Islets of Hope treatment options for persons with diabetes

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Article disclaimer
By Lahle Wolfe

Sources
MedlinePlus
e-Medicine
National Diabetes Information Clearinghouse


Insulin Therapy
Shot Therapy
Insulin Pump Therapy
Insulin Delivery Devices
Intensive  vs. Conventional
    
Insulin Therapy

Diabetes Medications
Listing by Drug Class
Listing by Name

Other Treatments
Alternative & Complementary Approaches
Islet Cell Transplant
Pancreas Transplant
Stress Management
Lifestyle Changes

Insulin Pump Therapy
Pump Therapy
Insulin Pump Studies
Types of Insulin Pumps
Pumping Resources
Tips for Pumpers
IOH Support Lists

Pump-Planet.com - Insulin Pump Support Groups

Also, see
Treating Hypoglycemia
Treating Hyperglycemia
Monitoring Your Blood Glucose
How to Give a Glucagon Shot
Diabetes Complications

Insulin Information
History of Insulin
Types of Insulin
Insulin Delivery Devices


   Dr Charles Fox
Type 1 Diabetes:  
It is an incredible book, which deals in depth with every detail of diabetes care in young people.  Dr. Fox is consultant physician at Northampton General Hospital, UK.

 ADA
ADA's Field Guide to Type 1 Diabetes:    As it always pays to be prepared before beginning a journey, it also pays for people with diabetes to be prepared before they start each day. In true Field Guide fashion, this book boils down vital information for readers into short sections and checklists of their necessities, what they need to do, and what to take with them on the course of their day.

 ADA
ADA Complete Guide to Diabetes:
 Perhaps the most complete and authoritative resource on diabetes, American Diabetes Association Complete Guide to Diabetes covers everything from how to manage types 1 and 2 and gestational diabetes, to traveling with insulin, sick-day action plans, and recognizing hypoglycemia.

Other contents include information on symptoms, complications, exercise and nutrition, blood sugar control, sexual issues, drug therapies, insulin regimes, and much more. Plus, information for every parent about children, schools, and day care. This updated third edition features new information on medications, diabetes management and new therapies, and new treatments for diabetes complications.

 A. Peters, MD
Conquering Diabetes:  As one of the top 20 physicians treating diabetes in America, director of the USC Clinical Diabetes Programs, and the physician currently in charge of developing the nation's largest outreach program for community-based diabetes prevention and treatment, Dr. Anne Peters treats a spectrum of patients, from Hollywood producers, writers, and stars who frequent her clinic in Beverly Hills to the poor who populate her free clinic in East L.A.

Authoritative and reassuring, Conquering Diabetes will arm readers and their physicians with the latest findings on the diabetes epidemic, helping them to confront the disease effectively and exponentially increase their quality of life.  For both Type 1 and Type 2 information.

Do you know?

... What the difference is between the Dawn Effect and the Somogyi Effect?

Did you know?

... that to help avoid nighttime lows be sure to have a healthy low-fat, carbohydrate and protein snack before bedtime. Many diabetics experience the Dawn Effect between the hours of 4 a.m. and 8 a.m.

High-fat bedtime snacks can cause sugars to stay high during the night which some may mistake for the Dawn Effect

... that Americans with diabetes are less likely to need hospitalization for serious  complications such as kidney failure than they were a decade ago,?  

This information comes from new research from the U.S. Centers for Disease Control and Prevention.

  
Betsy Carlisle

101 Medication Tips for People with Diabetes by University of New Mexico Diabetes Care Team.

 Peter Lodewick
A Diabetic Doctor Looks At Diabetes:
 Written from the unique perspective of a doctor who has lived with diabetes for the past 30 years, A Diabetic Doctor Looks at Diabetes has been updated to give people with diabetes the up-to-the-minute tools and information they need to understand, cope with, and live with the disease.

 W. H. Polonsky
Diabetes Burnout:
 Diabetes Burnout is an interactive book that addresses the emotional issues that contribute to poor glycemic control and provides guidance to overcoming the barriers to good self-care. Worksheets help readers assess their current state of motivation and establish a successful plan of action.

 John A. Seneff
Numb Toes and Aching Souls:  This is, in a nutshell, the best current work on the subject of neuropathy for lay people. It explains the problem, goes through the rational for treatment, and discusses the treatments one by one. In addition to the use of  PO medication, it covers vitamin therapy, physical therapies, psycho- therapy and for patients who fail standard treatments, it covers alternative therapies such as plasmapheresis and hyperbaric oxygen.

  
Diabetes Forecast
Caring for the Diabetic Soul:
 This new book is a collection of articles from the award-winning Diabetes Forecast magazine. Each chapter offers practical suggestions for dealing with the emotional challenges of daily diabetes care. Whether readers want to discover how to balance the emotional ups and downs or offer support and care for the child with diabetes. Caring for the Diabetic Soul provides insight, guidance, and most of all, peace of mind.

think like a pancreas  
Gary Scheiner, CDE
Think Like a Pancreas:  
  
IOH Rating 5/5 
  Many books offer advice on managing diabetes, but few focus specifically on the day-to-day issues facing those who use insulin.  Scheiner, a certified diabetes educator and himself an insulin user himself since 1985, gives you the tools to "think like a pancreas; "that is, to successfully master the art and science of matching insulin to the body’s ever-changing needs. Free of medical mumbo jumbo, comprehensive, and packed with useful information not readily available in other books, Think Like a Pancreas discusses: day-to-day blood glucose control and monitoring, designing an insulin program, measuring insulin to carbohydrate intake and physical activity ,  pluses and minuses of different insulin-delivery  methods, optimal management of diabetes using an insulin pump, hypoglycemia—the best ways to avoid it and treat it , the impact of emotions, stress, illness, and aging , making the best use of your health care team and community resources , plus dozens of other issues that everyone taking insulin needs to understand and master.   Read IOH Book Reviews

 

islets of hope diabetes medical library                               main Treatment Options page
Diabetes treatment options

Type 1 diabetes
Treatment options and care plans


Mini site index
Multi-Faceted Approach
Your Health Care Team
Long-Term Complications of Diabetes
Intensive (Flexible) Insulin Therapy
Conventional Insulin Therapy
Daily Concerns with Diabetes
Hypoglycemia
Hyperglycemia
Long-Term Complications of Diabetes
Preventive Medical Care

Multi-faceted approach to diabetes care and treatment
Also, see Type 1 Diabetes

Type 1 diabetes treatment is not just about taking insulin.  Treatment involves many things that work to complement each other to help you stay healthy today and in the future.  Some of the things your doctor will discuss with you include:

  • How and when to take your insulin
  • Lifestyle changes including maintaining a healthy body weight, regular exercise, and stress management
  • Following a diabetes-friendly diet (counting carbohydrates, and limiting fat and protein)
  • Some people may need oral medications for diabetes, high blood pressure, or cholesterol problems
  • Why it is important to work with closely with your diabetes support team (your doctor, a dietitian, and preferable a certified diabetes educator)
  • Counseling, or other mental health support for depression and coping skills for dealing with a chronic illness.


Your diabetes health care team

Managing type 1 diabetes requires teamwork.  You will need to work with an endocrinologist (a doctor that specializes in diabetes and other endocrine problems), registered dietitian, and when possible, a certified diabetes educator.  Good communication between you and your team of health professionals will help you to understand and manage your diabetes better.

When you see one of your health care team professionals be sure to have them write down your care plan instructions for you. Know how much insulin to take, when to take it, and what to do when blood glucose levels are not in normal range.  It is also important that you have a "sick" day plan in advance.  


Types of insulin therapy for diabetes

There are two basic types of approaches to diabetes care, conventional therapy, and intensive therapy.

Intensive (flexible) insulin therapy

Intensive therapy involves tight blood glucose control with frequent blood glucose checks and insulin is usually administered via an insulin pump or insulin pen.  Studies indicate that this type of therapy contributed to better HbA1c results and fewer long-term complications.

People on intensive therapy also have fewer hospitalizations from episodes of hypoglycemia, or from diabetic ketoacidosis from hyperglycemia.  They also are able to better manage their diabetes during times of stress and illness, especially those on insulin pumps because of the ease in adjusting basal (background) insulin.  Additionally, unlike with shots, there will be no insulin to "feed" because bolus insulin is only administered for correction of hyperglycemia or when food is eaten.  


Conventional insulin therapy

Conventional therapy usually involves one to three daily injections that are the same every day. The type(s) of insulin that you take and the number of injections and dose sizes are determined based on how much food you eat, when you eat, how much activity you have in a typical day, and other factors that you doctor can help you determine.

This type of therapy typically involves fewer blood glucose checks (usually only 4-5 times per day) than intensive therapy. This is because conventional therapy is used when a person takes insulin via a syringe (shot therapy) only once or twice, and sometimes three injections per day.  For most persons with diabetes, especially those who are newly diagnosed and unstable, or still honeymooning, this type of therapy can result in more frequent episodes of both hyperglycemia and hypoglycemia episodes.

For conventional therapy to keep your blood glucose in your target range, you need to balance eating and exercise by following the regimen that your health care team puts together for you and sticking to it every day. This means not only taking the same dose of insulin at the same time every day, but also eating about the same number of carbohydrates at the same time every day, and getting the same amount of exercise at the same time every day.

You and your doctor should decide together which type of therapy may be best for you.  While intensive therapy sounds great, insulin pumps are not ideal for all persons with type 1 diabetes.  It may help you to have information in hand about the various types of therapies and insulin delivery devices before you talk with your doctor.   

The best way to keep diabetes under control is to check your blood glucose often and take immediate steps to correct levels that are too high or too low. However, managing your diabetes is harder to do if you are not on the right type of insulin therapy to best suit your lifestyle.

For a list of free printable information visit our Publications section.


Daily concerns with diabetes

All people with diabetes should wear a medic-alert bracelet and carry detailed medical information with them.  In addition, those with diabetes on insulin should never go anywhere without adequate testing supplied, insulin, and fast-acting sugars.

It is also a good idea to train a co-worker, friend, your child's caregiver, and at least one family member how to give an injection of glucagon should you ever become unconscious.  Islets of Hope offers free printouts for emergencies, including medical information, how to give a glucagon shot, and the signs, symptoms and treatment of hypoglycemia.  Visit our Publications section for a list of printable information available.

There are two main concerns in dealing with diabetes on a daily basis are hypoglycemia (low blood glucose, or sugar) and hyperglycemia (high blood glucose, or sugar) 


Hypoglycemia (low blood glucose)

Low blood glucose (hypoglycemia) can present an immediate, life-threatening medical emergency.  It is important to know the causes of hypoglycemia, the signs and symptoms of hypoglycemia, how to treat low blood glucose, and how to prevent it.

Left untreated, hypoglycemia can result in seizures, loss of consciousness, insulin shock, and even death.  Severe hypoglycemia requires and immediate injection of glucagon and prompt follow-up medical attention.

For more information on hypoglycemia, visit:


Hyperglycemia (high blood glucose)

High blood glucose (hyperglycemia) does not happen rapidly like hypoglycemia can.  But uncorrected hypoglycemia can lead to diabetic ketoacidosis (DKA) and lactic acidosis, both of which can cause organ damage, coma, and death.  Your doctor may help you treat mild DKA at home, but usually when a person has entered DKA they require hospitalization.  

Treating DKA without supervision or hospitalization simply by giving more insulin can cause severe electrolyte imbalance, cerebral edema, heart attack, and even death.

ANYTIME your urine test positive for ketones in the moderate range or higher, call your doctor for instructions.  Even if you are testing in the low range on more than one occasion, you should still call your doctor because changes in your diabetes care plan may be necessary.

For more information on hyperglycemia and the complications that can result, please visit:


Long-term complications of diabetes

Good glycemic control can significantly reduce the risk of long-term complications of diabetes.  Poor glycemic control, especially having a high HbA1c, indicating chronic hyperglycemia (high) blood glucose levels can cause significant, permanent damage to blood vessels and nerves.  This can result in complications including:

All of these complications, should they result, will need to be treated with therapies in addition to diabetes care.

Things you can do to reduce the risk of long-term diabetes complications

Be sure to understand your diabetes care plan, what your target ranges for blood glucose levels are, and how to stay in those ranges.  It is very important that you communicate with your doctor anytime you are not able to maintain blood glucose in range.

You should always call your doctor (per his/her individual instruction):

  • on sick days, especially when vomiting or diarrhea are present, or you are unable to eat or drink normally
  • whenever urine ketones in the moderate (or higher) range are present
  • if you have two or more episodes of hypoglycemia or hyperglycemia episodes in a day
  • if you are waking with morning glucose fasting levels either too high or too low.

 


Preventive care

Knowing that diabetes can lead to other problems is important because preventive care is a critical part of diabetes treatment and daily care.  In addition to managing your blood glucose levels and taking good care of yourself on a daily basis, you should also include preventive health care practices.  Some of the things that you can do include:

See your doctor at 2- 4 times a year to have an HbA1c test done to see how well you are managing your diabetes over the long run.  An HbA1c of 7.0 or lower will dramatically reduce your risk of developing complications from diabetes hyperglycemia.  You can also perform your own HbA1c tests at home with a home test kit in between visits but do not use home kits as a substitute for the one that your doctor performs.  Follow the directions carefully and report any reading over 7.0 to your doctor who can make any adjustments in your care plan necessary to help you get better control of your diabetes.

Have your blood pressure  checked with each visit.  If you have high blood pressure your doctor may need to adjust your exercise routine to avoid activities like weight training that can damage your eyes.  Also, make sure your tell your opthomologist about your exercise routine.  An opthomologist can detect diabetic retinopathy which can be made worse by certain activities that raise blood pressure. (See our Lifestyles, Diabetes and Exercise section for more information.)

See your dentist twice a year to help prevent gum and teeth problems that are more common in people with diabetes.

Inspect your feet every single day.  People with diabetes can lose sensitivity to pain, especially in their feet so that even a small cut can go unnoticed and become infected.  Infections, especially if your blood glucose is not under tight control, can be hard to treat.  Unresponsive infections can lead to tissue death from gangrene and even amputation.  It is easy to avoid this complication by keeping your blood glucose in range (hyperglycemia causes nerve damage called "neuropathy" that can affect many parts of your body and functions including digestion, circulation, your feet, and eyes.)

See your opthomologist once a year and have your eyes dilated to help detect eye problems associated with diabetes like retinopathy.

Have your kidneys checked regularly to make sure they are functioning properly.  It's easy and painless -- your doctor will simply test your urine for proteins (microalbumin).  You can protect your kidneys by limiting protein and fat, and keeping your blood glucose in a safe range.

When you are newly diagnosed, another important thing you need to learn how to do is give yourself a glucagon shot.  Be sure to train family members or friends on how to give you a glucagon shot and what to do if you should lose consciousness.

IOH Health Tip:  Save expired glucagon kits to use when training other people how to give you an injection.  You may even want to refresh your own glucagon injection skills from time to time.  

Part of your treatment plan should include preventive care and being prepared for an emergency.  You should always carry with you:

  • Glucagon with you at all times
  • Fast acting sugars
  • Always wear medical alert identification (see Human Interest News Headlines for sobering stories about people with diabetes that lost consciousness and were assumed to be drunk)
  • Medical information including family and physician contact information, any medications you are on, allergies, and any medical conditions (including diabetes) that affect your health.  It is also helpful for emergency medical professionals to know the type and amount of insulin that you take and your injection schedule.  (Islets of Hope offers free printouts for emergency care information.)

There are many pro-active things that you can do to reduce the risk of complications and enjoy life more because the better you feel physically, the easier it is to take care of yourself. including:

My diabetes care check list

  • Test blood glucose at least as often as your doctor recommends (more is often better) and take corrective action when your blood glucose is out of your target range
  • Keep a journal for sugar tests, food, exercise, and illness
  • See an opthomologist at least once a year for a complete eye exam
  • Have your urine tested for proteins (microalbumin) regularly to see how your kidneys are functioning
  • Check feet and skin every day and report all problems with feet to your doctor immediately
  • See your dentist at least twice a year
  • Have an HbA1c done 2-4 times per year (do one or two at home in addition to the doctor’s test)
  • Have your blood pressure checked each doctor visit
  • Have your blood fat levels checked as often as your doctor advises
  • Follow a healthy, well-balanced diet especially designed for you by a dietitian
  • Exercise regularly and maintain a healthy weight
  • Take time to relax; seek counseling for support or treatment of depression
  • See a urologist at the first sign of sexual or bladder problems (don't be shy!).
  • If you smoke, stop
  • Adopt a healthy lifestyle of good nutrition, stress management, exercise regularly, and adequate rest (don’t forget to have fun too)

Visit our Diabetes Care Tips page to see how others manage their diabetes or subscribe to one of the magazine below.  They are all excellent sources of information for daily diabetes care, resources, tips, and support information.

 

                                                         
         Diabetes Self-Management                        Diabetes Health                               Diabetes Forecast

 

   

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  Richard R. Rubin, Ph.D., C.D.E.
Psyching Out Diabetes:  
This book examines the psychological obstacles of diagnosis such as panic, fear, anger, shame, and guilt and how to put them into perspective. Through proper maintenance, diet, and education, this book is tailor-made for the diabetic or anyone with a diabetic in their life who wants to overcome the negative emotions associated with this disease and learn the coping skills necessary to integrate diabetes into their daily life.  Dr. Rubin is a faculty member of the John's Hopkins Medical School.

Page Updated 03/12/2006