Outsmarting Diabetes

Richard S. Beaser

Description

From the world-renowned Joslin Diabetes Center and the coauthor of the million-copy seller, The Joslin Diabetes Manual, this book is based on the results of the ten-year Diabetes Control and Complications Trial (DCCT) from the National Institutes of Health--which proved that intensive control, opposed to standard methods, greatly reduces the effects of diabetes and the risk of long-term complications.
Can Diabetes Complications Be Prevented?

What Is Intensive Management?

Designing Your Own Plan.

Getting Started.

Living with an Intensive Plan.

Planning Your Meals.

Using Multiple Daily Insulin Injections.

Using Insulin Pumps.

Exercise and the Intensive Plan.

Pregnancy and Intensive Diabetes Therapy.

Psychological Concerns.

When Things Go Awry.

Appendices.

Sujets

• Santé et bien-être
• Santé du quotidien
• Santé au quotidien
• Santé au quotidien
• National Institutes of Health
• Fitness
• Diabetes
• Health
• Diabetes mellitus type 2
• Joslin Diabetes Center
• Diabetes mellitus type 1
• Diseases

Informations

• Publié par: Turner Publishing Company
• Date de parution: 21 avril 2008
• Nombre de lectures: 0
• EAN13: 9780470311486
• Langue: English

Extrait

OUTSMARTING DIABETES
A Dynamic Approach for Reducing the Effects of Insulin-Dependent Diabetes
Richard S.Beaser, M.D.
Joslin Diabetes Center Boston Massachusetts
OUTSMARTING DIABETES A Dynamic Approach for Reducing the Effects of Insulin-Dependent Diabetes, 1994 by Joslin Diabetes Center
All rights reserved. Except for brief passages used for review purposes, no part of this publication may be reproduced, stored in retrieval system or transmitted, in any form or by any means, electronic, photocopying, recording, or otherwise, without the prior written permission of CHRONIMED Publishing.
Views expressed in this publication are those of the author. This publication was not endorsed by or produced in affiliation with the Diabetes Control and Complications Trial.
Library of Congress Cataloging-in-Publication Data Beaser, Richard S., M.D. Outsmarting Diabetes: A Dynamic Approach for Reducing the Effects of Insulin-Dependent Diabetes p. cm. ISBN 1-56561-051-2 (pbk.) $14.95 1. Diabetes-Treatment. 2. Insulin. 3. Insulin pumps. I. Title. RC660.B364 1994 616.4 6206-dc20 94-11324 CIP
Edited by: Donna Hoel Cover design: Emerson, Wajdowicz Studios, Inc./NYC Interior design: Liana Vaiciulis Raudys
10 9 8 7 6 5 4 3 2 1
Published by: CHRONIMED Publishing P.O. Box 47945 Minneapolis, MN 55447-9727
Table of Contents
Can Diabetes Complications Be Prevented?
1 What Is Intensive Management?
2 Designing Your Own Plan
3 Getting Started
4 Living with an Intensive Plan
5 Planning Your Meals
6 Using Multiple Daily Insulin Injections
7 Using Insulin Pumps
8 Exercise and the Intensive Plan
9 Pregnancy and Intensive Diabetes Therapy
10 Psychological Concerns
11 When Things Go Awry
Appendices
A1 Intensified Conventional Treatment Programs
A2 Ultralente Programs
A3 Premeal Regular plus Bedtime Intermediate
A4 The Insulin Pump
A5 Calculating Daily Volume for Insulin Pump Therapy
A6 Exercise Guidelines
A7 Hyperglycemia
A8 Hypoglycemia
A9 Products and Foods for Hypoglycemic Reactions
A10 Sample Records Book
Acknowledgments
A book of this nature cannot be written without the assistance and support of others. Intensive diabetes therapy and, of course, diabetes treatment in general is a team effort. There are many members of the team who I would like to acknowledge.
Donna Richardson, R.N., C.D.E., past director of patient education, and Laurinda Poirier, R.N., C.D.E., the director of clinical and educational services at the Joslin Diabetes Center, were most supportive of this effort with time, advice, and moral support. Debra Conboy, R.N., C.D.E., our diabetes nurse educator who specializes in intensive diabetes therapy, as well as Susan Crowell, R.N., C.D.E., the head DCCT research nurse at the Joslin Diabetes Center site, provided tremendous amounts of insight and expertise. Carrie Stewart, R.N., M.S., C.D.E., Joslin DCCT nurse, also helped.
I would also like to acknowledge my colleagues with whom I worked as investigators as part of the DCCT team at Joslin: Alan Jacobson, M.D., Om Ganda, M.D., James Rosenzweig, M.D., and Joseph Wolfsdorf, M.D., and our study ophthalmologist, George Sharuk, M.D.
Joan Hill, R.D., C.D.E., Joslin s director of nutrition services, Beverly Halford, R.D., C.D.E., dietitian with the DCCT at the Joslin site, and Melinda Maryniuk, R.D., C.D.E., of Joslin s Affiliated Centers Program contributed their expertise to the sections on nutrition. In general, all members of the Joslin staff of Diabetes Nurse Educators and Registered Dietitians, working with our patients, either directly or indirectly provided assistance in the preparation of this book.
Joy Kistler, M.S., C.D.E., Joslin s exercise physiologist, provided input on the exercise section. Barbara Anderson, Ph.D., C.D.E., from our mental health section assisted with preparation of the chapter on the psychological impact of intensive therapy. Additional assistance and support were provided by Cynthia Pasquarella, R.N., B.S.N., C.D.E., our pediatric diabetes nurse educator. Julie Rafferty, director of communications, Thomas McCullough, public information manager, and Ray Moloney, director of publications at Joslin, also helped by coordinating efforts to get everybody s comments on the draft of this book incorporated into the final text. In addition, invaluable secretarial assistance was provided by Noreen Carson and Trisha Naughton.
Finally, I want to acknowledge the role of the 1,441 patients who volunteered for the Diabetes Control and Complications Trial (DCCT). While intensive diabetes therapy was being used before and during this study, it was this trial that proved, finally, that the effort involved in this treatment is worth it. These 1,441 people made this study possible-and this book necessary!
Introduction
Can Diabetes Complications Be Prevented?

What s this section about? What do we mean by control? Why is the DCCT study important? What does intensive mean? How can all this help you?
What does control mean?
If there s a health catchword for the 90s, it has to be control. In managing your diabetes, you hear the word probably more often than you would like. It means keeping your blood glucose levels as near to those of a person without diabetes as you possibly can. But will carefully controlling your blood glucose reduce your risks for eye problems, nerve degeneration, kidney failure, heart disease, or strokes?
Since the discovery of insulin, physicians and researchers have been guessing about the role control plays in reducing complications. Now we have some answers. Early in 1993, a major study called the Diabetes Control and Complications Trial, or DCCT, was stopped a full year early because of its dramatic and conclusive findings-that control matters. The Joslin Diabetes Center was one of the 29 centers participating in this study.
What is the DCCT?
The DCCT was started in the early 1980s to test the question: Will normalization or near normalization of blood glucose levels in people with diabetes help to delay or prevent diabetes complications? In addition, the study looked at whether it is practical and safe to maintain blood glucose levels in the normal or near-normal range in people with diabetes.
This long-term, multicenter study, sponsored by the National Institutes of Health (NIH), involved 1,441 volunteers aged 13 to 39, with type I, insulin-dependent diabetes. Half the volunteers used what has been known as conventional diabetes management: They took one or two injections of insulin each day, monitored their blood glucose or urine once a day, were given dietary education, and saw their physicians and diabetes health care teams four times a year. The other half of the patients used what is commonly called intensive therapy. This involved three or more injections each day or use of an insulin pump. Insulin was adjusted on the basis of four or more daily blood glucose tests. This group also had intensive diabetes education and dietary, exercise, and psychological counseling. They saw their physicians and diabetes health care teams every month.
Both groups were watched closely for signs of eye, nerve, and kidney disease. And the differences between the two groups was stunning.
The outcomes
With intensive therapy, the incidence of eye complications was reduced by as much as 76 percent. Kidney complications were reduced by up to 56 percent, and nerve problems by up to 60 percent. The study wasn t long enough to assess the heart and stroke risks, but researchers believe there is good evidence that careful physiologic control improves these risks also. By physiologic, we mean control that is as close as possible to what the nondiabetic body would do.
A measurement called the glycosylated hemoglobin test showed that the lower the amount of glucose in the blood for an extended period of time, the lower the risk for long-term complications.
What s the downside?
The main problem with intensive diabetes therapy is the high risk of insulin reactions. Even though the people who used the intensive program checked their blood four or more times a day, they had three times more severe low blood sugar reactions than the conventional treatment group. (By severe, we mean reactions requiring assistance from someone or emergency room visits.)
People using the intensive plan also gained weight. After five years, most were about 10 pounds heavier than matched partners using conventional treatment. This could be because the body uses calories more efficiently when insulin levels are kept closer to a nondiabetic level. Or it could be that increased flexibility in using insulin encourages people to eat more of the things they formerly avoided.
Another disadvantage is that the intensive approach is more expensive than conventional therapy-at least in the short run. However, once the cost of complications is added, intensive therapy seems to be a much better investment.
With proper training and follow-up, working together with your physician, dietitian, and nurse educator, you should be able to reduce significantly the risk of severe hypoglycemia and weight gain.
How intensive is intensive?
There are no magic numbers for glucose or for glycosylated hemoglobin. But the DCCT study showed that the closer to normal, nondiabetic levels, the better. Therefore, any improvement in your control, regardless of how high you are at the start and how much you are able to improve it, will be of benefit to you.
In the DCCT study, the goals were:
Fasting and premeal blood glucose levels of 70 to 120 mg/dl
After-meal levels of less than 180 mg
3 A.M. levels of more than 65 mg
Glycosylated hemoglobin as close to normal as possible (For the people in the DCCT study, this was about 6.05 percent, but the numbers vary depending on laboratory standards.)
What does this mean for you?
Every step you take toward better diabetes control can mean fewer problems in the future. Of course, there are no guarantee