Type 2 Diabetes in Adults of All Ages: How to Become an Expert on Your Own Diabetes(Class Health)

If you have recently been diagnosed with type 2 diabetes, you will need to make some changes in your life that seem unwelcome and unnecessary. There is a wide range of treatments for this form of diabetes, from dietary adjustment and increased activity through to tablets and the use of insulin. Each new stage can lead to anxiety and a feeling that you are not in control.The best way to deal with diabetes is to develop a thorough understanding of the condition and how it affects you personally.This comprehensive reference book will equip you with the knowledge you need to tackle all the different situations that daily life will throw at you. The scientific evidence proves that controlling your diabetes is the key to avoiding longterm health problems. If you can follow a healthy diet, control your weight and understand your medications you can look forward to good health and well-being for many years to come!With this practical handbook you can take control of your health in the best way possible, because the greatest expert on your diabetes should be you.

Table of Contents:
Preface xiiiAcknowledgments xvi1 Introduction 12 Getting to grips with diabetes 4When you first find out you have diabetes 4What happens next? 4Older people 5Teenagers and young adults 6Self-help groups 6Routine check-ups 6Living the life you choose 73 Caring for your own diabetes 8Goals for managing diabetes 8Goals of treatment 8How can you achieve these goals? 8Diabetes today - cornerstones of management 9Becoming your own expert 9Can you take time off from diabetes? 10Alternative and complementary therapies 114 Diabetes: some background 12Insulin history 12Type 1 diabetes 12Type 2 diabetes 12Risk factors for Type 2 diabetes 13Tablets for Type 2 diabetes 13Young people with Type 2 diabetes 13Principles of treatment for Type 2 diabetes 14Maturity-onset diabetes of the young (MODY) 14Latent autoimmune diabetes in the adult (LADA) 14How common is diabetes? 15Can you catch diabetes? 15Does eating too much sweet food cause diabetes? 155 How your body works 16Phases in glucose metabolism 16How insulin works 17Insulin 17What happens to the carbohydrates in the food? 18Your body doesn't realize it has diabetes 19Your body's anatomy 20Pancreas 21The islets of Langerhans 21Cellular metabolism 22A healthy cell 22Starvation 23Diabetes, insulin deficiency and insulin resistance 246 Regulation of blood glucose 25Where does the glucose in your blood come from? 25Counter-regulating hormones that increase blood glucose levels 25Effects of insulin 26The liver 26Body reserves during fasting and hypoglycaemia 26Liver and muscle stores 27Glucagon 27Glucagon injections 27Adrenaline 28Effects of adrenaline 30Cortisol 30Effects of cortisol 30Growth hormone 30The effects of growth hormone 307 High blood glucose levels 31What happens in the body when there is not enough insulin? 31Insulin resistance - not enough insulin to do the job? 32Early need for insulin in Type 2 diabetes 32What to do with a high blood glucose level 32Diet alone 32Anti-diabetes tablets 32Insulin treatment 33Symptoms of persistently high blood glucose 33Ketoacidosis 33Hyperosmolar non-ketotic coma (HONK) 33Blurred eyesight and diabetes 348 Nutrition 35Absorption of carbohydrates 36Factors that increase the blood glucose level more quickly 37Factors that increase the blood glucose level more slowly 37Emptying the stomach 38Sugar content in our food 39Aims of nutritional management 40Taking fluids with food 40Dietary fats 41Food rules of thumb 41Dietary fibre 42Glycaemic index 42Milk 43Vegetables 44Potatoes 44Bread 44Pasta 45Meat and fish 45Pizza 46Salt 46Herbs and spices 46Fruit and berries 46Mealtimes 46Special 'diabetic' food? 46'Fast food' 47Vegetarian and vegan diets 47Party-time 48Different cultures 48Religious fasting days 48Ramadan: the fasting month 48Sweeteners 49Sugar free? 49Non-nutritive sweeteners 49Aspartame 49Saccharin 50Acesulfame K 50Sucralose 50Cyclamate 50Nutritive sweeteners 51Fructose 51Sugar alcohols 51Diet drinks and 'light' foods 529 Weight control 53What is 'overweight'? 53Is weight always a problem? 53Definitions of central obesity 54Body mass index (BMI) 54Metabolic syndrome 55Weight loss: the benefits to your health 55Exercise and weight loss 55Are low carbohydrate diets useful? 55Are conventional low fat diets useful? 56Partial meal replacement diets 56Using the glycaemic index (GI) indietary planning for weight reduction 57Group therapy 57Drugs for weight loss 58Rimonabant 58Silbutramine 58Orlistat 5810 Exercise 59What happens during exercise? 59Planning and maintaining exercise 59The effects of exercise on the blood glucose level 60Exercise and mood 60Ways of introducing exercise into your daily life 61Exercise advice for people who have complications arising from diabetes 61Exercise and the cardiovascular system 61Benefits of exercise in Type 2 diabetes 62Exercise and its effects on blood sugar 62Exercise and muscle strength 62vi Type 2 Diabetes in Adults of All Ages 11 Monitoring 63The blood glucose testing dilemma 63Blood glucose self-monitoring guidelines 64Do you need to monitor at all? 65How many tests should you take? 66If you are on diet and exercise, metformin or glitazone treatment 66If you are on sulphonylureas 67If you are on insulin 67Urine tests 67'Good' or 'bad' tests? 67Are some things forbidden? 67Blood glucose 68Lancets 68How to take blood tests 69Borrowing someone else's finger-pricking device 69Why take blood tests? 69Sources of error when measuring blood glucose 69Does the meter show the correct value? 70Alternative site testing 70Self-monitoring around mealtimes 71Self-monitoring around mealtimes if you are not taking insulin 71Self-monitoring around mealtimes if you are taking insulin 71Self-monitoring around mealtimes: what it means for you 72Continuous glucose monitoring 72Does continuous finger-pricking cause loss of feeling? 73Ketones 73Acting on the information 7312 Glycosolated haemoglobin (HbA1c) 74HbA1c 74HbA1c and blood glucose 75What level should HbA1c be? 75Why check your HbA1c? 76HbA1c goals 76For how long do blood glucose levels affect HbA1c? 76How often should you check your HbA1c? 77Can your HbA1c be 'too good'? 77Can the HbA1c measurement give false information? 77Fructosamine 77Contents vii13 Tablets for lowering blood sugar 78Nine Key Points 78Tablet treatments for diabetes 79Biguanides (metformin) 79When should you not use metformin? 79Side effects of metformin 80Evidence for using metformin to manage your diabetes 80Other uses for metformin 81Glitazones (insulin sensitizers) 81When should you not use a glitazone? 82Side effects of glitazones 83Evidence for using glitazones to manage your diabetes 83Sulphonylureas 83When should you take a sulphonylurea, and how much? 84Commonly used sulphonylureas in the UK 85When should you not use a sulphonylurea? 85Side effects of sulphonylureas 85Evidence for using a sulphonylurea to manage your diabetes 85Postprandial glucose regulators (PPGRs) 86When should you avoid PPGRs? 86Side effects of PPGRs 86Evidence for using a PPGR 87Alpha-glucosidase inhibitors 87Who should avoid taking acarbose? 87Side effects of acarbose 87What is the evidence for using acarbose to treat Type 2 diabetes 88Gliptins 88Oral treatment pathways for blood glucose: what is the best form oftreatment? 8814 Insulin treatment 90Animal and human insulin 90Production of human insulin 90Methods of slowing the action of insulin 90Rapid-acting insulin 91Basal insulin 91New basal insulins 91Pre-mixed insulin 94Units and insulin concentrations 94Twice-daily treatment 94Multiple injection treatment 94Injections before meals (bolus insulin) 95When should you take your pre-meal dose? 95Can regular insulin injections be takenjust before a meal? 96Can I change my mealtimes? 97Can I skip a meal? 97Bedtime insulin 97When should the long-acting injection be taken? 97Mixing insulins 97Depot effect 98How accurate is your insulin dose? 98Insulin absorption 98What if you forget to take your insulin? 99Forgotten pre-meal injection (multiple injection treatment) 99Forgotten bedtime injection (multiple injection treatment) 99What if you take the wrong type of insulin? 99At bedtime 99During the day 100Factors influencing the insulin effect 100Having a lie in at weekends 101Staying awake all night 101Shift work 10115 Administering Insulin 102Injection technique 102Taking the pain out of injections 102Is it best to inject into fat or into muscle? 102Recommended injection sites 103In the tummy or the thigh? 104Rapid-acting and short-acting insulin 105Long-acting insulin 105Is it necessary to disinfect the skin? 105Storage of insulin 106Syringes 107Different ways of administering insulin 108Injections with syringes 108Pen injectors 108Why aren't all insulins available for pens? 108Replacing pen needles 108Mixing insulins in a syringe 109Different pens for day- and night-time insulin 109Air in the cartridge or syringe 109Insulin on the pen needle 110Used needles and syringes 111Automatic injectors 111Jet injectors 112Insuflon 112Insulin pumps 112What is an insulin pump and why bother with one in Type 2 diabetes? 112What do the studies about using pumps in Type 2 diabetes say? 113Tips for using indwelling catheters 113What's the conclusion? 114New methods of insulin delivery 114Inhaled insulin 114In development 11516 Changing insulin requirements 116Tablets with insulin: what can you expect? 116Insulin and metformin 116Triple regime 116Moving towards treatment by insulin alone 116Five common insulin regimes 118Why might an insulin regime need changing? 118Blood glucose goals 119Managing your insulin doses 119Keeping good records 120What to do if your blood glucose level is high 12017 Side effects and problems with insulin treatment 121Insulin and weight gain 121Key concerns patients have about insulin treatment 121Hypoglycaemia 122Why do patients with Type 2 diabetes have to take such large amountsof insulin? 123Insulin resistance syndrome 123Reducing the insulin dose 124Problems at the injection sites 124Lipoatrophy 124Lipohypertrophy 124Redness at injection sites 125Insulin antibodies 125Anticipating the problems 12518 Hypoglycaemia 126Stages of hypoglycaemia 127Blood glucose levels and symptoms of hypoglycaemia 127Symptoms of hypoglycaemia from the brain 128Symptoms of hypoglycaemia from the body 128Severe hypoglycaemia 129What caused your hypoglycaemia? 130Seizures 131Hypoglycaemia unawareness 131Driving and insulin 131Tips for safe driving 132Rebound phenomenon 132Too little food or too much insulin? 132Night time hypoglycaemia 132Symptoms indicating night time hypoglycaemia 133Taking the wrong type of insulin 133Can you die from hypoglycaemia? 134Why does the blood glucose level at which hypoglycaemia is noticedvary? 135The hot air balloon 13519 Treating hypoglycaemia 136Which dose of insulin contributed to your hypoglycaemia? 136Practical instructions 136Timing and hypoglycaemia 137Hypoglycaemia just before you eat 138Hypoglycaemia 45-60 minutes before your next meal 138Hypoglycaemia 1-2 hours before your next meal 138Should you always eat when you feel hypoglycaemic? 139Helping someone with diabetes who is not feeling well 139Glucose 139Fructose 140After hypoglycaemia 140Learning to recognize the symptoms of hypoglycaemia 14120 Stress 142Stress and daily life 143Stress 14321 Coping with sickness 145Feeling well or ill on insulin 145Illness and need for insulin 146Nausea and vomiting 146How do different illness affect blood glucose? 147The signs that tell you when to go to hospital 147Gastroenteritis 147Wound healing 148Surgery 148Drugs that affect blood glucose 149Teeth 149Gingivitis 149Having a tooth out 150Vaccinations 15022 Type 2 diabetes and younger people 151Why me? 151Type 2 diabetes and overweight 152Are the symptoms any different in younger people? 153What can be done? 153Is treatment with insulin inevitable in time? 153What does the future hold? 154Type 2 diabetes in young people who are not overweight 154Finding out more 15523 Smoking 156The risks 156How do I stop? 157Willpower 157Counselling services 157Complementary therapies 157Nicotine replacement therapy 157Buproprion 158New drugs 159Passive smoking 159Snuff 15924 Alcohol and other substances 160Alcohol and the liver 160Why is it dangerous to drink too much if you have diabetes? 160Alcohol and calories 161Basic rules 161What if you have had too much to drink? 161Dieting and weight loss 162Illegal drugs 162'Uppers' 162Benzodiazepines 163Cannabis 163Hallucinogenics 16325 Sexual problems and Type 2 diabetes 165Problems with your erection 165Depression 165Adequate investigation of any medical problems 165Medical treatment of erectile dysfunction 166Tablets 166Local agents 167Mechanical devices 167What happens if nothing works? 167What about women? 167Menstruation 168Fertility 168Contraception 168The Pill 168Contraceptive methods 169Interuterine devices and implants 169Staying healthy 17026 Pregnancy and diabetes 171Preparing for pregnancy 171Glucose control 172Blood pressure control 172During the pregnancy 173Gestational diabetes 173Delivery 174Feeding your baby 17427 Social and employment issues 175Social life 175Eating out 175Diabetes ID 176Being a parent with diabetes 176Adoption 177Diabetes and work 177The Disability Discrimination Act 177Fitness for employment 178Telling your colleagues 179Discrimination, and what to do about it 179Shift work 179Guidelines for safe shift-working for people on insulin 179Diabetes and the Armed Forces 180To consider while driving 180Driving and diabetes 18128 Travelling with diabetes 182Travelling with insulin 182Names of insulin abroad 183Passing through time zones when on insulin 183Multiple injection treatment 183Two-dose treatment 184Safety rules for flying within the US 184Travelling if you are taking blood glucose-lowering tablets 185Vaccinations 185Ill while abroad? 185Diarrhoea 185Problems with travel sickness 186Diabetes equipment you may need on the trip 18629 Psychological aspects of Type 2 diabetes 187Common responses to the diagnosis of Type 2 diabetes 187Need for information 188Handling the diagnosis of diabetes: what your health professional should do 188Psychological support 188Group/peer support 189Support from partners and other family members 189Anxiety and Type 2 diabetes 189Depression and Type 2 diabetes 190Diabetes and underlying psychiatric illness 190Schizophrenia 191Diabetes and severe psychosis 192Type 2 diabetes and eating disorders 192x Type 2 Diabetes in Adults of All Ages Can psychological interventions help? 192Taking control 19230 Complications of the cardiovascular system 193What are macrovascular complications? 193Blood glucose levels 193What is the evidence for the link between high blood glucose andmacrovascular complications? 193What can I do about it? 194Blood pressure 194What is the evidence for a link between higher blood pressure and macrovascularcomplications? 194What can I do about it? 195Cholesterol levels 195What is the evidence for a link between blood fats and macrovascularcomplications? 195What can I do about it? 196Insulin resistance 196What's the evidence for the link between insulin resistance and macrovascularcomplications? 196Heart and large blood vessel diseases: Diagnosis 196What can I do about it? 196Who needs aspirin treatment? 197New cardiovascular risk markers 197Helping yourself 19731 Microvascular complications 198Complications affecting the eyes (retinopathy) 198Treatment 199Disturbed vision at unstable blood glucose levels 199Glasses 199Contact lenses 200Complications affecting the kidneys (nephropathy) 200Stages of kidney damage 200Complications affecting the nerves (neuropathy) 201Treatment: loss of sensation 201Treatment: pain due to nerve damage 202The autonomic nervous system 202Problems with the autonomic nervous system 202Avoiding complications: the evidence 20332 Problems with feet 204Why do foot problems happen? 204Minimizing the risks of foot problems 205The major complications of diabetes causing foot problems 205Foot care rules 206Looking after your feet: first aid measures 207Treating foot ulcers 207Charcot foot 20733 Associated diseases 209Insulin resistance 209Features of the metabolic syndrome 210Problems associated with insulin resistance 210Polycystic ovarian syndrome 210Nonalcoholic steatohepatitis 210Acanthosis nigricans 210Maturity onset diabetes of the young (MODY) 210Causes of secondary diabetes 211Hormonal causes 211Cushing's syndrome 211Acromegaly 211Pancreatic disease and pancreatitis 211Haemachromatosis 21134 Diabetes in later life 212Best possible blood glucose levels 212Glucose-lowering drugs: which is best for you? 213Metformin 213Sulphonylureas 213Rosiglitazone and pioglitazone 213Insulins 214Management of other risk factors if you are older 214Aspirin therapy 214Control of blood pressure 215Control of blood fats (cholesterol) 215Management of erectile dysfunction if you're older 215Diabetes foot care 215Diabetes in a care home 21535 Support and information 217What should you be getting from your primary care team? 217National Service Frameworks 218What do NSFs do? 218The NSF for Diabetes 218Structured patient education programmes 218DESMOND 219X-PERT 220Diabetes UK 220Publications 221Living with diabetes 221Diabetes UK holidays 221Diabetes UK family weekends 221Local Diabetes UK groups 221Parent support groups 221Insurance 221Joining Diabetes UK 222Other useful organizations 222Juvenile Diabetes Research Foundation (JDRF) 222International Diabetes Federation (IDF) 222International Society for Pediatric and Adolescent Diabetes (ISPAD) 222Diabetes Federation Ireland 223Insulin-Pumpers 223British Heart Foundation 223National Kidney Federation (NKF) 223RNIB 224The Stroke Association 224Practical and financial support 224Claiming benefits 224Prescription advice 225Reimbursed accessories 225Using the Internet 22636 Outcome studies in Type 2 diabetes 227What is an 'outcome study'? 227UKPDS 227What did it show? 227What does all this mean? 228Heart Protection Study 228What did it show? 228What does this mean? 228CARDS 228What did it show? 228What does this mean? 229HOPE 229What did it show? 229What does this mean? 229PROactive 229What did it show? 229What does this mean? 230ASCOT 230What did it show? 230What does this mean? 230STENO-2 Study 230What did it show? 231What does this mean? 231DREAM 231ADOPT 231Future outcome studies reporting in the next few years 232NAVIGATOR 232ORIGIN 232ACCORD and VADT 232BARI-2D 232Outcome studies: what now? 232Outcome studies: key points 232Outcome studies: useful websites 23337 Research and new developments 234Weight loss drugs 234Newer glitazone type drugs 235Incretins 235How GLP-1 affects the beta cells 236Drugs acting on glucose re-absorption in the kidney 236Other methods of insulin delivery 236Pancreas transplants 237Looking ahead 23738Well-known people with diabetes 238Brian Cox 238Steve Redgrave 238Sue Townsend 239Glossary 240References and additional reading 245Index 253

About the Author :
Dr Charles Fox is a Consultant Physician with Special Interest inDiabetes at Northampton General Hospital Trust, with over 30 years ofexperience in diabetes care. He is also co-author of Type 2 Diabetes:Answers at your fingertips.Dr Ragnar Hanas is Consultant Paediatrician at Uddevalla Hospital in Sweden, specialising in diabetes. He is on the International Society for Paediatric and Adolescent Diabetes Writing Committee.