Care of People with Diabetes

PROFESSOR TRISHA DUNNING, AM, RN, MEd, PHD, CDE, FACN (DLF), is a Registered Nurse and credentialed Diabetes Educator. She is the Chair in Nursing at Barwon Health and Deakin University Partnership in Geelong, Australia. PROFESSOR ALAN SINCLAIR, MSC, MD, FRCP, is Director of the Foundation for Diabetes Research in Older People (FDROP) at Diabetes Frail, and Visiting Chair in Diabetes Care, King's College London, London, UK.

• Foreword xiiiPreface xvAcknowledgments xviiList of Abbreviations and Symbols xix1 Diagnosing and Classifying Diabetes 1Key points 1What is diabetes mellitus? 2Prevalence of diabetes 2Classification of diabetes 3Overview of normal glucose homeostasis 3Brain‐centric model of glucose homeostasis 10Metabolic syndrome in children and adolescents 13Types of diabetes 14Diagnosing diabetes 22Preventing diabetes 26Managing diabetes mellitus 29Key points 29Complications of diabetes 36Aims and objectives of diabetes care 38Technology and diabetes management 40A sobering final comment 42References 432 Holistic Personalised Diabetes Care 49Key points 49Rationale 49Shared decision‐making (SDM) 50Holistic diabetes care 51Communication and the power of language 52Reading fiction to improve empathy and communication skills 53Care models 53Characteristics of an holistic health history 55References 583 Assessing and Monitoring People with Diabetes 61Key points 61Rationale 61Key issues to consider in comprehensive assessments 62Monitoring glucose levels 62Monitoring 1: Blood glucose 64Key points 64Insulin pumps 75Monitoring 2: Urine glucose 76Key points 76Monitoring 3: Additional assessment 78Self‐care 82The annual review 83Summary 83References 834 Nutrition and Weight Management 87Key points 87Rationale 87The importance of good nutrition 88Malnutrition and undernutrition 88Method of screening for dietary characteristics and problems 90Principles of dietary management for people with diabetes 92Goals of dietary management 95Overweight and obesity 95Methods of measuring weight 99Managing obesity and diabetes 100Dietary management: overweight and obesity 101Factors associated with making dietary changes 103Key points 104Alcohol 107Exercise/activity 107References 108Further reading 1125 Medicine Management 113Key points 113Introduction 114QUM 114QUM and diabetes 114GLM 117Medicine interactions 129Combining GLMs and insulin 130When should insulin be initiated in Type 2 diabetes? 131Challenges to initiating insulin therapy 134Some strategies to overcome the barriers 135Insulin therapy 136Types of insulin available 136Storing insulin 139Injection sites and administration 140Mixing short/rapid acting‐ and intermediate‐acting insulins 141Commonly used insulin regimens 141Interpreting morning hyperglycaemia 143CSII 143Continuous blood glucose sensors 144Subcutaneous insulin sliding scales and top‐up regimens 145Uses of insulin infusions 147Insulin allergy 149Pancreas transplants 150Stabilising diabetes 150Stabilising diabetes in hospital 150Community and outpatient insulin stabilisation 151Lipid‐lowering agents 153Monitoring lipid medicines 157Antihypertensive agents 158Antiplatelet agents 159Medication safety, adherence, and medication self‐management 161Enhancing medication self‐care 163Example protocol for outpatient stabilisation onto insulin 166References 1676 Hypoglycaemia 175Key points 175Rationale 175Introduction 176The counter‐regulatory response 178Definition of hypoglycaemia 179Recognising hypoglycaemia 182The brain and glucose homeostasis 183Causes of hypoglycaemia 183Preventing and managing hypoglycaemia 184Hypoglycaemic unawareness 185Prevalence of HU 186Nocturnal hypoglycaemia 187Relative hypoglycaemia 189Medicine interactions 189Objectives of care 190Treatment 190Prolonged hypoglycaemia 191Patients most at risk of hypoglycaemia 192Psychological effects of hypoglycaemia 193Guidelines for administering glucagon 194Adverse reactions 195References 1967 Hyperglycaemia, Acute Illness, Diabetic Ketoacidosis (DKA), Hyperosmolar Hyperglycaemic States (HHS), and Lactic Acidosis 199Key points 199Rationale 200Prevention: proactively managing intercurrent illness 200Self‐care during illness 202Hyperglycaemia 202Diabetic ketoacidosis (DKA) 204Brittle diabetes and hyperglycaemia 211Euglycaemic DKA 211Hyperosmolar hyperglycaemic states 212Lactic acidosis 214References 2168 Long‐Term Complications of Diabetes 219Key points 219Introduction 220Diabetes and complexity 220Pathophysiology of diabetes complications 221Cardiovascular disease and diabetes 223Key points 223Cerebrovascular disease 236Diabetes and eye disease 237Diabetes and renal disease 243Peripheral and autonomic neuropathy 255Autonomic neuropathy 266References 2709 Management in Hospital, Surgery, and Investigations 279Emergency department 279Key points 279Surgical procedures 280Key points 280Preoperative care 284Postoperative care 289Guidelines for informing people with diabetes about what they should do prior to surgical procedures 290Insulin pump therapy in patients undergoing surgery 292Emergency procedures 292Bariatric surgery 293Investigative procedures 293Key points 293The objectives of care 294General management 294Eye procedures 295Complementary medicines and other therapies during surgery and investigative procedures 298Preoperative phase 298Postoperative phase 299Implications for care 299References 300Example Information 2(a): Instructions for people with diabetes on oral glucose-lowering medicines having procedures as outpatients under sedation of general anaesthesia 301Example Instruction Sheet 2(b): Instructions for people with diabetes on insulin having procedures as outpatients under sedation or general anaesthesia 30210 Conditions Associated with Diabetes 303Key points 303Introduction 303Enteral and parenteral nutrition 304Diabetes and cancer 309Smoking, alcohol, and illegal drug use 315Brittle or labile diabetes 326Oral health and diabetes 328Diabetes and liver disease 329Haemochromatosis 332Diabetic mastopathy 333Diabetes and coeliac disease 334Cystic fibrosis−related diabetes 336Incontinence 338Sleep disturbance and diabetes 340Diabetes and tuberculosis 341Diabetes and HIV/AIDS 342Diabetes and hearing loss 343Diabetes, musculoskeletal disease, and osteoporosis 345Corticosteroid medications and diabetes 347Key points 347Diabetes and driving 350Diabetes and fasting for religious observances 359Education and counselling 359References 36011 Sexual and Reproductive Health 371Key points 371Rationale 371Sexual health 372Sexual development 373Sexual problems 374Possible causes of sexual difficulties and dysfunction 374Sexuality and older people 375Women 376Men 377Sexual counselling 380Role of the clinician 383References 38312 Diabetes and Older People 385Key points 385Rationale 386Introduction 386Determining functional status 392Geriatric syndromes 394Cognitive functioning and dementia 395Depression and older people with diabetes 400Dementia 400Caring for older people with diabetes 401Education approaches 408Self‐care 409Factors that can affect metabolic control 410Overall care strategies 417References 41813 Diabetes in Children and Adolescents 425Key points 425Rationale 425Introduction 426Impact of hyper‐ and hypoglycaemia on brain development and function 429Managing children and adolescents with diabetes 430Aspects of care that apply to both type 1 and type 2 diabetes in children and adolescents 430Managing type 1 diabetes 431Managing type 2 diabetes 433Medicine self‐management 436Other conditions associated with diabetes 436Strategies for enhancing adherence during adolescence 437Ketoacidosis in children 438Complementary therapy use in children 438References 43914 Women, Pregnancy, and Gestational Diabetes 443Key points 443Rationale 443Polycystic ovarian syndrome 444Contraception options for women with diabetes 447Pregnancy 449Gestational diabetes 455Menopause and diabetes 459References 46215 Psychological and Quality of Life Issues Related to Having Diabetes 467Key points 467Rationale 468Introduction 468Clinician factors 469Adjustment and spirituality 472Diabetes: reputation and myths 473Diabetes‐related distress 474Quality of life 474Diabetes and depression 476Mental health and type 1 diabetes 480Mental health and type 2 diabetes 480Psychological distress and cardiovascular disease 481Psychiatric disorders, diabetes, and antipsychotic medicines 482Diabetes conversations and language 483References 486Further reading 49016 Diabetes Education 491Key points 491Rationale 492Introduction 492Learning styles 495Education and other theories/models 497Communication – having good conversations 500Teaching: an art and a process 503Health literacy 504Survival skills 507Empowerment 508Special issues 509The clinicians’ role in diabetes education 509Documenting diabetes education 512Evaluating diabetes education 515References 517Further reading 52117 Managing Diabetes at the End of Life 523Key points 523Introduction 524Explanation of terms: values, life limiting illness, palliative care, terminal care, and end‐of‐life care 524Palliative care 525General management considerations for managing diabetes at the end of life 531Diabetes‐specific considerations 532Medicine management 534Type 1 diabetes 534Nutrition and hydration 536Diabetogenetic medicines 537Supporting family/carers 538Withdrawing treatment 539Diabetes education 539References 54018 Complementary Medicine 543Key points 543Rationale 543Introduction 544CAM philosophy 546Integrating complementary and conventional care 547Can Complementary Therapies Benefit People with Diabetes? 549Spirituality 552CM and surgery 552Herb/medicine interactions 556How can CM be used safely? 556Clinician responsibilities 560Identifying quality health information on the internet 561Recommended resources 563References 563Index 567

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