromium, and alcohol. In each section, the guidelines review the recommended health care and focus on the role of the members of the health care team, including the patient. 81 references.

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Treating Low Blood Glucose. IN: Pediatric Diabetes: Health Care Reference and Client Education Handouts. Chicago, IL: American Dietetic Association. 2006. pp. 28-30.

Children can experience symptoms of hypoglycemia or low blood glucose levels as a result of delayed meals or snacks, increased levels of physical activity, many types of diabetes medications, or illness. This chapter on treating low blood glucose (hypoglycemia) is from a resource book that provides health-care professionals with practical, age-appropriate diabetes self-management and nutrition education materials for children and adolescents with type 1 and 2 diabetes. In this chapter, the author discusses low blood glucose in children, the interplay of physical activity and low blood glucose, rebounding (reactive hypoglycemia or Somogyi reaction), treating severely low blood glucose levels, and counseling suggestions. The author also reviews the use of glucagon kits to treat hypoglycemia in children. 9 references.

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Treatment of Diabetes With Pills. IN: Katsilambros, N., et al. Diabetes in Clinical Practice: Questions and Answers From Case Studies. Somerset, NJ: John Wiley & Sons. 2006. pp 341-370.

This chapter on treating diabetes with oral medication is from a book that deals with various aspects of diabetes in clinical practice, presented in the form of questions concerning diabetes diagnosis, management, and therapy, all based on real-life case studies. Topics covered include the five categories of antidiabetes pills, notably sulfonylureas, meglitinides, biguanides, thiazolidinediones, and alpha-glucosidase inhibitors; the use of medications to help prevent complications in patients with type 2 diabetes; how each type of oral medication should be used and their mechanism of action; medications that may interfere with diabetes medications; undesirable side effects of each type of antidiabetes medication; and recommendations for combining antidiabetes medications. Specific drugs discussed include repaglinide, nateglinide, metformin, and acarbose. The chapter presents three detailed case studies, with relevant questions posed and answered. Readers are walked through the diagnostic and patient care management process for the case studies presented. 2 figures. 1 table. 21 references.

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