Type 1 diabetes is a complex disease that can begin at any age. Healthcare professionals must diagnose and create individualized, flexible treatment plans to optimize blood glucose control in consideration of the psychosocial factors at the varying ages and developmental stages of each patient, all within the context of their individual support structures.
Completely updated and revised, this eighth edition of Medical Management of Type 1 Diabetes is an essential text addressing the fundamental aspects of type 1 diabetes for healthcare professionals. The book provides a fresh and comprehensive overview of the challenges and approaches to caring for patients with type 1 diabetes in accordance with the latest American Diabetes Association Standards of Medical Care in Diabetes.
"Index", Medical Management of Type 1 Diabetes, 8th Edition, M. Sue Kirkman, MD
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Note: Page numbers followed by an f refer to figures. Page numbers followed by t refer to tables.
A
A1C, 7, 44–45, 225
correlation with eAG, 45t
glycemic goals in children, 42t
glycemic goals in non-pregnant adults, 41t
Abnormal linear growth, 256–258
Acetoacetate (AcAc), 124
Acetone, 124
Adjunctive therapies, T1D, 119–122
Adolescents
developmental considerations, 203–204t, 205–206, 207
nutritional recommendations, 72–73
Adults, non-pregnant, glycemic goals, 41t
AGP. see Ambulatory Glucose Profile
Albuminuria, prevention of CVD, 248
Alcohol consumption, 72
Aligned diabetes management plan, 39
Ambulatory Glucose Profile (AGP), 49, 50f
SMBG data, 46
American Diabetes Association (ADA),
Education Recognition
Program, 61–62
Angiotensin converting enzyme inhibitors (ACE inhibitors), 232
Angiotensin receptor blockers (ARBs), 232
Anxiety symptoms, 199
Aspirin, prevention of CVD, 249–250
Association of Diabetes Care and Education Specialists, 61–62
Atypical neuropathies, 241
Autoimmune thyroid disease, 27
Autoimmunity with hyperglycemia, stage 2 of T1D, 25
Autoimmunity with normoglycemia, stage 1 of T1D, 23–24, 24f
Autonomic neuropathy, 239–241
symptoms and signs, 240t
B
Being active, DSME framework, 64–65
β-cells, 7
functional mass, 20f
monogenetic defects in function, 12
reduced mass, 15, 16f
replacement therapy, 181, 182f
β-Hydroxybutyric acid (β-HBA), 124
Bicarbonate and phosphate replacement, DKA, 144
Blood glucose monitor, comparison of standards, 47t
Blood pressure control, prevention of CVD, 248
C
Capillary or interstitial glucose monitoring, 124
Carbohydrate
adjusting for exercise, 110–113, 112t
Carbohydrates (continued) quality of adults, 71
children and adolescents, 72
rule of 15, 155
Cardiac autonomic neuropathy (CAN), 239–241
treatment, 239–240
Cardiovascular disease (CVD), 247–251
prevalence and risk factors, 247–248
prevention, 248–250
screening, 223t, 250
Celiac disease, 27
Cell-mediated immunologic dysfunction, T1D, 22
Cerebral edema, in DKA, 145–146
CGM. see Continuous glucose monitoring
Charcot foot deformity, 244
Cheiroarthropathy, 253–254, 254f
Children
consensus algorithm for treatment of DKA, 138–139f
glycemic goals, 42t
nutritional recommendations, 72–73
recommended monitoring, 126–127t
Chronic complications, 221–223, 222–223t. see also specific complication
Chronic Kidney Disease Epidemiology Collaboration (CDK-EPI), 230 Chronic pain, 197t
Clinic-performed monitoring, 125
Closed-loop insulin delivery systems, 97–98
Cognitive screening in older adults, 197t
Complicating factors, DSME critical time, 67
Continuous glucose monitoring (CGM), 44, 48–49, 79–80
intermittent scanned systems, 49
real-time systems, 49
standardized metrics for clinical care, 50t
use in assessing diabetic control, 49–51
D
Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease (DAPA-CKD)
trial, 233
Depression, 192, 194t
Diabetes. see also specific type due to other causes, 7
Diabetes Control and Complications Trial (DCCT), 16, 38–39, 61, 70, 232
Diabetes distress, 191–192, 193t
Diabetes management team, 39
Diabetes Medical Management Plan, 205
Diabetes self-management education and support (DSMES), 61–68
assessment, 63, 63t
critical times to consider, 66–68
documentation, 64
evaluation, 64
framework and content areas of, 64–66
general principles, 62
implementation, 63–64
multidisciplinary team, 61–62
national standards, 62
planning strategies, 63
processes, 62, 62t
Diabetic ketoacidosis (DKA), 11, 15, 135–148
acute care for, 137–144, 137t
bicarbonate and phosphate replacement, 144
cerebral edema in, 145–146
clinical signs and symptoms, 136, 137t
consensus algorithm for treatment, 138–139f
flow sheet, 140t
important treatment considerations, 144–145
insulin replacement, 142–143
intermediate care, 146
potassium replacement, 143–144
precipitating factors, 137
presentation and incidence, 135–137, 136t
prevention, 147–148
rehydration process, 141–142, 141t
Diabetic kidney disease (DKD), 230–235, 231f
pathogenesis, 230
prevention and treatment, 232–233
screening for, 231–232
stages, 230–231
Dialysis, 233–234
Distal symmetric sensorimotor polyneuropathy (DSPN), 236–239
prevention, 238
screening and diagnosis, 237–238, 238t
symptoms and signs, 238t
treatment, 239
DKA. see Diabetic ketoacidosis
DSMES. see Diabetes selfmanagement education and support (DSMES)
DSPN. see Distal symmetric sensorimotor polyneuropathy (DSPN)
E
eAG. see Estimated average glucose Eating disorders, 195t
Education Recognition Program, ADA, 61–62
Environmental triggers, T1D, 23
Epidemiology of Diabetes Interventions and Complications (EDIC), 38, 232, 238
Epigenetic modification, T1D, 23
Estimated average glucose (eAG), 45t
Estimated glomerular filtration rate (eGFR), 230
Exercise, 108–115
cardiovascular complications, 114–115
glycemic response to, 108–110, 109t
insulin and, 100–102, 101t, 102t
maintaining glycemic control with, 110–115
microvascular complications, 115
options with diabetes complications, 116t
potential risks, 109
prescription, 115–116
prevention of CVD, 249
training recommendations, 111t
F
Family history, T1D risk stratification, 22t
Family issues, 203–206. 203–204t
Family planning and contraception, T1D, 174
Federal guidelines for healthy eating, 70–71
Fetal condition assessment during pregnancy, 170–171t
biophysical profile, 172
growth assessment, 172
Foot care specialist, 245
Foot deformities, 243f
Foot issues due to neuropathy, 241–248
prevention, 242
G
Gene defects, MODY, 12
Genetics, T1D, 21–27, 22t
Gestational diabetes, 7, 11
GLP-1. see Glucagon-like peptide-1 (GLP-1)
Glucagon-like peptide-1 (GLP-1), 120–121
Glycated hemoglobin (A1C test), 125
Glycemic control, 37–39
American Diabetes Association guidelines, 41
goals of treatment, 39–41
maternal during delivery, 173
monitoring beyond, 125–127, 126–127t
prevention of CVD, 248
tests for, 124–125
Glycemic goals children, 42t
non-pregnant adults, 41t
other assessments, 42
philosophy of, 37
Glycemic index/glycemic load, 71
Growth abnormalities, mechanisms for, 256–257
Growth hormone (GH)/insulin-like growth factor 1(IGF-1) axis, 256
Growth rate, determination of, 256f, 257, 257f
H
Healthy coping, DSME framework, 64–65
Healthy eating
DSME framework, 64–65
federal guidelines, 70–71
prevention of CVD, 249
Healthy literacy and numeracy, 195t
Hemoglobin A1c. see A1C
High-insulin state, 19t
Home monitoring, 124
Honeymoon stage (remission), T1D, 16, 86–87
Hospitalizations and surgery, 177–180
general principles, 177–178
Hyperglycemia, 37–41
exercise and, 109, 114
Hypertension, DKD and, 232–233
HypoCOMPASS trial, 157
Hypoglycemia, 151–158
classification of, 151t
common causes, 154t
exercise and, 109, 113–114, 113t
fear of, 196–197t, 199
pathophysiology, 152–153
potential effects, 155
reducing the risk, 156–157
risk factors and causes, 153–155
signs and symptoms, 153–155
treatment, 155–156
Hypoglycemia-associated autonomic failure (HAAF), 153
I
ICR. see Insulin-to-carbohydrate ratio (ICR)
Impaired awareness of hypoglycemia (IAH), 153
Insulin, 77–104
allergy, 99–100
alternative delivery routes, 98–99
choice of and delivery during pregnancy, 165–167
chronic phase, 87
duration of action, 79–80, 80t
immunological resistance, 100
local reactions, 100
management during acute illness, 102–103
mixing, 85
newly diagnosed patients, 85–88
pens and apps, 85
pharmacokinetic and pharmacodynamic properties, 80t
pregnancy and postpartum, 167
remission or honeymoon phase, 86–87
special considerations, 100–104
species and purity, 79
subcutaneous regimens, 81–84t
Insulin preparations, 77–85, 78f
Insulin pump therapy, 93–98, 94f
initiation of, 96–97
integration with CGMS, 97–98
Insulin regimens
general principles, 88–89
matching with meal patterns and macronutrients, 73
multiple-component flexible, 91–93, 92f
subcutaneous, 81–84
two or three injections daily, 89–91, 90f, 91f
Insulin replacement, DKA, 142–143
Insulin sensitivity factor (ISF), 93
Insulin-to-carbohydrate ratio (ICR), 73
International Federation of Clinical Chemists (IFCC), 44
Islet cell transplants, 182
J
JDRF-CGM trial, 48
Joslin, Elliott, 61
Juvenile-onset diabetes. see Type 1 diabetes (T1D)
K
Ketone testing, 124–125
Ketonuria, testing for, 124
Kidney transplantation, 233–234
L
Language, diabetes care and education, 199–200
Leprechaunism, 12
Life and care transitions, DSME critical time, 67–68
Long-term treatment plan, 87
LOPS. see Loss of protective sensation (LOPS)
Loss of protective sensation (LOPS), 241–243, 244f
Low-insulin state, 19t
M
Macronutrient proportions and eating patterns
adults, 71
children and adolescents, 72–73
matching with insulin regimens, 73
Macular edema, 226
treatment, 228
Major surgery, 179
Maturity-onset diabetes of the young (MODY). see Monogenic diabetes
Mauriac Syndrome, 256
Medical nutrition therapy (MNT), 70
Mental health referrals, 213, 213t
Metabolic decompensation, T1D, 15
Metformin, 120
Minor surgery, 179
MNT. see Medical nutrition therapy (MNT)
Monitoring, 124–128
beyond glycemic control, 125–127, 126–127t
clinic-performed, 125
DSME framework, 64–66
home, 124
Monogenic diabetes, common causes, 10t, 12
Musculoskeletal complications, 252–255
N
National Glycohemoglobin Standardization Program (NGSP), 44
Nausea, insulin and, 102–103
NDM. see Neonatal diabetes
Neonatal diabetes (NDM), 12. see also Monogenic diabetes
treatment, 103–104
Neovascularity, 225
Nephrologist, 233
Neuroarthropathy, 244
Neuropathy, 236–246, 237t
overview, 236
Newborns and infants, diabetes treatment, 103–104
Nitroprusside reaction, 125
Non-insulin adjunctive therapies, 119–122
Non-nutritive sweeteners, 73–74
Non-proliferative retinopathy (NPDR). see Retinopathy
Non-steroidal anti-inflammatory drugs, 233
Nonstress test (NST), in pregnancy, 169
NST. see Nonstress test (NST)
Nutrition, 70–74
all age groups, 73–74
children and adolescents, 72–73
during pregnancy, 167–168
recommendations for adults, 71–72
weight considerations, children and adolescents, 73
O
OGTT. see Oral glucose tolerance test (OGTT)
Osteoporosis and fractures, 252–253
Overweight and obesity, nutritional therapy, 71–72
P
Pancreas and islet cell transplantation, 181–183
Pancreas transplant alone (PTA), 181
Peers, diabetes effects, 202–203
Perioperative management, 178
Personal digital assistant (PDA), control of insulin pump, 95
Person-centered assessment, DSMES, 63, 63t
Plasma glucose concentration
fasting, 7–8, 8t
random, 7
Postpartum care, 173–174
Potassium replacement, DKA, 143–144
Pramlintide, 119–120
Prediabetes, 8
Preeclampsia, in diabetes, 164
Pregnancy, 161–174
acute metabolic complications, 164–165
adverse outcomes with pre-existing diabetes, 162–164
fetal well-being, 169, 170–171t
glucose monitoring during, 167
glycemic controls during, 166t
insulin and delivery methods, 165–167
insulin doses during and postpartum, 167
labor and delivery, 173
managing T1D, 165–167
maternal metabolism during, 161
maternal self-assessment, 169
multiple daily injections during, 166
nonstress test, 169
nutrition needs, 167–168
obstetric care, 169
outpatient care, 168–169
postpartum care, 173–174
preconception care and counseling, 161–162, 163t
timing of delivery, 172–173
worsening of diabetes complications, 164
Problem solving, DSME framework, 64, 66
Proliferative retinopathy (PDR). see Retinopathy
Psychosocial issues, 191–2011, 192f
R
Rabson-Mendenhall syndrome, 12
Reducing risk, DSME framework, 64, 66
Rehydration process, DKA, 141–142, 141t
Renin-angiotensin-aldosterone pathway (RAAS), 232
Retinopathy, 224–228
advanced, treatment, 227
mild, prevention of progression, 227
non-proliferative (NPDR), 224–225
proliferative (PDR), 225
screening for, 226–227
stages, 225t
Risk calculators, use in T1D, 250
Rule of 15, 155
S
School, diabetes effects, 202–203
Self-care, 196f
adherence to, 198f
Self-monitoring of blood glucose (SMGB), 42, 45–46, 79–80
frequency of, 46–47
successful, 48
Simultaneous pancreas and kidney transplant (SPK), 181
SMGB. see Self-monitoring of blood glucose
Smoking, risk factor for CV, 249
Social determinants of health (SDoH), 199
Sodium-glucose cotransporters-2 (SGLT2), 121–122
Sodium glucose-like transporter 2 (SGLT-2), 233
Statin therapy, prevention of CVD, 248–249
Stockholm Diabetes Intervention Study, 38–39
Syndromes of limited joint mobility (Cheiroarthropathy), 253–254, 254f
T
Taking medication, DSME framework, 64–65
The Environmental Determinants of Diabetes in the Young (TEDDY), 22
Time of diagnosis, DSME critical time, 66–67, 67t
TODAY (Treatment Options for Type 2 Diabetes in Adolescents and Youth) Study, 9
Transplantation, pancreas, 181
Type 1 diabetes (T1D), 7
adults, developmental considerations, 207–209
autoimmunity with hyperglycemia (stage 2), 25
autoimmunity with normoglycemia (stage 1), 23–24, 24f
characteristics, 9
children, 202–205, 203–204t, 203–205
chronic complications, 221–223, 222–223t (see also specific complication)
clinical presentation, 14
criteria for diagnosis, 7–8, 8t
distinguishing among types, 11
early age adults, developmental considerations, 207–208
environmental triggers, 23
epigenetic modification, 23
genetics of, 21–27, 22t
hospitalizations and surgery, 177–180
hyperglycemia with typical symptoms (stage 3), 25
non-insulin adjunctive therapies, 119–122
older adults, developmental considerations, 211
onset of symptoms and metabolic decompensation, 15
other autoimmune diseases and, 26–27
pancreas and islet cell transplantation,181–183
pathogenesis, 18–27
pathophysiology of clinical onset, 18–20, 19t
psychosocial factors and, 191–207, 192f
children and adolescents, 203–206
recommended monitoring, 126–127t
remission or honeymoon stage, 16
screening and intervention trials, 25–26
stages in development, 20–21, 20f
Type 1A and Type 1B, 18
young and middle-aged adults, developmental considerations, 209
Type 2 diabetes (T2D), 7
characteristics, 9
distinguishing among types, 11
U
Urine ketone testing, 124
V
Vomiting, insulin and, 102–103
W
Weight management, prevention of CVD, 249
Wolfram syndrome, 12
