Diabetes Management

Diabetes is a chronic disease involving self management by the patients. This book teaches providers the skills to translate and transfer complex medical information to empower patients to participate in making well informed decisions about their own care on a daily basis, as directed by the American Diabetes Association.

Janet Titchener, MD, is the Medical Director of GPSI Diabetes Ltd, New Zealand, and provides care for all types of diabetes, across all age groups. Her clinical practice adheres to the principles of patient-centred clinical medicine so that each patient is considered the expert with regard to knowing which management approach will best fit with their life and life's choices.

INTRODUCTION 1. THE PHYSIOLOGY OF GLUCOSE METABOLISM There are two sources of glucose There are two 'kinds' of insulin - basal and bolus Other hormones assist with glucose homeostasis The kidneys also play a crucial role 2. THE PATHOPHYSIOLOGY OF DIABETES Type 1 diabetes Type 2 diabetes Monogenic diabetes Gestational diabetes Other types of diabetes 3. MAKING THE DIAGNOSIS OF DIABETES Criteria for the diagnosis of diabetes Screening: testing for diabetes in asymptomatic patients Management following a positive test 4. ORAL MEDICATIONS 5. INSULINS AND INSULIN MANAGEMENT Insulin pharmacokinetics Insulin delivery Insulin dose calculations Essential teaching points 6. SURGICAL MANAGEMENT OF DIABETES Metabolic/bariatric surgery Transplantation 7. CONSIDERATIONS WHEN APPROACHING DIABETES MANAGEMENT Consider the patient as a whole Consider underlying pathology when selecting management options Consider the durability of management Determining the patient's type of diabetes and underlying pathologies 8. GLYCAEMIC MANAGEMENT Medical management of glycaemia Individualisation of HbA1c target Self-monitoring of blood sugars Blood glucose management Remission of diabetes 9. LIFESTYLE MANAGEMENT Exercise Foods 10. CARDIOVASCULAR RISK MANAGEMENT Diabetes Blood pressure Cholesterol Smoking Weight Renal protection Aspirin use 11. PROVIDING PATIENT-CENTRED CARE Establish a working relationship Find a common language Understand the patient Acknowledge the patient as the expert Find common ground Empower the patient 12. EMPOWERING THE PATIENT FOR LIFELONG SELF-MANAGEMENT Provide opportunity for ongoing education Ensure supports and safety nets are in place - for both patient and provider Hand over the controls PATIENT HANDOUTS