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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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