The effects of uncontrolled diabetes on the kidneys
Glomerulous Incoming arteriole Outgoing arteriole Glomerulous Incoming arteriole Outgoing arteriole As diabetes proceeds, if control of the blood glucose is poor, the glomerular basement membrane and other nearby structures begin to thicken and take up the space occupied by the capillaries see Figure 5-4 . The tight quarters mean that the capillaries can't filter as much blood as they should. The rate of filtration, or glomerular filtration rate, begins to fall. glomerulus in uncontrolled...
Encourage Your Child to Play Video Games Really
Video games are a favorite pursuit of today's kids, and they have so many different games to choose from. Now there are video games that teach about T1DM Two of the top games are Starbright Life Adventure Series Diabetes and Packy and Marlon. 1 Starbright Life Adventure Series Diabetes comes from the Starbright Foundation, a nonprofit organization that develops programs to help seriously ill children cope with the challenges of their illnesses. This particular program uses interactive...
The pros and cons of an islet transplant
The advantages of the islet transplantation include 1 Freedom from the need for insulin injections 1 Reversal of long-term diabetic complications 1 An end to hypoglycemia and hyperglycemia 1 A return of hypoglycemic awareness Several risks are associated with islet transplantation. They include the following 1 Danger of bleeding because heparin is given to prevent clotting of the portal vein for the injection 1 All the risks of the antirejection drugs used for intact pancreas transplantation...
Jet injectors
Jet injectors use a puff of air under pressure to release a jet stream of insulin that's forced through the skin by the pressure of the air. There's no needle involved. You simply draw up the amount of insulin needed, and you can use the device again and again. Figure 10-4 shows a typical jet injection device. Although jet injection devices avoid the use of a needle, they still cause some bruising. For many patients, they're a satisfactory substitute for a syringe and needle. Jet injectors may...
Insulin infusers
Insulin infusers are needles or catheters placed in the tissue under the skin and taped there for two to three days. When insulin needs to be given, the syringe is attached to the infusion set and injected into it by you or your child. An infuser is useful when your child just hates the idea of three or four needle sticks a day and prefers to have something already under the skin into which you inject the insulin. The downside is that the infusion site sometimes gets infected, in which case you...
Disorders of automatic autonomic nerves
Disorders of automatic or autonomic nerves often go unrecognized even though they may have a profound effect on the patient's quality of life and even survival. As you're reading this page, many movements are going on in your body, but you're unaware of them. Your heart muscle is squeezing down and relaxing. Your diaphragm is rising up to empty the lungs of air and then relaxing to draw air in. Your esophagus is carrying saliva or food, if you're a multitasker who's eating and reading from your...
Busting myths about having a chronic disease
Neither you nor your child or anyone else is to blame for your child's diabetes. As I explain in Chapter 2, T1DM occurs in a susceptible individual who comes in contact with a virus that shares tissue similarities with the person's beta cells. As your child's body attempts to reject the virus, it destroys his beta cells, the ones that make insulin. As a parent, you're not responsible if your child gets diabetes you certainly had nothing to do with that villainous virus. Help your child remember...
The real risk of hypoglycemia in the workplace
A study in Diabetes Care in June 2005 represents an important accomplishment for people who take insulin. In this study, researchers looked at 243 employees ranging in age from 20 to 69 who were taking insulin for diabetes. Over a 12-month period, researchers recorded the frequency, severity, and consequences of hypoglycemia occurring at work or elsewhere. They focused on hypo-glycemia because it's the most common complication that employers point to as the reason they don't want to hire people...
Syringes and needles
More and more, people are using insulin pens to administer their insulin I discuss these devices later in this chapter . Compared to a syringe and needle, the pen is just more convenient and easier to determine the correct dose. However, you and your child still need to know how to measure and deliver insulin with a syringe and needle the oldest and still most common method for delivering insulin in case you run out of pens or pen refills. Numerous different brands of syringes and needles are...
Emphatic Exercising
As evidenced in a survey article, the fortunate folks who have received medals from the Joslin Diabetes Center for having lived with diabetes on insulin for 50 years or more have several things in common see Chapter 17 for the full story . One is that they exercise more than most other people at their age. The authors conclude that exercise may be an important protective factor. You can say that again The T1DM patients in my practice with the lowest hemoglobin A1c, the least need for insulin,...
Macrovascular Complications Protecting Your Heart
Macrovascular complications are the complications involving the large blood vessels of the body, particularly the coronary arteries in the heart. In this section, I discuss how diabetes can lead to damage to the heart by causing blockage of these arteries. Heart disease and heart attacks are the major macrovascular complications found in people with T1DM. How does heart disease lead to a heart attack Coronary artery disease CAD , which is also known as atherosclerotic heart disease, is the...
Bentover rowing
To do bent-over rowing, follow these instructions and see Figure 9-5 1. Hold a dumbbell in each hand, arms hanging down, with your legs straight and back parallel to the floor. 2. Raise the dumbbells to your chest. 3. Lower the dumbbells back toward the floor. To do good mornings, follow these instructions and refer to Figure 9-6 1. Hold the ends of one dumbbell above your head, arms straight. 2. Lower the dumbbell forward as you bend forward so that your back is parallel to the floor. 3. Stand...
Index
AADE American Association of Diabetes Educators , 336 Abbott Laboratories, 121, 339 abdominal pain as symptom of DKA, 57 as symptom of T1DM, 27 ACE angiotensin converting enzyme inhibitor, 110, 327 acesulfame, 143 acetone defined, 327 smell on breath as symptom of DKA, 57 smell on breath as symptom of T1DM, 28 acromegaly, 37 acupuncture, 209-210 adrenal glands, 327 adrenaline, 23, 327 adrenegic symptoms of hypoglycemia, 48-49 ACTH , 38-39 adult onset diabetes. See type 2 diabetes advanced...
Deciphering lipid panel results
If your doctor wants to know the levels of all the fat particles in your child's bloodstream, your child has to fast for 12 hours before undergoing a test known as a lipid panel, but if he is satisfied with the results of a total cholesterol and the good cholesterol, no fasting is required before the test. Make sure that the doctor performs a lipid panel on your child once a year or more often if the results aren't normal . A lipid panel is done with a blood specimen in which the various types...
Taking the right doses
Some people recently diagnosed with T1DM can use a pump immediately, but most people who decide to start using a pump are switching from the following routine i Long-acting insulin once or twice a day, which corresponds with the basal insulin of the pump i Multiple daily injections with rapid-acting insulin before meals, which corresponds to the boluses given by the pump The total insulin dose from a pump is about 20 percent less than the amount of rapid-acting plus long-acting insulin from...
Preventing and treating hypoglycemia
Preventing hypoglycemia may be time-consuming, but it's possible and entirely worth the effort Even if prevention doesn't work and your child still has episodes of hypoglycemia, you can treat it in several different ways, as you find out in the following sections. The best way to prevent hypoglycemia is to be constantly aware of your child's blood glucose. Meters are being developed that can measure glucose every five minutes and beep if it falls below a set level. See Chapter 7 for more on...
Adjusting insulin intake in a different time zone
The old saying, Go West, young man could be altered to Go West, young person with type 1 diabetes. When T1DM is involved, it's a lot easier to travel west than east over several time zones. Here are the differences in insulin intake depending on your child's time zone changes i You add hours to your day when you head west, so all your child has to do is check his blood glucose an extra time or two and add short-acting insulin to cover those hours. He doesn't change the long-acting insulin but...
The pros and cons of a pancreas transplant
Are you nervous at the thought of undergoing a pancreas transplant Fret not here are several advantages of receiving a new pancreas i The benefit of needing no insulin injection and no dialysis after a combined kidney and pancreas transplant is enormous. Your quality of life improves tremendously. i With a combination kidney and pancreas transplant, your new kidney doesn't suffer the same deterioration as the original, damaged kidney. Without the healthy pancreas, the new kidney would...
AccuChek Spirit Insulin Pump System
The Accu-Check Spirit insulin pump is made by Diesetronic, which is owned by Roche Diagnostics. Here's a rundown of this pump's the specific features and requirements 1 The reservoir holds 315 units of insulin. 1 You can set up to 24 basal hourly rates in five different patterns. You also can set temporary rates. 1 The basal rates range from 0.1 to 25 units per hour. 1 The smallest bolus dose is 0.1 units. 1 It can recall the last 30 boluses, daily insulin totals, and temporary rate increases...