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2008 Resource Guide. Diabetes Forecast. 61(1): RG1-RG60. January 2008.
This special section of Diabetes Forecast offers the annual guide to diabetes products and services. The guide lists items in seven categories: new diabetes products, type 2 oral medications, insulin, insulin delivery, blood glucose monitoring and data management systems, products for treating low blood glucose, and urine testing. Specific products include human and analog insulin, syringes, injection aids, insulin pens and pen needles, insulin pumps, aids for people who are visually and physically impaired, blood glucose meters, ways to pair the blood glucose meter with software, blood-sampling supplies, meter supplies, glycohemoglobin tests, microalbuminuria testing kits, and over-the-counter products for meal replacement. Each category includes a section of text, bringing readers up to date on the changes in that area, and charts summarizing the products available. The guide includes a list of manufacturers and distributors, arranged alphabetically. 10 figures. 20 tables.
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Diagnosing and Managing Latent Autoimmune Diabetes in Adults. Practical Diabetology. 21(1): 32-37. March 2008.
This article reviews the diagnosis and management of latent autoimmune diabetes in adults (LADA), defined as a slowly progressive form of autoimmune diabetes mellitus characterized by mature age at diagnosis, the presence of pancreatic autoantibodies, and the lack of an insulin requirement at diagnosis. The author notes that patients with LADA present with better-preserved beta-cell function than those with classic type 1 diabetes mellitus, but they usually experience a rapid and progressive loss of beta-cell function and tend to become rapidly unresponsive to intervention with oral medications and parenteral agents such as incretin mimetics. The article discusses the importance of the correct diabetes diagnosis, differentiating autoimmune diabetes from diabetes caused by insulin resistance, the prevalence of LADA, the pathogenesis of LADA, screening and testing that can be done for LADA, and treatment strategies for these patients. The author concludes that, although treatment guidelines for LADA have not been published, intensive management with insulin therapy provides a theoretical advantage by preserving any remaining endogenous pancreatic beta-cell function and minimizing long-term complications. 2 tables. 23 references.
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Non-Insulin Medications for Diabetes. 5th ed. Timonium, MD: Milner-Fenwick. 2008. (DVD).
This DVD program reviews noninsulin medications that may be used to help manage type 2 diabetes. The program focuses on the causes of type 2 diabetes and the role of different oral medications, including combination medications, in keeping blood glucose levels under control. One section describes the use of exenatide (Byetta), an injectable drug used for type 2 diabetes. Safe medication use is emphasized. Viewers are reminded of the importance of a comprehensive self-management plan for keeping diabetes under control. The video depicts a variety of people who share their experiences with diabetes management and oral medications. Simple graphics are used to explain most of the topics covered. Short video segments about the drug classes sulfonylureas, biguanides, alpha-glucosidase inhibitors, thiazolidinediones, meglitinides, DPP-IV, and combinations appear at the end of the full presentation. Viewers are referred to the American Association of Diabetes Educators website for more information and to find a local diabetes educator.
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What I Need to Know About Diabetes Medicines. Bethesda, MD: National Diabetes Information Clearinghouse. 2008. 16 p.
This booklet helps readers with diabetes understand how diabetes medicines help keep their blood glucose levels in healthy target ranges. Written in nontechnical language, the booklet describes how these medications work; recommended targets for blood glucose levels, including for before and after meals; how blood glucose levels are affected by the presence of diabetes; medicines that may be used for each of the types of diabetes, including type 1, type 2, and gestational diabetes; and the types of diabetes medications and their forms, including insulin injections and insulin pumps, the side effects of insulin, the different types of insulin, oral medications, and injections other than insulin. Inside the back cover of the booklet is a folder with numerous inserts that provide information about specific drugs. The first insert is a form on which readers and their health care providers can record the medications currently prescribed. A second insert offers a list of questions patients might want to ask about their diabetes medications, and a third insert summarizes the different types of insulin. The remaining inserts provide specific information about the following drugs: the alpha-glucosidase inhibitors Glyset (miglitol) and Precose (acarbose); the biguanides Glucophage (metformin), Glucophage XR (long-acting metformin), and Riomet (liquid metformin); Starlix (nateglinide); the DPP-4 inhibitor Januvia (sitagliptin); a meglitinide called Prandin (repaglinide); sulfonylurea compounds including Amaryl (glimepiride), DiaBeta (glyburide), Diabinese (chlorpropamide), Glucotrol (glipizide), Glucotrol XL (long-acting glipizide), Glynase (glyburide), Micronase (glyburide), and the generics tolazamide and tolbutamide; thiazolidinediones Actos (pioglitazone) and Avandia (rosiglitazone); the combination pill Actoplus Met (pioglitazone and metformin); and the amylin mimetic Symlin (pramlintide). Each drug insert explains what the drug is supposed to do, who should and should not take the drug, and possible side effects. A final insert discusses low blood glucose levels. Blank spaces in different sections of the booklet allow readers to note their own individual prescriptions. The booklet concludes with a list of resources from which readers can get more information and a brief description of the goals and activities of the National Diabetes Information Clearinghouse.
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Comparative Effectiveness and Safety of Oral Diabetes Medications for Adults With Type 2 Diabetes. Executive Summary. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ). 2007. 16 p.
This fact sheet compares the effectiveness and safety of oral diabetes medications for adults with type 2 diabetes. The author notes that as new classes of medications have become available, clinicians and patients have faced an array of oral medications with different mechanisms of action. The fact sheet explores how oral diabetes medications for the treatment of adults with type 2 diabetes differ in their ability to affect the following proximal clinical outcomes: glycated hemoglobin, weight, blood pressure, serum lipid levels, and 2-hour postprandial glucose (PPG) levels; considers how these medications differ in their ability to affect distal diabetes-related complications, including mortality, coronary artery disease, myocardial infarction, stroke, transient ischemic attack, arrhythmia, coronary artery stenosis and in-stent restenosis, retinopathy, nephropathy, neuropathy, and peripheral arterial disease (PAD); discusses the impact of these medications on other health outcomes, including quality of life and functional status; reviews the life-threatening and less serious adverse events that are associated with each of these medications; and considers whether the safety and effectiveness of these medications vary across particular adult populations such as those based on demographic factors or comorbid conditions. Specific drugs discussed are thiazolidinediones, second-generation sulfonylureas, metformin, repaglinide, acarbose, rosiglitazone, alpha-glucosidase inhibitors, pioglitazone, and glyburide. A summary table presents the main conclusions from published evidence regarding the comparative effectiveness of oral diabetes medications, organized by key question and type of outcome. A second table presents a summary of the comparative effectiveness of the oral diabetes medications. The fact sheet is from a series called the Effective Health Care Program, established to provide valid evidence about the comparative effectiveness of different medical interventions. The goal is to help consumers, health care providers, and others in making informed choices among treatment alternatives. 2 tables.
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Comparing Oral Medications for Adults With Type 2 Diabetes: Clinician’s Guide. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ). 2007. 4 p.
This guide helps clinicians understand the current thinking on oral hypoglycemia agents used for adult patients with type 2 diabetes. The guide summarizes evidence from both observational studies and controlled trials that compare the effectiveness and safety of oral hypoglycemia agents. Standard oral hypoglycemic regimens include single drugs and combinations of two or three drugs from different classes, such as metformin and a sulfonylurea. Choosing among available oral hypoglycemia agents requires consideration of their benefits as well as their adverse effects and cost. The dose and prices of the drugs reviewed in the comparative studies are listed on the back page. As single agents, all second-generation sulfonylureas, thiazolidinediones, metformin, and repaglinide work well to reduce hemoglobin A1C levels by about 1 percentage point on average. Combination therapies reduce HbA1c levels about 1 percentage point more than single drug therapies. People taking sulfonylureas, thiazolidinediones, and repaglinide gain about 2 to 10 pounds. Metformin does not cause weight gain. This guide does not address insulin, combining oral medications with insulin, older first-generation sulfonylureas, or the new class of DPP-4 inhibitors. Readers are encouraged to consult the Agency for Healthcare Research and Quality’s website at www.effectivehealthcare.ahrq.gov for more information.
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Educating Patients With Type 2 Diabetes on a New Class of Drug, Dipeptidyl Peptidase 4 Inhibitors. Diabetes Educator. 33(Suppl 5):111S-113S. May - June 2007.
New and innovative antihyperglycemic therapies for people with type 2 diabetes have recently become available. This article is from a special supplement about an American Association of Diabetes Educators’ continuing education program called a Multidisciplinary Approach in Addressing Novel Mechanisms in the Management of Type 2 Diabetes, held in Los Angeles in August 2006. In this article, the author considers patient education approaches for people with type 2 diabetes who are being treated with dipeptidyl peptidase 4 (DPP-4) inhibitors. DPP-4 inhibitors, including sitagliptin and vildagliptin, can be given orally once a day and are not associated with an increased risk for hypoglycemia or weight gain. Patient adherence to any drug regimen remains a problem; reports show that adherence to oral medications ranges from 65 to 85 percent. The author briefly reviews some of the reasons for patient nonadherence and offers suggestions about how diabetes educators can be an active part of the diabetes patient care team. The patient with a good health care team, appropriate support, and adequate diabetes self-management education (DSME) is more likely to comply with drug regimens and prevent complications. 1 figure. 1 table. 8 references.
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Overcoming Barriers to the Initiation of Insulin Therapy. Clinical Diabetes. 25(1): 36-38. Winter 2007.
This article explores some of the barriers to the initiation of insulin therapy in patients with type 2 diabetes, noting that new recommendations for these patients call for more rapid use of both oral medications and insulin therapy. Although most health care providers agree that insulin is an effective therapy for the management of type 2 diabetes, many still consider insulin therapy as the last resort and indicate that their patients are hesitant to take insulin. The author of this article recommends physicians first assess the patient‘s perspective regarding insulin therapy; many barriers can be identified from this discussion. The author briefly discusses some of these barriers, which include beliefs that the insulin use demonstrates personal failure, insulin is not effective, insulin injections are painful, insulin causes complications or death, fear of hypoglycemia, insulin causes weight gain, and insulin use will have a negative impact on lifestyle. The next section considers provider-identified barriers to insulin therapy and how to address each of them. These suggestions include referring patients for diabetes self-management education and medical nutrition therapy (MNT), providing ongoing self-management support, using strategies already proven successful, and addressing emotional issues. 4 references.
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What's New in Diabetes Care?. Diabetes Wellness News. 13(4): 1-2. April 2007.
This article briefly summarizes some new medications, new ways to deliver insulin, and new ways to monitor blood glucose levels for people with diabetes. The author discusses inhaled insulin, Exubera; two new injectable medications: Byetta and Symlin, which have effects in addition to lowering blood glucose levels, notably in reducing hunger and helping patients to lose weight; a new class of oral medications, the DPP–4 inhibitors: Januvia and Galvus, which lower blood glucose levels but also help control blood glucose levels after meals when they tend to be highest; the use of the oral medication Avandia to prevent or delay type 2 diabetes; the use of continuous blood glucose monitoring; and work on islet transplants. 1 figure.
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American Diabetes Association 2006 Resource Guide. Diabetes Forecast. 59(1): RG4- RG69. January 2006.
This special section of Diabetes Forecast offers the annual guide to diabetes products and services. The guide lists items in seven categories: new diabetes products, type 2 oral medications, insulin, insulin delivery, blood glucose meters and data management systems, products for treating low blood glucose, and urine testing. Specific products include human and analog insulin, syringes, injection aids, insulin pens and pen needles, insulin pumps, aids for people who are visually and physically impaired, pairing the blood glucose meter with software, blood-sampling supplies, meter supplies, glycohemoglobin tests, microalbuminuria testing kits, and over-the-counter products for meal replacement, blood glucose stabilization, and preventing low blood glucose. Each category includes a section of text, bringing readers up to date on the changes in that area, and charts summarizing the products available. The guide includes a list of manufacturers and distributors. 8 figures. 16 tables.
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Class Action: Type 2 Pills Update. Diabetes Forecast. 59(1): RG10-RG13. January 2006.
This section on diabetes pills is from a special issue of Diabetes Forecast that offers the annual guide to diabetes products and services. This section reviews the five classes of diabetes pills and the combination oral medications that are now available. The author first reviews the normal physiology of the pancreas, insulin, and blood glucose levels, then describes what happens in type 2 diabetes. Many people benefit from taking two or more diabetes drugs, each of which addresses a different problem. Such combination therapy is so common that some drug companies now market combination pills. The remainder of the article consists of a detailed chart summarizing oral agents for type 2 diabetes, including the class of drug, the generic name, the brand name, and comments or cautions for the use of the drug. One figure depicts how and where each of these drugs works in the body. 1 figure. 1 table.
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Control Your Glucose, Control Diabetes Complications. Diabetes Health Monitor. 11(4): 15. July 2006.
This brief newsletter article reminds readers with diabetes of the importance of tight blood glucose (glycemic) control. The fact sheet covers the monitoring tests used for blood glucose (HbA1c or glycosylated hemoglobin, a measurement of blood glucose levels over time), microvascular complications, macrovascular complications, and strategies for achieving tight blood glucose control. For people with type 1 diabetes, tight glycemic control usually requires three or more daily injections of insulin or continuous treatment using an insulin pump. For people with type 2 diabetes, treatment usually involves lifestyle changes (diet and exercise) for 3 to 6 months, then adding oral medications, stepping up treatment whenever the previous regimen fails to be effective. One sidebar notes a recent finding that links increased consumption of red meat and whole milk products with insulin resistance. 1 figure.
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Diabetes in Clinical Practice: Questions And Answers From Case Studies. Somerset, NJ: John Wiley & Sons. 2006. 467 p.
This book 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. The book offers 30 chapters, beginning with an introduction to diabetes and followed by topics including the pathophysiology of type 1 and type 2 diabetes, glycemic control, hypoglycemic, diabetic coma, surgery in diabetes, acute illness in diabetes, diabetes and exercise, diabetes and pregnancy, diabetes and the young, diabetes and old age, diabetic retinopathy, diabetic nephropathy, diabetic neuropathy, microangiopathy in diabetes, diabetic foot, skin disorders in diabetes, sexual function in diabetes, musculoskeletal system and diabetes, infections in diabetes, hypertension and diabetes, lipids and diabetes, diabetes and driving, diabetes and travel, nutrition, oral medications, insulin, new therapies, and the prevention of diabetes. Each chapter presents three to six case studies, which are individually discussed, and relevant questions are posed and answered. Each chapter concludes with a list of references for further reading. Some chapters are illustrated with black-and-white photographs. A detailed subject index concludes the text.
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Diabetes Pills. Diabetes Health Monitor. 11(2): 16. March-April 2006.
This article, from a patient education publication, brings readers up-to-date on the oral medications that may be used as part of a management program for type 2 diabetes. The author describes five different classes of oral diabetes medications that are available in the United States: biguanides (metformin), sulfonylureas, non-sulfonylurea secretagogues (the meglitinides), thiazolidinediones, and alpha-glucosidase inhibitors. The author briefly explains how each class of drugs works, possible side effects, and when the drugs might be prescribed. The article stresses that no one drug is best, but each group of drugs may be used to address different issues at different stages of the disease.
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Erectile Dysfunction. IN: Obesity and Diabetes. Totowa, NJ: Humana Press. 2006. pp. 363-376.
This chapter on erectile dysfunction (ED) is from a comprehensive text on obesity and diabetes. ED is defined as the consistent or recurrent inability to attain or maintain a penile erection sufficient for sexual intercourse. ED is a common sexual dysfunction, especially among men with diabetes. Diabetes mellitus, hypertension, hyperlipidemia, and coronary artery disease are known to increase the likelihood of having ED. The author discusses a definition and epidemiology of ED, its pathophysiology, the diagnostic evaluation, treatment options, and the costs of various treatments. Vascular impairment in diabetes will lead to ED from large-vessel disease, but more important, from problems with intrapenile blood flow. Diagnostic components should include the patient's history, a physical examination, and diagnostic testing, including tests that measure nocturnal penile activity and patient symptom surveys. Treatment options include optimizing glycemic control, oral medications, injectable therapy, transurethral therapy, vacuum assistance devices, constriction rings, and penile implants. 1 figure. 5 tables. 35 references.
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Exenatide: From Gila Monster to You. Diabetes Self-Management. 23(1): 36-40. January-February 2006.
This article familiarizes readers with exenatide, the first of a new class of drugs called incretin mimetics. These substances enhance insulin secretion in response to elevated blood glucose levels. Exenatide also suppresses secretion of glucagon (a hormone that raises blood glucose levels) and slows the emptying of the stomach, both of which help improve blood glucose regulation. The author reviews the research that led to the drug's development and marketing, as well as its use in people with type 2 diabetes, how exenatide works in tandem with other oral medications to stabilize blood glucose levels, injection aids (including a prefilled injector pen that holds a 30-day supply of the drug), and how exenatide is similar to and differs from another new diabetes drug, pramlintide. Exenatide is currently approved for use only in people with type 2 diabetes, and only in those who take one or both of two oral medications (metformin and one of the sulfonylureas). It is not approved for use in people who use insulin, but is presently being studied with this use in mind. The author concludes by briefly reviewing other incretin mimetics currently under development. One sidebar offers some basic information about the Gila monster (Heloderma suspectum), the animal from which exenatide was first synthesized.
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First Inhaled Insulin Product Approved. FDA Consumer. 40(2): 28-29. March- April 2006.
This article reports on the recent approval (January 2006) of Exubera, a powdered form of human insulin that is inhaled into the lungs through the patient’s mouth using a specially designed inhaler. The author briefly reviews the different major types of diabetes, then outlines the research studies that resulted in the approval of Exubera. Peak insulin levels were achieved in about 50 minutes, range 30 minutes to 90 minutes, with Exubera inhaled insulin compared with 105 minutes, range 60 to 240 minutes, with regular insulin. In type 1 diabetes, inhaled insulin may be added to longer-acting insulins as a replacement for short-acting insulin taken with meals. In type 2 diabetes, inhaled insulin may be used alone, along with oral medications that control blood sugar, or with longer-acting insulins. As with other insulin products, hypoglycemia is a side effect of Exubera, and patients need to monitor their blood glucose levels regularly. Exubera is not for patients who smoke or those who have quit smoking within the previous six months; baseline tests for lung function are recommended before beginning treatment. 1 figure.
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Manufacturers and Exclusive Distributors. Diabetes Forecast. 59(1): RG67-RG69. January 2006.
This manufacturer's guide is from a special section of Diabetes Forecast that presents an annual guide to diabetes products and services. The guide lists items in seven categories: new diabetes products, type 2 oral medications, insulin, insulin delivery, blood glucose meters and data management systems, products for treating low blood glucose, and urine testing. Specific products include human and analog insulin, syringes, injection aids, insulin pens and pen needles, insulin pumps, aids for people who are visually and physically impaired, pairing the blood glucose meter with software, blood-sampling supplies, meter supplies, glycohemoglobin tests, microalbuminuria testing kits, and over-the-counter products for meal replacement, blood glucose stabilization, and preventing low blood glucose. This final section lists the name, address, telephone number, and web site addresses of the manufacturers of the products and supplies listed in the guide.
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Nutritional Strategies in Pregestational, Gestational, and Postpartum Diabetic Patients. IN: Mechanick, J.; Brett, E., eds. Nutritional Strategies for the Diabetic and Prediabetic Patient. Boca Raton, FL: CRC Press. 2006. pp. 133-148.
This chapter on nutritional strategies in pregestational, gestational, and postpartum diabetic patients is from a book written to advance physicians’ knowledge in nutrition as it relates to diabetes and to help them provide evidence-based recommendations to their patients with diabetes. The authors note that medical nutrition therapy (MNT) is now focused on providing adequate calories, nutrients, minerals, and vitamins to maintain a healthy pregnancy while keeping glucose levels as close to normal as possible. The chapter discusses pregestational diabetes and prepregnancy planning; oral medications and insulin; prepregnancy assessment of diabetes-related medical conditions, including retinopathy, renal function, and heart disease; gestational diabetes mellitus and its screening; diets designed to minimize postprandial hyperglycemia for the pregnant diabetic woman; proper weight gain; the role of exercise; insulin therapy; and postpartum care. 6 tables. 57 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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Shrinking Stomach: What You Need to Know About Stomach Surgery for Weight Loss. Diabetes Forecast. 59(7): 57-60. July 2006.
This article explains bariatric surgery, surgical treatment for obesity, focusing on the implications for people with diabetes. The authors note that there are no special preoperative concerns for patients who have diabetes and who seek surgical treatment for obesity, other than the best possible control of their blood glucose levels prior to surgery. After the gastric bypass, however, insulin becomes part of the treatment regimen for all diabetes patients. This is true whether they were on oral medications or insulin prior to surgery. This is because after these surgeries, patients significantly reduce the amount of calories and carbohydrates they consume, and insulin can be regulated more easily than oral medications. Most patients will require significantly fewer diabetes medications within days or weeks after their surgeries. A final section of the article walks readers through the preoperative tasks, including meeting with various members of the health care team and understanding health insurance coverage.
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Taking Medicines: How to Get Them Down Smoothly. Diabetes Forecast. 59(4): 17-18. April 2006.
This article helps readers learn how to take oral medications effectively. Designed for people with diabetes who may be taking a number of different oral medications, the article offers suggestions for timing of medications, how to take pills that are to be swallowed versus those that should be dissolved in the mouth, the need for fluids while taking pills, and the importance of knowing which medications should be taken on an empty stomach and which should be taken with food or drink. Another section considers liquid medications. The author concludes with ideas for patients who are having problems taking their prescribed oral medications. 1 figure.
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Insulin and Type 2 Diabetes Management. Today's Dietitian. 7(9): 19-20. September 2005.
This article reviews the use of insulin in the management of type 2 diabetes. Recent research has established the importance of intensive blood glucose control in reducing diabetes-related morbidity and mortality. The author notes that aggressive treatment with oral medications and the early introduction of insulin therapy may improve metabolic outcomes and reduce hyperglycemia-associated morbidity in people with type 2 diabetes. The author explains the pathophysiology of type 2 diabetes and the indications for drug therapy, primarily when medical nutrition therapy (MNT) and physical activity fail to maintain blood glucose levels within healthy guidelines. When multiple oral agents fail to achieve metabolic control, insulin is added to the treatment regimen. The author reviews some of the studies that indicate the benefits of early intervention with insulin. A final section discusses the resistance to initiating insulin therapy that is often encountered in patients with type 2 diabetes.
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Managing the ABCs of Diabetes. Philadelphia, PA: American College of Physicians. 2005. 8 p.
This booklet helps readers understand the risks of diabetes and the importance of adequately managing the disease in order to prevent complications. The booklet briefly reviews the different types of diabetes, then outlines the ABCs of diabetes: A is for A1c, a test used to monitor blood glucose levels over time; B is for blood pressure, an important measurement in people with diabetes, who are at increased risk for cardiovascular disease; and C is for cholesterol, another way to monitor cardiovascular health and risk. The booklet then reviews meal planning tips, the importance of regular exercise, and the role of medications, including oral medications and insulin. The back cover of the booklet describes the American College of Physicians, the specialty of internal medicine, and why one might choose an internist for their health care provision. The booklet is copiously illustrated with full-color photographs and includes charts for recording individualized information as well as specific tips for getting started on a program of healthy diabetes management. The booklet is also available in Spanish. 4 figures. 1 table.
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Oral Medicines for Type 2 Diabetes. Diabetes Self-Management. 22(4): 6-12. July-August 2005.
This article describes the use of oral medications that may be used by people with type 2 diabetes. Although eating well and exercising are the first line of therapy for all types of diabetes, there may come a time when oral hypoglycemic agents may be needed as part of a complete plan of diabetes control. The author discusses the pathology of type 2 diabetes (what goes wrong) and then explains the benefits of keeping blood glucose levels at or near normal levels in order to reduce complications. The author then describes the different types of oral diabetes medications and how they work. A final section considers special situations such as pregnancy and puberty, and how to optimize the medications through appropriate dosing and timing. One detailed chart lists seven classes of oral diabetes medicines and summarizes the included drug names, how they work, how they are taken, potential side effects, and comments on use. 2 tables.
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Overcoming Barriers to Intensive Insulin Administration. Reducing Cardiovascular Risk in the Patient with Type 2 Diabetes (AADE Proceedings). p. 7-8. 2005.
This article, from the proceedings of a symposium on reducing cardiovascular risk in people with type 2 diabetes, considers strategies to overcome barriers to intensive insulin administration. The author argues that in order to reach and maintain blood glucose target levels, clinicians must implement more intensive treatment regimens than the traditional stepwise approach that begins with lifestyle modifications, then hypoglycemia agents, then adds insulin. However, the earlier use of exogenous insulin preserves and improves beta cell function, helps to restore normal insulin sensitivity, and improves the effectiveness of oral medications. Some of the barriers to insulin therapy include patient reluctance, concerns about lifestyle changes and restrictions, social embarrassment, painful injections, and the association of insulin with worsening health. Physicians and patients both worry about weight gain and hypoglycemia associated with insulin use. Many primary care providers lack the experience and support they need (access to other diabetes health care providers, for example) to successfully manage insulin regimens. The author focuses on the implementation of simple insulin regimens as a vital part of the care of patients with type 2 diabetes. 7 references.
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Recommendations for Management of Diabetes During Ramadan. Diabetes Care. 28(9): 2305-2311. September 2005.
Muslims who fast during Ramadan must abstain from eating, drinking, use of oral medications, and smoking from predawn to after sunset; however, there are no restrictions on food or fluid intake between sunset and dawn. This article outlines recommendations for patients with diabetes who follow the fasting requirements of the Muslim season of Ramadan. The Koran specifically exempts the sick from the duty of fasting, especially if fasting might lead to harmful consequences for the individual. Patients with diabetes fall under this category because their chronic metabolic disorder may place them at high risk for various complications if the pattern and amount of their meal and fluid intake is markedly altered. However, many patients with diabetes insist on fasting during Ramadan. The authors note their goals as threefold: to invite an open dialogue on this important topic; to offer a set of medical opinions and suggestions; and to identify topics of research needed to answer important medical questions regarding fasting during Ramadan. The authors emphasize that fasting, especially for patients with type 1 diabetes with poor glycemic (blood glucose) control, is associated with multiple risks. These risks include hypoglycemia (low blood glucose levels), hyperglycemia (high blood glucose levels), diabetic ketoacidosis (a metabolic complication that can result in coma), and dehydration and thrombosis (the development of clots). The authors conclude by stressing that a patient's decision to fast should be made after ample discussion with his or her physician concerning the risks involved. Patients who insist on fasting should undergo pre-Ramadan assessment and receive appropriate education and instructions related to physical activity, meal planning, glucose monitoring, and dosage and timing of medications. Close follow-up is essential to reduce the risk for complications. 3 tables. 30 references.
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Taking Control of Your Diabetes. Clearwater, FL: CCS Medical. 2005. 52 p.
This booklet is designed to help readers who are newly diagnosed with type 2 diabetes understand and manage their disease. The booklet is also helpful for readers who havehad diabetes for a while and who may have experienced a change in health that requires a new treatment strategy. The booklet first reviews the types of diabetes and general signs and symptoms of the disease. Then it discusses diabetes care management in detail, covering meal planning, counting carbohydrates, the use of exchange lists, food labels, snack ideas, the importance of portion control, the use of sweeteners, dietetic foods, cholesterol, sodium, alcohol, dietary fiber, eating out at restaurants, weight control, exercise, insulin, oral medications, other medications, testing for control (including self-monitoring of blood glucose, or SMBG), low blood glucose (hypoglycemia), high blood glucose (hyperglycemia), testing for ketones, care during illness (sick-day management), complications, and the psychosocial impact of living with diabetes. Readers are encouraged to share the booklet with friends and family so they, too, can understand diabetes and how it can be managed. The booklet is illustrated with line drawings and tables that clarify the material presented. 14 figures. 7 tables.
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Vacationing with Diabetes: Be Prepared. Voice of the Diabetic. 20(2): 10-11. Spring 2005.
This patient education newspaper article offers suggestions for traveling with diabetes. The author's focus is on adequate preparation as the best way to enjoy traveling. Topics include managing blood glucose, monitoring blood glucose, diet considerations, the use of oral medications, and insulin needs. The author encourages readers to use common sense, to choose and plan vacations wisely, to travel with a companion who understands diabetes needs, and to carry appropriate documentation for all medications. The author concludes that readers should plan for problems; if something out of the ordinary happens, it can be easily dealt with and one can go on with the vacation as planned.
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Oral Antidiabetic Agents. In: Harmel, A.P. and Mathur, R. Davidson's Diabetes Mellitus: Diagnosis and Treatment. 5th ed. Orlando, FL: W.B. Saunders Company. 2004. p. 71-108.
In recent years, the number of oral agents available with which to treat diabetes has expanded considerably. In addition to monotherapy, combination therapy has become an accepted approach for treating diabetes. Because many of these drugs function at different sites (targeting not only pancreatic production of insulin, but also muscle sensitivity and hepatic glucose regulation), combining agents produces a greater effect than any one drug in isolation. This chapter on oral antidiabetic agents is from a textbook that provides readers with current information on the diagnosis and treatment of patients with diabetes, including the latest advances, medications, and research studies. This chapter is divided into three parts. The first section describes a general approach for using oral agents in patients with type 2 diabetes. The second section deals with each class of available oral agents, and discusses in detail their background, mechanisms of action and pharmacology, appropriate usage, dosage, side effects, and contraindications. These agents are classified overall as insulin secretagogues and noninsulin secretagogues. The third section deals with combination therapy and provides strategies for managing specific patients with multiple oral medications. Case examples are provided. 18 figures. 11 tables. 90 references.
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Quick Guide to Medications. Chicago, IL: American Association of Diabetes Educators. 2004. 19 p.
Approximately 90 percent of people with diabetes require oral glucose-lowering medications, insulin injections, or both, to reach blood glucose goals. This lengthy brochure is designed to provide in quick reference format an overview of the oral medications used to manage diabetes mellitus. In addition to oral medications and insulin, the drug therapies for a person with diabetes often include other medications to treat the associated conditions or complications of diabetes. The drugs are considered in separate categories: oral glucose-lowering agents, insulins available in the United States, major classes of agents used to treat high blood pressure, and lipid-lowering therapies. Other charts cover a comparison of human insulins and analogs, guidelines for mixing insulin or prefilling syringes, the use of glucagons injection for severe hypoglycemia, drug-food interactions of diabetes medications, adverse effects of drugs on body systems, drug-disease and drug-drug interactions, and drug therapies for the treatment of dyslipidemia in people with diabetes. The brochure emphasizes that health care professionals must be knowledgeable of the total range of therapies that are available for comprehensive diabetes care, not just the therapies that are used for glycemic control. 2 figures. 6 tables. 1 reference.
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Diabetes Sourcebook. 3rd ed. Detroit, MI: Omnigraphics. 2003. 621 p.
This book provides information for people seeking to understand the risk factors, complications, and management of type 1 diabetes, type 2 diabetes, and gestational diabetes. The book offers 67 chapters in seven sections: diabetes types and diagnosis; lifestyle and related diabetes management concerns; exercise and nutrition for diabetes management; medication management of diabetes; complications of diabetes; treatment of end stage renal disease (ESRD); and diabetes-related research and statistics. Specific topics include risk factors, impaired glucose tolerance (IGT), insulin resistance, HbA1c (glycosylated hemoglobin) testing, blood glucose testing, urine testing, SMBG (self monitoring of blood glucose), non-invasive blood glucose monitors, preventing complications, how stress affect diabetes, alternative therapies for diabetes, exercise, exchange lists, carbohydrate counting, eating at restaurants, insulin administration and dosage, oral medications, amputation, kidney disease (diabetic nephropathy), diabetic retinopathy (eye disease), diabetic neuropathy (nerve disease), gastroparesis (reduced motility of stomach contents), hypoglycemia (low blood glucose levels), hyperglycemia (high blood glucose levels), erectile dysfunction (ED formerly called impotence), research advances in diabetes, and diabetes in ethnic and racial groups. The book includes a glossary of related terms, information about locating financial help for diabetes care, and a list of resources, including organizations, recipes and cookbooks.
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Pharmacologic Therapies for Glucose Management. In: Franz, M.J., et al., eds. Core Curriculum for Diabetes Education. 5th ed. (Volume 2) Diabetes Management Therapies. Chicago, IL: American Association of Diabetes Educators (AADE). 2003. p. 93-154.
For the majority of people with diabetes, their treatment includes pharmacologic (drug) intervention. In addition to oral medications or insulin, the pharmacologic therapies for a person with diabetes often include other agents to treat the myriad of associated comorbid conditions or complications of diabetes. This chapter on pharmacologic therapies for glucose management for diabetes is from a handbook of the CORE Curriculum, a publication that helps educators prepare for the Certified Diabetes Educators (CDE) exam, serves as a key reference for the Advanced Diabetes Management credential exam, and provides an authoritative source of information for diabetes education, training, and management. This chapter covers the physiologic effects of insulin; the different types of insulin preparations based upon species, source, type, purity, and concentration; proper administration and storage of insulin; the limitations of insulin mixing; the similarities and differences of potential insulin therapy regimens, including the use of insulin pumps, and indications for specific insulin products; commonly encountered insulin regimens in people with type 1 and type 2 diabetes; the differences between use of insulin in a person with type 1 and type 2 diabetes; the mechanisms of action of sulfonylureas, d-phenylalanine derivatives, meglitinides, biguanides, alpha-glucosidase inhibitors, and thiazolidinediones; the clinical use of these drug families; the use of combination therapy in people with type 2 diabetes; the clinical use of glucagon; and potential drug-disease, drug-drug, and drug-food interactions. The chapter includes an introduction, a list of learning objectives, key definitions (glossary), key educational considerations, self review questions, references, and a post-test (including an answer key). 8 figures. 9 tables. 84 references.
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Self-Care for Diabetes. [Autocuidado para la Diabetes.]. Yardley, PA: The StayWell Company: KRAMES Health and Safety Education. 2003. [4 p.].
This brochure, available in English or Spanish, reviews the basic components of diabetes self-management: understanding the disease, monitoring blood glucose, taking medication, and making healthy food choices. Specific topics include the complications that can arise from high blood glucose levels (hyperglycemia), the goals of self-care, monitoring strategies (including SMBG), glycosylated hemoglobin (HbA1c, a measure of blood glucose levels over time), how to treat high blood glucose levels, how to manage episodes of low blood glucose (hypoglycemia), oral medications, insulin, healthy eating, shopping hints, meal planning, foot care, footwear, and the role of exercise. The brochure is printed on heavy cardstock and is illustrated with brightly colored graphics. 7 figures. 1 table.
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Class Action. Diabetes Forecast. 55(2): 62-66. February 2002.
There are now five classes of diabetes pills (oral medications); this article reviews how each class can help people control their type 2 diabetes. Type 2 diabetes results in high blood glucose (sugar) levels because the pancreas does not produce enough insulin, the liver releases too much glucose, and the muscle cells do not readily take in glucose. Biguanides work primarily in the liver and keep the liver from releasing too much glucose. Sulfonylureas stimulate the pancreas to release more insulin. Meglitinides stimulate the pancreas to release more insulin. Thiazolidinediones make muscle cells more sensitive to insulin. And alpha glucosidase inhibitors work in the intestine to slow the digestion of some carbohydrates, resulting in after meal blood glucose peaks that are not as high as without the drug. The author provides information on the drugs through a diagram that illustrates where and how the drugs work, and a chart that summarizes the different drugs available in each class, how they work, and risk factors for hypoglycemia (low blood glucose levels) with each. 1 figure. 1 table.
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Diabetes: A Growing Public Health Concern: Either You Have It or You Don't. FDA Consumer. 36(1): 26-33. January-February 2002.
This article reminds readers that diabetes is a definite diagnosis; there is no such thing as 'a little diabetes.' The author stresses that an accurate diagnosis is essential, because while a person can live a long and healthy life with diabetes, ignoring it or not taking it seriously can be deadly. Much of the treatment depends largely on self care practices. Monitoring blood sugar (glucose) levels is a key component in the treatment and management of the disease. People who keep their blood glucose levels within individual target ranges set by their doctors stand a good change of reducing the risk of complications from diabetes. In many cases, intensive lifestyle changes in diet and exercise can actually prevent, reduce or delay the risk of developing one type of the disease. The author reviews diabetes and the metabolism of insulin production and physiology, lists the characteristics of type 1 diabetes, describes type 2 diabetes and gestational diabetes, summarizes the treatment goals for controlling diabetes, discusses insulin therapy and oral medications, and explains the use of organ transplants (pancreas and kidney). The article concludes with the contact information for four resource organizations, including their web sites. One sidebar summarizes recent advances in diabetes monitoring and treatment devices; two charts summarize insulin and oral drugs available. 5 figures. 2 tables.
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What to do When You Have Type 2 Diabetes. Alexandria, VA: American Diabetes Association. 2002. 59 p.
This Fast Facts booklet was written to help readers newly diagnosed with diabetes understand the first steps towards taking care of themselves and preventing complications. The booklet explains what diabetes is and then discusses diet therapy, the important role of exercise, oral hypoglycemic agents (oral medications), the use of insulin, blood glucose monitoring (SMBG), and how to get and stay motivated. A final section outlines the different types of complications that can arise with diabetes, including eye problems, foot problems, kidney disease, nerve disease, and cardiovascular disease; strategies to monitor and prevent each are discussed. The booklet concludes with a brief description of the American Diabetes Association (www.diabetes.org). 5 figures. 3 tables.
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Clinical Management of Diabetes in the Elderly. Clinical Diabetes. 19(4): 172-175. 2001.
Managing type 2 diabetes in the elderly population is difficult because of complex comorbid (other illnesses present at the same time) medical issues and the generally lower functional status of elderly patients. Nationally published guidelines often do not apply to geriatric care, and practitioners' individualized approaches to therapy are highly variable. This article reviews the clinical management of diabetes in the elderly. Clinicians should be aware of and primed to recognize the syndromes more commonly occurring in elderly patients with diabetes: diabetic neuropathic cachexia (painful peripheral neuropathy or nerve disease, anorexia, depression and weight loss), diabetic neuropathy, amyotrophy (muscle weakness and muscle wasting), malignant otitis externa (external ear infection), and osteoporosis (low levels of bone density). Goals of therapy for elderly patients with diabetes should include an evaluation of their functional status, life expectancy, social and financial support, and their own desires for treatment. Coexisting health problems, such as dementia or psychiatric illnesses, may require a simplified approach to diabetes care. Overall goals should aim at reduction of all cardiovascular risk factors, smoking cessation, improvement in exercise, elimination of obesity, and optimal control of hypertension (high blood pressure). The authors review five different types of medications and their use in elderly patients: alpha glucosidase inhibitors (Precose and Glyset); biguanides such as metformin (Glucophage); sulfonylureas (e.g., Glucotrol, Micronase, Glynase, Diabeta); thiazolidinediones (Avandia, Actos); and insulin. Complicating aspects of the physiology of aging include changes in the pharmacokinetics (how a drug works) of both insulin and oral medications. Changes in drug absorption, distribution, metabolism, and clearance must be considered when treating any condition in elderly patients. The authors conclude that ideal geriatric care requires a multidisciplinary approach. Successful diabetes care in the aging population requires an understanding of the physiology of aging, recognition of the special issues facing the elderly, and interaction with geriatricians, diabetologists, pharmacists, social workers, diabetes educators, and dietitians to ensure the most effective treatment. 1 table. 22 references.
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Creating A Diabetes Sick-Day Plan. Diabetes Forecast. 54(8): 90-93. August 2001.
This article provides people who have diabetes with guidelines for creating a sick day plan. Illness can affect blood glucose levels regardless of whether a person controls his or her diabetes with insulin, oral medications, or diet and exercise alone. A sick day plan should indicate how often a person should check his or her blood glucose and how to deal with the presence of ketones in the urine, list a variety of foods that a person can eat when he or she cannot adhere to a regular diet, list general nonprescription medications that will not affect blood glucose or interact with other medications, and tell when to contact a doctor. In addition, the article stresses that a person who has diabetes should not stop taking his or her insulin during an illness.
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Managing Your Own Diabetes. In: Lincoln, T.A.; Eaddy, J.A. Beating the Blood Sugar Blues. Alexandria, VA: American Diabetes Association. 2001. p.148-150.
This chapter is from a book that offers first hand knowledge from two doctors who have more than 100 years of combined experienced with the day-to-day balancing act of blood glucose (sugar) and diabetes. The authors, both of whom have type 1 diabetes, share their own stories as well as those of over 40 of their patients. In this final chapter, the authors reiterate the importance of self management of diabetes and the need for patients to educate themselves and take charge of their own health care. The first impulse of people who are newly diagnosed with diabetes is to depend on their physicians to tell them exactly what to do. And, indeed, a general plan for diet, insulin or oral medications, and exercise can be prescribed by a physician, but it will not result in good blood glucose control unless it is skillfully implemented by the patient. The treatment of diabetes also has to follow the particulars of each person's career, family life, and lifestyle. The authors encourage patients to take classes and workshops about diabetes care, to find and read instructional materials, and to measure their own blood glucose levels at least four times a day. Like learning a new sport or dance, coaching plus practice are the secrets for success.
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Not 'Adults-Only' Anymore. Diabetes Forecast. 54(3): 82, 84. March 2001.
This article discusses the increase in the number of young people who have type 2 diabetes. Risk factors for type 2 diabetes include being an African American, Mexican American, or Native American; having a relative with diabetes; and being overweight and inactive. Young people diagnosed with type 2 diabetes are usually treated with a diet and exercise program; however, oral medications may be needed if such a program is ineffective. The article presents a case study of an 11 year old girl who was diagnosed with type 2 diabetes following a routine school physical. The case study includes a description of her symptoms and a discussion of her treatment regimen and prognosis. The article includes advice to parents about ways to reduce their children's risk of type 2 diabetes.
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Ramadan Fasting: Impact on Diabetes Mellitus and Guidelines for Care. Practical Diabetology. 20(3): 7-11, 14. September 2001.
Ramadan is the ninth lunar month in the Islamic calendar. During this month, all healthy adult Muslims, male or female, are expected to abstain from foods, fluids, oral medications, intravenous fluids and nutrients, smoking, and sexual intercourse from dawn to sunset. This article discusses the impact of this cultural and religious requirement on people who have diabetes. The classic Islamic point of view is that Ramadan fasting is good for the health and is also good for the spiritual cleanliness of Muslims. Ramadan fasting is a type of intermediate or partial fasting because individuals can eat again after 12 to 14 hours. The physiologic aspects of Ramadan are influenced by the combination of food and water deprivation, the periodic nature of fasting, and the modification of physical activities during the daytime hours. In people with diabetes, the blood glucose response to fasting is individual and variable. It has been suggested that the fasting blood glucose of such patients can be influenced by dietary noncompliance as a result of eating high carbohydrate meals (a tradition during Ramadan). This dietary factor may outweigh factors such as age, sex, and weight in influencing blood glucose in fasting patients with diabetes. The author notes that Ramadan fasting per se does not impair glycemic control in patients with diabetes. The glycemic control strategy in such patients should be considered individually in light of the control level before Ramadan, presence of complications, and course of the diabetes. The author discusses the impact of fasting on insulin, lipids (fats), renal (kidney) physiology, and body weight. Specific guidelines for diabetes care during Ramadan are outlined. A patient education handout about fasting for religious purposes and its impact on diabetes control is offered in the same journal issue. 26 references.
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Treating Type 2 Diabetes for Life. Alexandria, VA: American Diabetes Association. 2001. [4 p.].
This brochure helps readers with type 2 diabetes take a long-range approach to their program of diabetes management. The brochure emphasizes that over time, the treatments used to keep one's diabetes in good control may need to change. Changing and modifying the treatment plan can help patients maintain good blood glucose levels. Topics include monitoring to determine the need for a change, the importance of not blaming oneself about needing additional therapy, the different types of oral medications that are available, and the use of insulins for patients with Type 2 diabetes. One sidebar reports a mock interview between a certified diabetes educator and a patient regarding how her diabetes management changed over a ten year period. The brochure includes space for readers to record their medications (including the administration and dosage of each drug) and their health care provider's contact information. The brochure is copiously illustrated with brightly colored graphics.
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Type 2 Diabetes in Children and Adolescents: An Emerging Disease. Journal of Pediatric Health Care. 15(4): 187-193. July-August 2001.
This review article presents pediatric nurse practitioners with the most recent information about type 2 diabetes in children and adolescents, summarizes current understanding about diagnosis, and outlines treatment options. Although children and adolescents are usually diagnosed with type 1 diabetes, within the past 10 years children as young as 8 years old have been diagnosed with the type 2 diabetes. Type 2 diabetes in youth is an emerging disease, so its natural history is not well understood. Risk factors for type 2 diabetes in children and adolescents are similar to those in adults, including non-European ancestry, family history of type 2 diabetes, obesity, insulin resistance, and age. African American and Hispanic youth are at greater risk than white youth. The initial assessment of children and adolescents with a potential diagnosis of diabetes is critical. Although youth with type 2 diabetes may or may not have the classic symptoms of polydipsia, polyuria, and polyphagia, they often have features associated with insulin resistance syndrome such as dyslipidemia, hyperglycemia, obesity, hypertension, polycystic ovarian syndrome, and acanthosis nigricans. Blood glucose levels are essential to the diagnosis of diabetes, but additional laboratory measures are also important. The aim of treatment is to normalize blood glucose and glycosylated hemoglobin values. Fundamental to this aim is an individualized plan for nutrition and activity. The choice of pharmacologic management will depend on the child's clinical presentation. Currently, insulin and metformin are the only drugs approved by the Food and Drug Administration for the treatment of diabetes in children; however, selected oral medications have been used with success. Diabetes self management education is also an essential component in the management of diabetes. Education must focus on psychomotor skills, medical nutrition therapy, and physical activity. Routine follow up care should occur every 3 to 4 months. Primary prevention activities include counseling all patients about the importance of a healthy diet and exercise and monitoring physical development. The article presents a case study and discusses the nursing and research implications of type 2 diabetes in youth. 1 figure. 2 tables. 28 references. (AA-M).
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What's Your Type?: Type 1, Type 2-or Something Else?. Diabetes Self-Management. 18(3): 99, 101-103. May-June 2001.
This article provides information on the classification of diabetes. There are just two major types of diabetes. Over the years, the names of these two types of diabetes have changed. In 1979, the terms juvenile and adult onset diabetes were changed to insulin dependent and noninsulin dependent. In 1997, the American Diabetes Association and the World Health Organization issued new guidelines about the classification of diabetes. Insulin dependent diabetes became known as type 1 diabetes, and noninsulin dependent diabetes was renamed type 2 diabetes. These guidelines based the classification on the cause of diabetes rather than the treatment. Type 1 diabetes is an autoimmune disease in which the immune system attacks and destroys the insulin producing beta cells of the pancreas. Although the classical type 1 patient is diagnosed in childhood, some older people develop type 1 diabetes. Their disease is called latent autoimmune diabetes of adults. Type 2 diabetes is a combination of insulin resistance and relative insulin deficiency. A careful diagnosis is essential for determining the type of diabetes being treated because therapy decisions based on the diagnosis are potentially very important. For a person with classic type 1 diabetes, the appropriate treatment is insulin therapy. A person with the classic symptoms of type 2 diabetes may have a range of treatment options, including diet, exercise, oral medications, and insulin. The article identifies some of the factors that might go into a diagnosis of type 1 or type 2 diabetes. In addition, the article addresses the possibility of the existence of type 3 diabetes, represented by people who have both type 1 and type 2 diabetes.
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Diabetes Home Video Guide: Skills for Self-Care. Timonium, MD: Milner-Fenwick. 2000. (videocassette).
This videotape provides people who have diabetes with information on the basic skills needed to keep blood glucose in the target range and offers tips for incorporating these skills into daily life. Part one focuses on diabetes and related health concerns. One chapter in this segment of the tape explains how diabetes affects the body, what the long term complications are, and how to determine an appropriate blood glucose range. Another chapter examines related health concerns such as smoking, high blood cholesterol, high blood pressure, and excess body weight. Part two deals with blood glucose management, focusing on education, diet, exercise, monitoring, and medications. The chapter on education discusses the importance of education, the diabetes care team, and other resources. The chapter on nutrition provides nutrition guidelines and discusses other aspects of healthy eating. The chapter on exercise explains how to create an exercise plan. Other topics include doing aerobic and weight bearing exercises, keeping exercise fun and safe, and maintaining physical activity. The chapter on blood glucose monitoring focuses on laboratory testing, blood glucose self testing, and self testing techniques. Other topics include blood glucose records, medical emergencies, and equipment and supplies. The chapter on medications focuses on oral medications and insulin. Topics include insulin care, injection, and supplies; hypoglycemia; and medication tracking systems. Part three addresses the challenges of self management and offers strategies to help the viewer balance diabetes management with living. One chapter in this segment focuses on understanding the importance of pattern management, recognizing patterns, and adjusting a treatment plan. Another chapter deals with solving problems associated with sick days, dining out, unusual schedules, travel, special occasions, and holidays. A third chapter discusses lifestyle changes and emotions, focusing on incorporating change into daily life, managing emotions, handling sexual dysfunction and stress, dealing with close relationships, and finding support. The final chapter of the segment offers suggestions on maintaining good health, focusing on foot, skin, eye, and dental care; immunizations; and medical appointment and test scheduling. The video is accompanied by a foldout guide that provides an overview of diabetes self care skills.
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Diabetes Pills and Your Travels. In: Kruger, D.F. Diabetes Travel Guide. Alexandria, VA: American Diabetes Association. 2000. p. 75-84.
This chapter, part of a diabetes travel guide, provides tips for packing and taking oral medications. The chapter advises readers to try to continue to eat the same number of meals and snacks on a trip that they are accustomed to having at home, have snacks with them, carry a letter from their health care provider stating that they have diabetes, know whether their diabetes medications can cause low blood glucose levels, and take any missed dose of any medication as soon as they remember it unless it is almost time to take the next dose. Other topics include handling time zone changes, dealing with meals and physical activity, coping with illness, and creating a diabetes survival kit. 2 tables.
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Diabetes Travel Guide. Alexandria, VA: American Diabetes Association. 2000. 172 p.
This book organizes the process of traveling for people who have diabetes. Chapter one focuses on preparing for a trip. Topics include researching one's destination; seeing one's health care provider prior to departure, carrying a letter from one's doctor; locating medical facilities at one's destination; taking one's medications along; and obtaining health insurance, passports, and visas. Chapter two explains how to pack clothing, diabetes supplies, snacks, and items for an emergency and offers tips for preventing foot infections and other complications from happening. Chapter three provides detailed guidelines for packing and using insulin, syringes, a blood glucose meter, test strips, ketone strips, and a glucagon kit. Other topics include adjusting insulin and an insulin pump for various time zone changes. Chapter four provides tips for packing and taking oral medications, handling time zone changes, dealing with meals and physical activity, and creating a diabetes survival kit. Chapter five provides guidelines for traveling by auto, airplane, or boat. Chapter six addresses the issue of eating well and exercising while away from home. Topics include dealing with time zone changes, deciding where and when to eat, following a meal plan, eating fast foods, and adjusting insulin or diabetes pill doses according to physical activity level. Chapter seven uses a question and answer format to provide tips for coping with illness while traveling. Topics include receiving immunizations prior to traveling if necessary; checking blood glucose and ketones during an illness; dealing with vomiting, diarrhea, colds, jet lag, and urinary tract or vaginal infections; avoiding constipation; preventing insulin pump site infections; and preparing for health care prior to traveling. Chapter eight explains how to plan for situations that may occur during overseas travel, outdoor trips, and scuba diving. 22 appendices. 6 tables.
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How Does Diabetes Affect Pregnancy?. In: Hirsch, I.B. 12 Things You Must Know About Diabetes Care Right Now!. Alexandria, VA: American Diabetes Association. 2000. p. 61-75.
This chapter discusses the impact of preexisting and gestational diabetes on pregnancy. Pregnant women who have diabetes are classified into those who had diabetes before pregnancy and those whose diabetes developed during pregnancy. Both type 1 and type 2 diabetes can affect fetal development. Thus, good diabetes control is important to reduce complications in the baby. Possible complications of preexisting diabetes include miscarriage and birth defects. Adolescents and women in their childbearing years should discuss contraceptive needs and concerns about a future pregnancy with their health care team. Women who are taking oral medications for diabetes need to stop using these drugs before they become pregnant. During pregnancy, women need to undergo various tests to determine risks to both them and their infant. Other issues confronting pregnant women with preexisting diabetes include emotional stress, life expectancy, the impact of pregnancy on eye problems and kidney disease, and home testing of blood glucose and urine. Gestational diabetes develops in 2 to 3 percent of pregnant women. Screening is recommended for all pregnant women except those in the low risk group at 24 to 28 weeks after conception. If gestational diabetes is diagnosed and managed properly, there are few complications. Women diagnosed with gestational diabetes need to achieve normal blood glucose levels and eat enough good foods. Women may avoid unplanned pregnancies by using some form of contraception, including the pill, Norplant, Depo-Provera, the diaphragm, condoms, intrauterine devices, the rhythm method, and sterilization. 4 tables.
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Life with Diabetes: A Series of Teaching Outlines by the Michigan Diabetes Research and Training Center. 2nd ed. Alexandria, VA: American Diabetes Association. 2000. 676 p.
This teaching guide presents outlines on many diabetes related topics. The primary purpose of the outlines is to guide health professionals in the education of patients who have diabetes mellitus. Although the content is generally for adults who have type 1 or type 2 diabetes, the information can be adapted for use with younger patients or those with special learning needs. The first section consists of core outlines that present basic information generally taught to people who have diabetes. Topics focus on living with diabetes; understanding the impact of food on diabetes; planning meals; exercising; taking oral medications or insulin; monitoring diabetes; regulating blood glucose; coping; caring for skin, feet, and teeth; understanding long term complications; and changing behavior. The second section presents supplementary outlines that focus on specific situations. Topics include food and weight, dietary cardiovascular risk factors, carbohydrate counting, diabetes exchanges, sexual health, pregnancy, intensive insulin therapy, and insulin pump therapy. Each outline in these two sections includes a statement of purpose; prerequisites that participants should know before attending a particular session; objectives; materials needed for teaching a session; a recommended teaching method; a content outline that includes the general concepts to be covered, specific details, and instructor's notes or teaching tips; a skills checklist; an evaluation and documentation plan; suggested readings related to each topic; and visuals and handouts. The third section provides support materials, including resources for health professionals and people who have diabetes, supplemental reading, and sample educational objectives.
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Oral Medications. In: Michigan Diabetes Research and Training Center; Funnell, M.M., et al. Life with Diabetes: A Series of Teaching Outlines by the Michigan Diabetes Research and Training Center. 2nd ed. Alexandria, VA: American Diabetes Association. 2000. p. 157-170
This teaching outline, part of a series of teaching outlines on living with diabetes, provides information about the purpose, action, use, and adverse effects of oral hypoglycemic agents. The outline includes a statement of purpose; prerequisites that participants should know before attending a particular session; objectives; materials needed for teaching a session; a recommended teaching method; a content outline that includes the general concepts to be covered, specific details, and instructor's notes or teaching tips; an evaluation and documentation plan; and suggested readings. Concepts covered in the outline include types of oral medications such as sulfonylureas, biguanides, alpha-glucosidase inhibitors, thiazolidinediones, and meglitinide; the side effects of oral agents; and the administration and dosage of oral agents. Other topics include the occurrence of hypoglycemia when taking oral agents, the care and storage of oral medications, and the importance of diet and exercise. A visual is also provided.
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Saying a Mouthful About Oral Diabetes Drugs. Nursing2000. 30(11): 34-39. November 2000.
This article reviews the various oral medications available to treat type 2 diabetes and describes the unique features of each type. The physiologic characteristics of the patient, the drug's site of action, and the patient's response to therapy have a role in determining the appropriate regimen. Five classes of oral medications are used to manage type 2 diabetes: sulfonylureas, meglitinide, biguanide, alpha glucosidase inhibitors, and thiazolidinediones. Sulfonylureas are the oldest class of oral diabetes drugs. Their primary effect is to stimulate insulin release from the pancreas. An ideal candidate for sulfonylurea therapy early in the course of diabetes is an average weight adult who has no lipid abnormalities. Meglitinide increases insulin release but more rapidly than the sulfonylureas. The only meglitinide currently available is repaglinide. Metformin, which is the only biguanide currently available, works by reducing hepatic glucose production, enhancing tissue response to insulin, and improving glucose transport to cells. This drug does not promote weight gain and may help improve blood lipid levels. Alpha glucosidase inhibitors, acarbose and miglitol, limit the absorption of carbohydrates from the small intestine. The two currently available thiazolidinediones, rosiglitazone and pioglitazone, work by increasing insulin sensitivity at insulin receptor sites on the cells. Once a single oral agent becomes ineffective, combining therapies can be highly effective. A table presents the daily dosage range, dose per day, contraindications, potential adverse effects, and nursing considerations for each class. The article also presents guidelines for nurses to use when teaching a patient about oral medications. 1 table. 4 references.
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Step Lively!: The Wonders of Walking. Diabetes Forecast. 53(10): 60-64. October 2000.
This article discusses the benefits of walking for people who have type 1 or type 2 diabetes. Brisk walking has been shown to improve cardiovascular health, promote weight loss, and provide a person with a sense of well-being. Walking also has a beneficial metabolic effect on type 2 diabetes. Walking can have enough impact on insulin sensitivity and blood glucose so that people taking oral medications may be able to lower the amount they take. The benefits of walking on type 2 diabetes are particularly noticeable in younger people and people who have more easily controlled diabetes. In people who have type 1 diabetes, the benefits of walking are more evident in an improved overall quality of life. The article provides guidelines for beginning a walking regimen, including undergoing a physical examination, buying a decent pair of walking shoes, making an action plan, and building up to 30 minute walks at least three or four times per week. The article includes one sidebar that offers tips on selecting appropriate shoes and keeping feet injury free and another that lists target heart rates. 1 table.
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What Do I Need to Know About Diabetic Eye Disease?. In: Hirsch, I.B. 12 Things You Must Know About Diabetes Care Right Now!. Alexandria, VA: American Diabetes Association. 2000. p. 77-85.
This chapter provides information on diabetic eye disease. The major eye problems that cause people who have diabetes to lose their eyesight are diabetic retinopathy, cataracts, and glaucoma. These problems can be avoided or treated to lessen their impact if they are diagnosed early. Diabetic retinopathy is a disease of the retina. One type of retinopathy is background or nonproliferative retinopathy, and another is proliferative retinopathy. Both types of retinopathy can be treated with laser surgery. The Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetes Study both showed that careful blood glucose control reduces the chances of getting diabetic retinopathy. Cataracts cause the lens of the eye to cloud. This problem is particularly frequent in older people who have diabetes. Treatment involves surgery or the use of sunglasses to relieve visual symptoms. Glaucoma is more common in people who have type 2 diabetes. Vision loss from glaucoma is due to nerve damage from increased pressure in the eye. Treatment options include eyedrops or oral medications. The chapter provides guidelines on the frequency of eye examinations among people who have type 1 and type 2 diabetes, women with diabetes who are pregnant, and people who already have eye disease. The chapter includes a list of questions a patient may ask a doctor and questions a doctor may ask a patient. 1 figure.
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