Intensive diabetes management is a treatment paradigm wherein virtually all individuals with diabetes — type 1 or type 2 — can improve their glycemic control and overall health. The model has proven very effective and is now often the rule, rather than the exception, in diabetes care.
Intensive Diabetes Management is intended for healthcare practitioners who want to implement this method with their patients. It emphasizes a team approach to patient care and offers guidance in helping providers and patients gain the skills and confidence to move toward treatment goals appropriate for individual needs and medical conditions.
Intensive Diabetes Management, now in its 7th edition, has been revised to include the latest advances in medical research, incorporating new insights into diabetes and how they specifically impact this means of treatment.
The data, guidelines, and procedures reflect the most recent updates to the American Diabetes Association’s Standards of Care.
"Index", Intensive Diabetes Management, Devin Steenkamp, MD
Download citation file:
Note: Page numbers followed by an f refer to figures. Page numbers followed by t refer to tables.
A
A1c (glycated hemoglobin A1c)
adherence and, 50
in children, 69
continuous glucose monitoring (CGM) and, 127
diabetes self-management education and support (DSME/S) and, 28,29t, 30
eating disorders and, 46
fear of hypoglycemia and, 45
glycemic control and, 143–146, 144t, 145t
glycemic control targets for, 63, 64t
inhaled insulin and, 78
insulin dosage and, 93
lispro and, 78
measurement of, 3
medical nutrition therapy (MNT) and, 164
Mediterranean diet and, 163
monitoring of, 143–146, 144t, 145t
in older adult patients, 69–70
postprandial glycemia/glucose (PPG) and, 64t
in pregnancy, 68
problem-solving with, 50
time in range (TIR) and, 127
total daily insulin dosages (TDD) and, 110
type 1 diabetes (T1D) and, 3
type 2 diabetes (T2D) and, 162
Acetoacetate, 7
ketones and, 142
Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE), 4
Action to Control Cardiovascular Risk in Diabetes (ACCORD), 4
Active insulin time, 107
Acute adjustments, to insulin dosage, 94–95
Adherence
long-term, 55–56
screening, psychosocial issues with, 50–51, 51t
Adipose tissue, 7
Alanine, 7
Albumin, 81
urinary screening, 146t, 148
Albuminuric diabetic kidney disease, 4
Alcohol
diabetes self-management education and support (DSME/S) and, 29t, 30
intensive diabetes management and, 66t
medical nutrition therapy (MNT) and, 157t, 170
substance abuse of, 48
Ambulatory glucose profile (AGP), 63, 127–128
for self-monitoring of blood glucose (SMBG), 144
American Diabetes Association (ADA), 16, 27, 44, 68, 69, 108, 155
Amino acids, 6–7
Amylin analogs, 55
weight gain and, 176
Anorexia, with type 1 diabetes (T1D), 46
Anticonvulsants, 176
Antidepressants, 176
Antihyperglycemic medications, 177
Antiplatelet therapy, 4
Antipsychotics, 176
Anxiety, 44–46
Arthritis, 66t
Asparagine, 80
Aspart (Fiasp), 74, 75, 76, 78f, 79
continuous subcutaneous insulin infusion (CSII) for, 91, 106
injection devices for, 96
mixtures of, 84
NPA, 77t, 84
prandial insulin and, 87
stability of, 85
timing of, 85–86
Association of Diabetes Care and Education Specialists (ADCES), 27
Atherosclerotic cardiovascular disease (ASCVD), 147–148
Atorvastatin, 147t
B
Basal glucose production, 6, 106
Basal insulin, 7–8
continuous subcutaneous insulin infusion (CSII) for, 91
insulin dosage of, 93, 109–111
insulin dosage pattern adjustments to, 95t
insulin pumps for, 106
in multicomponent insulin regimens, 88
NPH insulin and, 88–91, 88f–90f
total daily insulin dosages (TDD) and, 75
for type 2 diabetes (T2D) and, 93
weight gain and, 176–177
Basal-bolus insulin therapy, 4
medical nutrition therapy (MNT) and, 154
monitoring of, 139–141
popularity of, 91
Basal-bolus-correctional insulin, 92
Biguanides, 5, 167
Binge eating, with type 2 diabetes (T2D), 47
Biosimilars (follow-on biologic insulins), 84
Blind patients, 84
Blood glucose
carbohydrate and, 6
continuous glucose monitoring (CGM) and, 132
continuous subcutaneous insulin infusion (CSII) and, 108, 109t
depression and, 44
diabetes self-management education and support (DSME/S) and, 30
fat metabolism and, 7
insulin and, 8
insulin dosage and, 92
insulin dosage acute adjustments and, 94
insulin dosage pattern adjustments and, 95
intensive diabetes management and, 9
ketones and, 142
monitoring of, 139–141
prandial insulin and, 88
protein and, 156
stressors and, 48
Blood glucose meter with continuous glucose monitoring (CGM), 131
in Diabetes Forecast, 108
diabetes self-management education and support (DSME/S), 29, 33t
Blood pressure, 4
medical nutrition therapy (MNT) and, 164
monitoring of, 148
BMI (body mass index), 159f, 160t, 163, 164
Bolus insulin. See also Basal-bolus insulin therapy
dose of, 111–112
self-monitoring of blood glucose (SMBG) for, 132, 140
Branched-chain amino acids, 6–7
Bulimia, with type 1 diabetes (T1D), 46–47
C
Caffeine, 165
CANVAS trial, 177
Carbohydrate. See also Insulinto-carbohydrate ratio alcohol and, 157t
glycemic index and, 6, 86, 113, 123–124, 130, 156t
hyperglycemia and, 168
hypoglycemia and, 168, 170–171
insulin dosage and, 92–93
insulin dosage acute adjustments and, 94
intensive diabetes management and,2
medical nutrition therapy (MNT) and, 156t, 160–161, 164
metabolism of, 6
multiple-dose insulin (MDI) and, 175
total daily insulin dosages (TDD) and, 75
type 2 diabetes (T2D) and, 162
Carbohydrate counting, 5, 153
diabetes self-management education and support (DSME/S) and, 29t
in medical nutrition therapy (MNT), 172
Cardiac arrhythmias, 66t
Cardiovascular disease atherosclerotic cardiovascular disease (ASCVD), 147–148
intensive diabetes management and, 66t
medical nutrition therapy (MNT) and, 161
with type 2 diabetes (T2D), 4, 66
Catecholamine, fuel metabolism and, 7t, 8–9
α-cells, 8
β-cells, 8
total daily insulin dosages (TDD) and, 75
type 2 diabetes (T2D) and, 66, 142
Center for Epidemiological Studies Depression Scale (CES-D), 43
Central nervous system (CNS), 7
Certification Board for Diabetes Care and Education, 27
Certified Diabetes Care and Education Specialist (CDCES), 27
Certified Diabetes Educator (CDE),27
Children glycemic control targets for, 69
ketones in, 142
snacks for, 176–177
total daily insulin dosages (TDD) for, 75, 110
with type 1 diabetes (T1D), 53, 69
Chromium, 157t
Chronic care model, 16
Clinical considerations, 60–70
Coefficient of variation (CV), 126, 127
Cognitive-behavioral therapy, for needle phobia, 45
Complications
glycemic control and, 2
intensive diabetes management of, 2, 3, 65
monitoring of, 146–149, 146t
psychosocial issues with, 49
team approach, in intensive diabetes management for, 16
with type 2 diabetes (T2D), 66
Continuous glucose monitoring (CGM), 3, 5, 122–133
adjustments to, 75
alerts, alarms, and rate of change for, 129–132, 131f
for basal insulin, 111
benefits of, 123–124
blood glucose and, 132
for bolus insulin, 111
for children, 69
continuous subcutaneous insulin infusion (CSII) and, 91
diabetes self-management education and support (DSME/S) and, 29
for fear of hypoglycemia, 45
glycemic control targets for, 63, 64t, 126–127
for hypoglycemia, 67, 68
of insulin dosage, 93
insulin dosage acute adjustments and, 94
insulin dosage pattern adjustments and, 95
insulin pumps with, 132–133
interpretation of, 127–129
medical nutrition therapy (MNT) and, 165–167, 166t
for multicomponent insulin regimens, 74, 87
postprandial glycemia/glucose (PPG), 123–124
for prandial insulin, 88
in pregnancy, 68
for stressors, 48
timing for, 86
for type 1 diabetes (T1D), 9, 63, 141
wearing of, 126
weight gain and, 177
Continuous subcutaneous insulin infusion (CSII), 75, 91, 91f, 104–122, 168
basal insulin and, 88
benefits of, 108, 109t
for fear of hypoglycemia, 45
hyperglycemia and, 115–117, 116t
hypoglycemia and, 117–119
insulin dosage with, 93
ketoacidosis and, 115–117, 116t
multiple-dose insulin (MDI), 113
patient education for, 120–121, 121t, 122t
postprandial glycemia (PPG) and, 93
for prandial insulin, 93
risks of, 114–119
skin infection with, 114–115
wearing of, 119–120
Coping diabetes self-management education and support (DSME/S) and, 28, 30
psychosocial issues with, 49–50
with stressors, 48
Coronary artery disease, 66t
Correction doses, 94, 104
Correction factor (CF), 33t, 94, 104,119t, 121t, 133
Cortisol, 7t, 9
Counterregulatory hormones, 8–9
alcohol and, 170
Creatinine, 146t, 148
D
Dawn phenomenon, 9
continuous subcutaneous insulin infusion (CSII) and, 108, 109t
diabetes self-management education and support (DSME/S) and, 29t
Decubitus ulcers, in older adult patients, 70
Degludec, 74, 77t, 81, 168
absorption of, 85
basal insulin and, 88
insulin dosage pattern adjustments to, 95t
mixtures of, 84
stability of, 85
U-200 insulin, 83
Dehydration, in older adult patients, 70
Depression, 43–44
in older adult patients, 69
Detemir, 74, 81, 168
absorption of, 85
insulin dosage pattern adjustments to, 95t
stability of, 85
Diabetes burnout, 43
Diabetes Control and Complications Trial (DCCT), 3, 16, 147, 172
Diabetes distress, 43–44
Diabetes Distress Scale (DDS), 43
Diabetes Eating Problem Survey - Revised (DEPS-R), 47
Diabetes Forecast (ADA), 108
Diabetes Prevention Program (DPP), 162
Diabetes self-management education and support (DSME/S), 16, 26–37
action planning for, 35–36
assessment in, 28–29, 28t, 29t
content of, 32
curriculum for, 33t–34t
documentation of, 37
education in, 28
evaluation of, 36, 36t, 37t
motivation and support in, 34, 34t
planning for, 31
sequencing of, 32
strategies for, 32–34
teacher qualities for, 30–31, 31t
team approach, in intensive diabetes management and, 27–28
for type 1 diabetes (T1D), 35t
Diabetic ketoacidosis (DKA), 43
eating disorders and, 46, 47
sodium glucose cotransporter-2 (SGLT2) inhibitors and, 142
Diet. See also Medical nutrition therapy (MNT)
insulin dosage adjustments and, 112–113
Dietary Intervention Randomized Controlled Trial (DIRECT), 163
Dining out, diabetes self-management education and support (DSME/S) and, 29t
Dipeptidyl peptidase-IV inhibitors (DPP-IV), 5, 167
Dose, of basal insulin, 109–111
E
Eating disorders, 46–48
Education Recognition Program, 37
End-stage diabetes, 66t
Epidemiology of Diabetes Interventions and Complications (EDIC), 3
Epinephrine, 8–9
Esposito, K., 163
Exercise. See Physical activity
Extended bolus, 107
F
Family, 52–53
Fat continuous subcutaneous insulin infusion (CSII) and, 108
hypoglycemia and, 177
insulin dosage and, 172–175
intensive diabetes management and, 2
medical nutrition therapy (MNT) and, 156t–157t
metabolism of, 7
Fear of hypoglycemia, 44–45
Fiasp. See Aspart
Fiber continuous glucose monitoring (CGM) and, 130
medical nutrition therapy (MNT) and, 156t
for type 2 diabetes (T2D), 162–163
Fight or flight, 8
Fluvastatin, 147t
Follow-on biologic insulins (biosimilars), 84
Food and Drug Administration (FDA), 85, 132
medical nutrition therapy (MNT) and, 156t
on weight loss, 177
Foot examinations, 148–149
Free fatty acids, 7, 113
Fuel metabolism, 7t
in intensive diabetes management, 6–9
Fumaryl diketopiperazine (FDKP), 78
G
Gastroparesis, continuous subcutaneous insulin infusion (CSII) and, 108, 109t
Gestational diabetes, 68
Glargine, 77t, 168
absorption of, 85
insulin dosage pattern adjustments to, 95t
stability of, 85 U-100, 74, 80, 88
U-300, 74, 81, 83, 88
Glinides, 5
Glucagon diabetes self-management education and support (DSME/S) and, 29t
fuel metabolism and, 7t, 8
Glucagon-like peptide-1 receptor agonist (GLP-1RA), 4, 55, 167
type 2 diabetes (T2D) and, 66
weight gain and, 176, 177
Glucocorticoids, 176
Glucogenesis, 8
Gluconeogenesis, 6
alcohol and, 170
cortisol and, 9
Glucose monitor indicator (GMI), 126–127, 128–129
Glucose monitor/management indicator (GMI), A1c and, 144–145, 145t
α-glucosidase inhibitors, 5
Glulisine, 74, 75, 79
continuous subcutaneous insulin infusion (CSII) for, 91, 106
injection devices for, 96
prandial insulin and, 87
stability of, 85
timing of, 86
Glutamine, 6
Glycated hemoglobin A1c. See A1c
Glycemic control A1c and, 143–146, 144t, 145t
carbohydrate and, 6
complications and, 2
continuous subcutaneous insulin infusion (CSII) for, 108
Diabetes Control and Complications Trial (DCCT) on, 3
Epidemiology of Diabetes Interventions and Complications (EDIC) on, 3
hypoglycemia and, 67
intensive diabetes management for, 4–5
with multiple-dose insulin (MDI), 114
in pregnancy, 3
rapid-acting insulin and, 109
type 2 diabetes (T2D) and, 162
weight loss and, 177
Glycemic control targets, 63, 64t
for children, 69
with continuous glucose monitoring (CGM), 126–127
insulin for, 75
medical nutrition therapy (MNT) and, 160–161
for older adult patients, 69–70
in pregnancy, 68
total daily insulin dosages (TDD) and, 75
Glycemic index carbohydrate and, 6, 86, 113, 123–124, 130, 156t
continuous glucose monitoring (CGM) and, 130
medical nutrition therapy (MNT) and, 156t
Glycemic load, 6
Glycerol, 7
Glycine, 80
Glycogen, 6
Growth hormone, 7t, 9
H
Heart attack, 4
Heart failure, 4
Hexadecanedioic acid, 81
Humalog, 78f
Hybrid closed-loop (HCL), 68, 91, 132–133
β-hydroxybutyrate (BHB), 7, 141, 142
Hyper-fatty acidemia, 8
Hyperglycemia basal insulin secretion and, 8
carbohydrate and, 168
continuous subcutaneous insulin infusion (CSII) and, 91, 108, 109t, 115–117, 116t
diabetes self-management education and support (DSME/S) and, 29t
glucagon and, 8
growth hormone and, 9
insulin for, 106
ketones and, 142
lispro and, 78
medical nutrition therapy (MNT) and, 153
in older adult patients, 70
time above range (TAR) for, 126
Hypertension, 148
Hypertriglyceridemia, 93
Hypoglycemia. See also Nocturnal hypoglycemia
alcohol and, 170
carbohydrate and, 170–171
catecholamines and, 8
in children, 69
continuous subcutaneous insulin infusion (CSII) and, 108, 109t, 117–119
cortisol and, 9
counterregulatory hormones and, 8
depression and, 44
diabetes self-management education and support (DSME/S) and, 28, 29t
fat and, 177
fear of, 44–45
glucagon and, 8
intensive diabetes management for, 4, 66t, 67–68, 67t
medical nutrition therapy (MNT) and, 153, 167–168, 167t
in older adult patients, 70
oral treatment of, 170–171
in pregnancy, 68
protein and, 6, 156, 177
risk of, 63, 67, 67t
time below range (TBR) for, 126
unawareness, 9, 66t, 67–68
weight gain and, 177
Hypoglycemia-associated autonomic failure (HAAF), 8
I
Ideal body weight, 164
Inhaled insulin, 74, 77t, 78, 79f
for needle phobia, 45
prandial insulin and, 87
Insulin. See also specific types and topics
absorption and availability of, 74, 85–86
analogs of, 3
carbohydrate and, 5, 6
concentrated formulations for, 82–84
eating disorders and, 47–48
fear of hypoglycemia and, 45
fuel metabolism and, 7–8, 7t
for glycemic control targets, 75
for hyperglycemia, 106
injection devices for, 96
injection site for, 85
in intensive diabetes management, 2
mixtures of, 83–84
multicomponent regimens for, 74–96
needle phobia with, 45–46
for older adult patients, 69
self-monitoring of blood glucose (SMBG) and, 2
stability of, 84–85
timing and action of, 76–84, 77t, 85–86, 168
for type 1 diabetes (T1D), 5
weight gain and, 176
Insulin dosage. See also Total daily insulin dosages
acute adjustments to, 94–95
adjustments to, 75, 93–95, 95t
of basal insulin, 93, 109–111
fat and, 172–175
macronutrients and, 175
medical nutrition therapy (MNT) and, 168–169
pattern adjustments to, 95, 95t
physical activity and, 113–114
protein and, 172–175
for type 1 diabetes (T1D), 92–93
for type 2 diabetes (T2D), 93
Insulin dosage adjustments diet and, 112–113
in medical nutrition therapy (MNT), 172–175
weight gain and, 177
Insulin pen, 83, 85, 96. See also Continuous subcutaneous insulin infusion
Insulin pumps, 3. See also Continuous subcutaneous insulin infusion
for basal insulin, 106
with continuous glucose monitoring (CGM), 131, 132–133
in Diabetes Forecast, 108
extended bolus from, 107
insulin dosage for, 109–114
ketones and, 142
for needle phobia, 45–46
weight gain and, 177
Insulin resistance growth hormone and, 9
medical nutrition therapy (MNT) and, 161
psychological, 46
weight loss and, 158
Insulin sensitivity factor (ISF), 104
for bolus insulin, 111–112
continuous subcutaneous insulin infusion (CSII) and, 107, 108
Insulin-to-carbohydrate ratio (ICR), 92, 104
for bolus insulin, 111–112
continuous subcutaneous insulin infusion (CSII) and, 107
medical nutrition therapy (MNT) and, 161, 172, 174t
snacks and, 111
Integrated continuous glucose monitoring (iCGM), 131
Intensive diabetes management clinical considerations of, 60–70
of complications, 2, 3, 65
diabetes self-management education and support (DSME/S) in, 26–37
fuel metabolism in, 6–9
goal of, 4–5, 60–70
for hypoglycemia, 4, 66t, 67–68, 67t
implications for therapy, 9
medical nutrition therapy (MNT) and, 151–177
monitoring in, 139–149
multicomponent insulin regimens in, 74–96
patient selection for, 60–70
physiological basis of, 3–9
psychosocial issues with, 40–57, 66t
rationale for, 2–9
team approach in, 14–21
for type 1 diabetes (T1D), 65
for type 2 diabetes (T2D), 66
weight gain with, 175–177, 176t
Intermediate-acting insulin. See NPH insulin
Intermittently scanned continuous glucose monitoring (IS-CGM), 123–126
International Conference on Eating Disorders and Diabetes Mellitus Guidelines, 47
Interquartile range (IQR), 128
Isophane. See NPH insulin
K
Ketoacidosis. See also Diabetic ketoacidosis
continuous subcutaneous insulin infusion (CSII) and, 115–117, 116t
diabetes self-management education and support (DSME/S) and, 29t
Ketogenesis, 7
basal insulin secretion and, 8
Ketones, 7
in children, 142
diabetes self-management education and support (DSME/S) and, 29
monitoring of, 141–142
Ketosis, 8
Kumamoto Study, 4
L
Label reading, diabetes self-management education and support (DSME/S) and, 29t
L-arginine, 76
Life expectancy, 4, 66t
Lifestyle interventions medical nutrition therapy (MNT) and, 162, 164
psychosocial issues with, 51–52
for type 2 diabetes (T2D), 5
Lipid screening, 147–148, 147t
Lipoatrophy, 86
Lipohypertrophy, 86
Lipolysis, 7
basal insulin secretion and, 8
Lispro (Lyumjev), 74, 75, 76–78, 79
continuous subcutaneous insulin infusion (CSII) for, 91, 106
injection devices for, 96
mixtures of, 83–84
NPL, 77t, 83–84
prandial insulin and, 87
stability of, 85
timing of, 86
U-200 insulin, 83
Long-acting insulin, 74, 77t, 80–81, 168
absorption of, 85
weight gain and, 176–177
Long-term adherence, psychosocial issues with, 55–56
Look AHEAD study, 47, 51
Lovastatin, 147t
Lysine, 81
Lyumjev. See Lispro
M
Macronutrients, 157t
insulin dosage and, 175
prandial insulin and, 175
snacks and, 93
Marijuana, substance abuse of, 48
Medical nutrition therapy (MNT), 151–177
alcohol and, 157t, 170
continuous glucose monitoring (CGM) and, 165–167, 166t
goals of, 154–155, 155t
hypoglycemia and, 153, 167–168, 167t
insulin dosage and, 168–169
insulin dosage adjustments in, 172–175
insulin-to-carbohydrate ratio (ICR) and, 161, 172, 174t
meal-planning in, 172, 173t
physical activity and, 169–170
self-management in, 171
targets of, 155, 155t–157t
for type 1 diabetes (T1D), 152, 158–161, 159f, 160t
for type 2 diabetes (T2D), 152, 161–164
Mediterranean-style diet, 156t, 162–163
Metabolic surgery, 163
Micronutrients, 157t
Monitoring, 139–149. See also Continuous glucose monitoring; Self-monitoring of blood glucose of A1c, 143–146, 144t, 145t
of blood glucose, 139–141
of blood pressure, 148
of complications, 146–149, 146t
of ketones, 141–142
by team approach, in intensive diabetes management, 142–143, 143t
Monosaccharides, 6
mSCOFF, 47
Multicomponent insulin regimens, 74–96, 168
general points on, 87–91, 87f–91f
premeal program in, 88–91, 88f–90f
Multiple-dose insulin (MDI) carbohydrate and, 175
continuous subcutaneous insulin infusion (CSII), 113
glycemic control with, 114
for hypoglycemia, 68
nutrition medical therapy (NMT) and, 167
N
Needle phobia, 45–46
Niacinamide (vitamin B3), 76
Nocturia, in older adult patients, 70
Nocturnal hypoglycemia, 81
continuous subcutaneous insulin infusion (CSII) for, 91, 108, 109t
glycemic control targets for, 63
NPH insulin for, 90
Noninsulin pharmacotherapies, 3, 167
for type 2 diabetes (T2D), 63, 66
Norepinephrine, 8–9
NovoRapid, 78f
NPA insulin (aspart protamine suspension), 77t, 84
NPH insulin (isophane), 74, 75, 77t, 80, 168
absorption of, 85
basal insulin and, 88–91, 88f–90f
dose of, 93
injection devices for, 96
insulin dosage pattern adjustments to, 95t
mixtures of, 83–84
stability of, 84–85
weight gain and, 176–177
NPL (lispro protamine suspension), 77t, 83–84
Nutrition. See also Medical nutrition therapy
diabetes self-management
education and support (DSME/S) and, 30
O
Obesity atherosclerotic cardiovascular disease (ASCVD) and, 147
with type 2 diabetes (T2D), 47, 94, 163
Older adult patients, 84
continuous glucose monitoring (CGM) for, 127
glycemic control targets for, 69–70, 127
physical activity for, 177
Omega-3 fatty acids, 156t–157t
Omnipod pump, 106
P
Patient Health Questionnaire 9
(PHQ-9), 43
Patient selection, 60–70
Pattern adjustments, to insulin dosage, 95, 95t
Personal diabetes management (PDM), 106
Pharmacodynamics of detemir, 81, 82f
insulin absorption and, 85
Pharmacokinetics (PK), 78
Physical activity (exercise) continuous subcutaneous insulin infusion (CSII) and, 91
diabetes self-management education and support (DSME/S) and, 29t, 30
insulin absorption and, 86 insulin dosage and, 113–114
intensive diabetes management and, 2
medical nutrition therapy (MNT) and, 169–170
weight gain and, 177
Pioglitazone, 167
Pitavastatin, 147t
Point-of-care (POC), A1c, 145
Postprandial glycemia/glucose (PPG), 142
A1C and, 64t continuous glucose monitoring (CGM), 123–124
continuous subcutaneous insulin infusion (CSII) and, 93
medical nutrition therapy (MNT) and, 164
in pregnancy, 68
Prandial insulin, 7, 8
continuous subcutaneous insulin infusion (CSII) for, 93
insulin dosage of, 93
insulin dosage pattern adjustments to, 95t
macronutrients and, 175
medical nutrition therapy (MNT) and, 160–161
for multicomponent insulin regimens, 75, 87–88
protein and, 156
Pravastatin, 147t
PREDIMED trial, 163
Pregnancy continuous subcutaneous insulin infusion (CSII) and, 108, 109t
glycemic control in, 3
glycemic control targets in, 68
intensive diabetes management in, 65
retinopathy in, 146
total daily insulin dosages (TDD) and, 75
Problem Areas in Diabetes (PAID), 43
Problem-solving, psychosocial issues with, 49–50
Progestins, weight gain and, 176
Protein continuous subcutaneous insulin infusion (CSII) and, 108
hypoglycemia and, 177
insulin dosage and, 172–175
intensive diabetes management and, 2
medical nutrition therapy (MNT) and, 156t
metabolism of, 6–7
Psychosocial issues, 40–57, 66t
with adherence screening, 50–51, 51t
anxiety, 44–46
with complications, 49
with coping, 49–50
diabetes burnout, 43
diabetes distress and depression, 43–44
eating disorders, 46–48
with lifestyle interventions, 51–52
with long-term adherence, 55–56
with problem-solving, 49–50
with social support, 52–55
with stressors, 48–49
substance abuse, 48
R
Rapid-acting insulins, 74, 77t, 79, 168, 175
bolus insulin and, 111–112
continuous subcutaneous insulin infusion (CSII) for, 91, 91f, 106
glycemic control and, 109
stability of, 85
timing of, 85–86
weight gain and, 176–177
Real time-continuous glucose monitoring (RT-CGM), 123–126
Reasonable weight, 159f, 164
Registered dietitian nutritionist (RD/ RDN), 152, 171
Retinopathy, 146–147
Rosuvastatin, 147t
S
Self-efficacy diabetes self-management education and support (DSME/S) and, 28
patient-healthcare professional relationship and, 55
for problem-solving, 50
psychological insulin resistance with, 46
Self-monitoring of blood glucose (SMBG), 2, 3, 5
adjustments to, 75
ambulatory glucose profile (AGP) for, 144
for bolus insulin, 132, 140
insulin dosage acute adjustments and, 94
for ketones, 141
for multicomponent insulin regimens, 74, 87
Severe hypoglycemia (SH), 126
Short-acting insulin, 74, 75, 77t, 79–80, 80f
Sick-day management, diabetes selfmanagement education and support (DSME/S) and, 29t
Simvastatin, 147t
Skeletal muscle, 6, 8, 9
Skin infection, with continuous subcutaneous insulin infusion (CSII), 114–115
Smoking
atherosclerotic cardiovascular disease (ASCVD) and, 147
cessation, 4
physical activity and, 86
Snacks, 168
alcohol and, 170
for children, 176–177
diabetes self-management education and support (DSME/S) and, 30
for hypoglycemia, 171
insulin mixtures and, 84
insulin-to-carbohydrate ratio (ICR) and, 111
macronutrients and, 93
NPH insulin and, 84, 92
weight gain and, 176–177
Social drugs diabetes self-management education and support (DSME/S) and, 30
substance abuse of, 48
Social support depression and, 44
diabetes self-management education and support (DSME/S) and, 30
from family, 52–53
in living with others, 53–54
in patient-healthcare professional relationship, 55–56
for problem-solving, 50
psychosocial issues with, 52–55
Sodium glucose cotransporter-2 (SGLT2) inhibitors, 4, 55, 168
diabetic ketoacidosis (DKA) and, 142
type 2 diabetes (T2D) and, 66
weight gain and, 176, 177
Square-wave bolus, 107, 113
Statins, 147–148, 147t
Stressors catecholamines and, 8
diabetes self-management education and support (DSME/S) and, 30
insulin dosage acute adjustments and, 94
intensive diabetes management and, 2
psychosocial issues with, 48–49
Stroke, 4
Substance abuse, 48, 66t
Sulfonylureas, 5
SUSTAIN 1–3, 177
T
Team approach, in intensive diabetes management, 14–21
communication in, 20–21, 20t, 21t
for complications, 16
diabetes self-management support and education (DSME/S) and, 27–28
improvements to, 17t
integrated diabetes management team, 17–18, 18t
members’ roles in, 19–20, 19t
monitoring by, 142–143, 143t
Thiazolidinediones, 5, 176
Time above range (TAR), 126
Time below range (TBR), 126
Time in range (TIR), 126–127
TODAY Study, 47
Total daily insulin dosages (TDD), 75, 104
A1c and, 110
for basal insulin, 111
for children, 75, 110
Traveling, diabetes self-management education and support (DSME/S) and, 29t
Treprostinil, 76–77
Triglyceride, 7
Type 1 diabetes (T1D) A1c in, 3
basal insulin dosage for, 109–111
children with, 53, 69
continuous glucose monitoring (CGM) for, 9, 63, 141
coping by, 49–50
diabetes self-management education and support (DSME/S) for, 35t
eating disorders with, 46–47
family and, 53
fat for, 157t
glucagon and, 8
honeymoon phase of, 75
hypoglycemia in, 8
inhaled insulin for, 78
insulin dosage for, 92–93
insulin for, 5
intensive diabetes management for, 65
lipids and, 148
medical nutrition therapy (MNT) for, 152, 158–161, 159f, 160t
in pregnancy, 68
protein for, 156
psychosocial issues with, 40–57
sodium glucose cotransporter-2 (SGLT2) inhibitors for, 142
stressors and, 49
substance abuse with, 48
time in range (TIR) for, 126
total daily insulin dosages (TDD) and, 75
U-300 glargine for, 81
urinary albumin screening for, 148
Type 2 diabetes (T2D), 3
alcohol and, 170
binge eating with, 47
cardiovascular disease with, 4, 66
children with, 69
fat for, 156t
insulin dosage for, 93
intensive diabetes management for, 66
Kumamoto Study on, 4
lifestyle interventions for, 5
lipids and, 148
medical nutrition therapy (MNT) for, 152, 161–164
noninsulin pharmacotherapies for, 63
obesity with, 47, 94, 163
in pregnancy, 68
protein for, 156
psychological insulin resistance with, 46
psychosocial issues with, 40–57
sodium glucose cotransporter-2 (SGLT2) inhibitors for, 142
stressors and, 49
time in range (TIR) for, 126
U-300 glargine for, 81
- U.
K. Prospective Diabetes Study (UKPDS) on, 4
urinary albumin screening for, 148
weight and, 66, 93, 158, 162, 163–164
U
U-100 glargine, 74, 80, 88
U-200 insulin, 83
U-300 glargine, 74, 81, 83, 88
U-500 insulin, 83
U.K. Prospective Diabetes Study (UKPDS), 4, 51
Ultra-long-acting insulin, 74, 77t, 81, 82f
basal insulin and, 88
Ultra-rapid acting insulins, 74, 75, 76–78, 77t, 78f, 79f, 175
insulin dosage pattern adjustments to, 95t
prandial insulin and, 87
stability of, 85
Urinary albumin screening, 148
Urinary incontinence, in older adult patients, 70
V
Very-low-carbohydrate (VLC), 162, 163
Veterans Affairs Diabetes Trial (VADT), 4
Visual impairment, 66t
Vitamin B3 (niacinamide), 76
Vitamin B12, 157t
Vitamin D, 157t
W
Weight (gain/loss). See also Obesity adherence and, 50
antihyperglycemic medications for, 177
depression and, 44
insulin resistance and, 158
with intensive diabetes management, 175–177, 176t
medical nutrition therapy (MNT) and, 153
physical activity and, 170
protein and, 156
type 2 diabetes (T2D) and, 66, 93, 158, 162, 163–164
