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Your Guide to Diabetes: Type 1 and Type 2. Bethesda, MD: National Diabetes Information Clearinghouse. 2006. 62 p.

This booklet helps people with type 1 or type 2 diabetes understand their disease and learn how to take care of themselves and how to prevent some of the serious problems diabetes can cause. Diabetes is a disease in which blood glucose levels are above normal. People who have diabetes often experience complications due to these high blood glucose levels, including in the heart, blood vessels, eyes, and kidneys. This booklet, written in nontechnical language, offers six sections covering the different types of diabetes, their causes, the signs and symptoms, and recommended blood glucose levels; everyday diabetes care, including meal planning, physical activities, diabetes medications, self-monitoring of blood glucose (SMBG), and recordkeeping; hyperglycemia and hypoglycemia; the complications associated with diabetes, including those affecting the heart and blood vessels, eyes, kidneys, nerves, and gums and teeth; diabetes care in special circumstances, such as illness, at school or work, away from home, and during pregnancy; and where to find additional information about diabetes and self-care. A final section briefly summarizes the activities of the National Diabetes Information Clearinghouse. The booklet is illustrated with black-and-white line drawings. 18 figures. 3 tables.

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Adjusting Insulin Doses: From Knowledge to Decision. Patient Education and Counseling. 56(1): 98-103. January 2005.

This article reports on a study that investigated the reasons for the absence of adjustment of insulin doses in patients with poorly-controlled Type 1 diabetes. The study included 28 patients whose HbA1c (glycosylated hemoglobin, a measure of blood glucose over time) was higher than 8.5 percent during the last 6 months. The patients performed at least three capillary blood glucose determinations per day, and completed a questionnaire on the degree of confidence in their own knowledge, the nature of their health beliefs, their fear of hypoglycemia, and their own appreciation on how they adjust their insulin doses (subjective score). An analysis of the patients' diabetes logbooks provided an objective score of the adjustment of doses actually performed. There was not a significant correlation between the subjective and objective scores of adjustment. There was a significant negative correlation between the score of uncertainty on knowledge and the subjective score of adjustment of the insulin doses, but not with the objective score. There was a significant correlation between the score of positive health beliefs and the subjective score of adjustment of the insulin doses, but not with the objective score. The fear of hypoglycemia was the most frequently given reason for not adjusting the insulin doses, when the question was asked to the patients with an open answer. The authors conclude that their study illustrates the difference between thinking and doing. The degree of confidence in one's own knowledge, the health beliefs, and the fear of hypoglycemia differently influence the perception that the patients have of their behavior, and what they really do. 1 figure. 2 tables. 18 references.

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Adventure Travel and Type 1 Diabetes: The Complicating Effects of High Altitude. Diabetes Care. 28(10): 2563-2572. October 2005.

In keeping with recommendations to stay physically fit, increasing numbers of people with type 1 diabetes now participate in extreme forms of physical activity, including high-altitude trekking and mountain climbing. However, exercise at altitude imposes a number of unique challenges for people with type 1 diabetes, including impairment in glycemic control and additional problems for patients with complications. This article reviews what is known about the impact of altitude on individuals with type 1 diabetes, then offers strategies for dealing with these challenges. High altitude is defined as 3,000 to 5,000 meters (10,000 to 16,000 feet) and extreme altitude as that greater than 5,000 meters. The author reviews three studies in this area, then discusses acute altitude sickness (also called acute mountain sickness or AMS), the effects of altitude on glycemic control and on glucose meter performance, altitude-induced anorexia, altitude and temperature, and other concerns including the impact of long-distance travel, poor hygiene, gastrointestinal disturbances, food supplies, and isolation. The author concludes that there are no absolute contraindications to travel at high or extreme altitudes for the knowledgeable individual with type 1 diabetes who is free of complications. However, there is some risk, including the possible consequences of hypoglycemia, illness, or injury. Specific recommendations for individuals with type 1 diabetes traveling at altitude are summarized in a table. 1 figure. 3 tables. 78 references.

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Amylin: Insulin's Partner. Diabetes Self-Management. 22(4): 40-43. July-August 2005.

This article describes pramlintide (brand name Symlin), a synthetic analog of amylin, a neuroendocrine hormone that can be used in conjunction with insulin. Amylin is currently approved for people with type 1 diabetes and people with type 2 diabetes who use insulin. The author describes how the medication works in tandem with insulin, how amylin can ease problems with high postprandial (after a meal) blood glucose levels, oxidative stress, and the history of pramlintide's journey from research laboratory to FDA approval. The author notes that side effects associated with pramlintide, including nausea and hypoglycemia, occur early in the course of treatment and tend to ease over time.

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Back to School: Getting Your Child, And the School, Ready. Diabetes Vital. 1(3): 8-9. Fall 2005.

This article helps parents review the steps they can take to help their child with diabetes adjust to a new school year. Parents are encouraged to involve all the adults who will be interacting with the child, including the principal, teachers, nurse, bus drivers, coaches, and other school staff members. The author provides specific suggestions for providing information to the school, including recordkeeping, educating the staff about the disease of diabetes, establishing any special permission for snacks or breaks, and providing contact information for parents and other emergency helpers (such as health care providers). The article concludes by reminding parents of the importance of including the child in these plans and discussions. A diabetes education website address is also provided, for readers looking for additional information (www.ndep.nih.gov/diabetes/youth/youth.htm). One sidebar lists the symptoms of, causes of, and treatment for hypoglycemia (low blood glucose) and hyperglycemia (high blood glucose).

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Blood Glucose Awareness Training: What is It, Where is It, and Where is It Going?. Diabetes Spectrum. 19(1): 43-49. Winter 2005.

Management of type 1 diabetes requires a balance of insulin, caloric intake, and metabolic demand (such as exercise). This can best be accomplished with awareness of the blood glucose levels as well as where those levels are going and knowledge of how to manipulate insulin, calories, and exercise to manage blood glucose. This article describes Blood Glucose Awareness Training (BGAT), a psychoeducational intervention that can be used to address the need for better understanding of blood glucose. The authors review 15 research studies from the United States and Europe that focus on BGAT. These studies have validated the benefits of BGAT which include: improved accuracy of blood glucose estimations, improved detection of hypoglycemia and hyperglycemia, improved judgments related to decisions to self-treat when blood glucose is low, reduction in motor vehicle mishaps across time, reduction in episodes of severe hypoglycemia, and reduction in fear associated with hypoglycemia, while improving diabetes knowledge and quality of life. The authors describe how BGAT has recently been reconfigured for internet delivery, making it available both for clinicians to use with their patients and for individuals with type 1 diabetes to pursue as a self-directed tutorial. 2 tables. 32 references.

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Blood Glucose Monitoring: What Do the Numbers Tell You?. Diabetes Self-Management. 22(5): 65-68. September- October 2005.

This article helps readers understand the results that they get from checking their blood glucose levels. The author notes that many people dutifully check their blood glucose levels but have no idea what the numbers mean. The situation is complicated by the fact that blood glucose levels constantly fluctuate and are influenced by many factors. The author first reviews the physiology of insulin and how insulin production and metabolism differ in type 1 and type 2 diabetes. The next section discusses target goals for blood glucose and suggestions for self monitoring of blood glucose (SMBG), including how often to check, when to check, and record-keeping. The final section of the article offers suggestions for addressing common problems, including higher blood glucose levels in the morning, high blood glucose levels all day, blood glucose levels within range, except for two hours after eating, and a sudden change in blood glucose patterns. One sidebar considers the use of blood glucose meter averages; most blood glucose meters store a certain number of readings in their memory and also report either a 14-day or 30-day average of readings. Readers are encouraged to work closely with their health care providers to understand their blood glucose readings and implement that understanding into their regular program of diabetes care.

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Burden of Mortality Attributable to Diabetes: Realistic Estimates for the Year 2000. Diabetes Care. 28(9): 2130-2135. September 2005.

Routinely reported statistics based on death certificates seriously underestimate mortality from diabetes, primarily because individuals with diabetes most often die of cardiovascular and renal disease and not from a cause uniquely related to diabetes, such as ketoacidosis or hypoglycemia. This article reports on a study undertaken to estimate the global number of excess deaths due to diabetes in the year 2000. The authors used a computerized generic formal disease model (DisMod II), used by the World Health Organization to assess disease burden through modeling the relationships between incidence, prevalence, and disease-specific mortality. Baseline input data included population structure, age-specific and sex-specific estimates of diabetes prevalence, and available published estimates of relative risk of death for people with diabetes compared to people without diabetes. The results showed that the excess global mortality attributable to diabetes in the year 2000 was estimated to be 2.9 million deaths, equivalent to 5.2 percent of all deaths. Excess mortality attributable to diabetes accounted for 2 to 3 percent of deaths in the poorest countries and over 8 percent in the United States, Canada, and the Middle East. In people aged 35 to 64 years, 6 to 27 percent of deaths were attributable to diabetes. The authors conclude that globally, diabetes is likely to be the fifth leading cause of death. 1 figure. 3 tables. 28 references.

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Can't Feel Your Lows?: Understanding Hypoglycemia Unawareness. Diabetes Forecast. 58(12): 55-56. December 2005.

This article reviews the problem of hypoglycemia unawareness, the inability of a person to feel the symptoms of low blood glucose levels. Normal signs of hypoglycemia include sweating, shakiness, and dizziness. The author notes the fact that the more often a person experiences hypoglycemia, the higher the likelihood that hypoglycemia unawareness may occur. People who at one time were able to feel symptoms of low blood glucose at 70 milligrams per deciliter may get to where they do not feel the symptoms of hypoglycemia until their blood glucose levels drop to 60, 50, or even lower. The author also discusses intensive diabetes management and how striving for tight blood glucose control may result in more frequent episodes of hypoglycemia unawareness. The author concludes with a brief section on the role of ongoing patient education to better combat the problem of hypoglycemia unawareness.

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Collaborative Islet Transplant Registry Annual Report. Bethesda, MD: National Diabetes Information Clearinghouse. 2005. 214 p.

The number of transplant centers performing clinical islet cell transplantation continues to increase, as does the number of centers participating in and reporting to the Collaborative Islet Transplant Registry (CITR). The CITR was founded in September 2001 to provide support for logistics, data capture, quality control monitoring, statistical design and analysis, and other Registry activities. This second Annual Report of the CITR describes the progress in islet or beta cell transplantation. The information is drawn from 19 North American islet transplant programs, representing 138 transplant recipients. The information is presented in four sections: a summary of Registry data; islet-transplant-alone recipient, donor, and outcome information; islet-after-kidney recipient, donor, and outcome information; and Registry data quality. The Report describes patient care, surgical experiences, follow-up care, complications, hypoglycemia, insulin independence, and immunosuppression in these patients. The Report provides data on the recipients, pancreas donors, pancreas preservation, islet processing, islet infusions, recipient treatment, post-transplant islet function, and adverse events. The Report is designed to provide information that can form the basis necessary for the development of islet transplantation as a curative therapy for type 1 diabetes. Readers are referred to the Registry’s website, www.citregistry.org, for more information. 210 figures.

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