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Book cover

INSULIN-DEPENDENT DIABETES in Children, Adolescents and Adults
How to become an expert on your own diabetes

Table of contents


Foreword 9

Introduction 11

Type 1 diabetes (insulin- dependent diabetes, IDDM) 11
Type 2 diabetes (non insulin- dependent diabetes, NIDDM) 11
How common is diabetes? 12
Can you catch diabetes? 12
Did I get diabetes because I have eaten too much candy? 12

The first time with diabetes 13

Can I carry on with my previous life style? 15

How does a healthy body work? 16

Insulin 17
Your body will always think as if it was still non-diabetic 18

The anatomy of your body 19

Cellular metabolism 20

Insulin and blood glucose 22

Taking care of your diabetes 23

Goals for managing diabetes 23
How do you achieve these goals? 23
Becoming your own expert 24
Can I take some time off from my diabetes? 24
Alternative treatments 25

High blood glucose levels 27

Insulin deficiency 28
How to treat a high blood glucose level 28
Ketoacidosis (diabetic coma) 29
Why is my sight sometimes blurred? 30

Hypoglycemia 31

Counter-regulation 31
The liver 32
Glucagon 32
Adrenaline 35
Cortisone 36
Growth hormone 36
Symptoms of hypoglycemia 36
Severe hypoglycemia 38
Convulsions 39
Will the development of my child be affected by severe hypoglycemias? 40
At which blood glucose level will I experience symptoms of hypoglycemia? 40
Hypoglycemic unawareness 42
Symptoms of hypoglycemia at a high blood glucose level? 43
Rebound phenomenon 43
Somogyi phenomenon 44
Dawn phenomenon 44
Too little food or too much insulin? 45
Nighttime hypoglycemia 45
Can you die from hypoglycemia? 47
Why do I notice hypoglycemia at different blood glucose levels? 48

Treating hypoglycemia 50
Time table of hypoglycemia 51
What should I do if I find someone with diabetes who is not feeling well? 51
Glucose 52
Fructose 52
After the hypoglycemia 53
Practice recognizing hypoglycemic symptoms! 54

Insulin treatment 55

Regular short-acting insulin 55
Intermediate-acting insulin 56
Long-acting insulin 56
Intravenous insulin 57
Pre-mixed insulin 57
Direct-acting insulin (lispro) 57
A larger dose lasts longer 58
Units 58
Twice-daily treatment 58
Multiple injection treatment 58
Premeal injections 59
Can I skip a meal? 61
Bedtime insulin 61
Can I change my meal times? 61
When should I take the bedtime insulin of NPH type? 61
When should I take the long-acting injection? 62
Mixing insulins 62
Depot effect 62
How accurate is my insulin dose? 63
Insulin absorption 64
What should I do if I forgot to take my insulin? 65
Can I sleep in on weekends? 66
What if I stay awake all night? 67
Birthday parties 67
Insulin at school or day-care centers 68
Sleeping away from home 68

Insulin requirements 69

How much insulin does my body need? 69
Puberty and growth 69
Remission phase 70
Insulin requirements during the remission phase 70
How much insulin does my pancreas produce? 71
Insulin sensitivity and resistance 71
Ideal insulin doses? 74

Testing 75

How many tests should I take? 75
Urine tests 75
Blood tests 76
When should I take tests? 76
Diabetes or not? 77
Are some things forbidden? 78

Urine tests 78
Renal threshold 78
Ketones in the urine 79
Vomiting and ketones 81

Blood tests 82
Pricking a hole in children 82
How do I take blood tests? 82
If the child refuses to take a blood glucose test 84
Does a high blood glucose level make you feel ill? 85
Is it worth taking tests? 85
How should my HbA1c be? 86

HbA1c 86
Can HbA1c be "too good"? 88
HbA1c when travelling 89

Fructosamine 89

Injection technique 91

How do you get used to injections? 91
Mom and dad must also try injections 91
How do I inject with a minimum of pain? 91
Where do I inject the insulin? 92
Do I need to disinfect the skin? 94
Storage of insulin 94
Syringes 95
Injections with syringes 95
Pen injectors 96
Why are all types of insulin not available for pens? 96
Replacing pen needles 97
What should I do if I take the wrong type of insulin? 97
Different pens for daytime and nighttime insulin 98
Air in the cartridge or syringe 98
A drop of insulin on the pen needle? 98
Needle shortener 99
Used needles and syringes 99

Injection aids 100

Indwelling catheters 100
When should the catheter be replaced? 101
Which insulin can be given in the catheter 101
Dead space 102
High blood glucose after a few days use? 102
Infection and redness 102

Automatic injector 103

Jet injector 103

Adjusting insulin doses 105

Distribution of insulin doses 105
How much does insulin lower the blood glucose level? 106

Temporary changes of insulin doses 107
If I eat more or less than usual? 107
Physical exercise or relaxation? 108
Changing the size of a meal to affect blood glucose 108
What do I do if the blood glucose level is high? 108

Permanent changes of insulin doses 110
Low blood glucose levels 111
Insulin for evening meal 112
Bedtime insulin 112
Insulin for breakfast 116
Insulin for lunch and dinner 118
Using direct-acting insulin (Humalog) 118
Holiday or weekday? 120
Exercising or relaxing? 120
Experiment! 120
Insulin adjustments during the remission phase 120
Puberty 121

Insulin pump 123

The basal rate 124
Premeal bolus doses 126
Change of insertion site 128
Insulin depot with a pump 129
Ketoacidosis (diabetic coma) 130
More frequent home testing 131
Disconnecting the pump 131
Pump alarm 131
"No delivery alarm" 132
Leakage of insulin 133
Air in the tubing 133
Intercurrent illness and fever 135
Doses without the pump 135
Being admitted to the hospital 135
Nighttime pump? 136
Is the pump disturbing? 137
Will I gain weight when I start with the pump? 137
Taking a bath or shower 137
Travel tips 137
Pregnancy 137
Humalog in the pump? 138

Side effects of insulin treatment 140

Pain 140
Insulin leakage 140
Bruises after injections 140
Fat pads 140
Redness after injections 141
Insulin antibodies 141
Lipoatrophy 142
Insulin edema 142

Diet 143

Emptying the stomach 145
Sugar content in our food 146
Fat 147
Drinking with food 148
Milk 148
Dietary fibers 149
Vegetables 150
Bread 150
Pizza 151
Meal times 151
Snacks 152
Do I have to eat at the same time every day? 152
Hungry or full? 152
School 152
Special "diabetic" food? 153
"Fast food" 153
Party-time 153
Vegetarian diet 154
Different cultures 154

Sweeteners 155

Sugar free? 155
Fructose 156
Light? 156

Candy and ice cream 157

How much insulin should I take extra? 158
Ice cream 158
Saturday candy 159
Candy stop? 160
Pastilles (small candy) 161
Chewing gum 162

Weight control 163

Being full or "stuffed"? 163
Reducing weight 163
The little extras 164
Losing weight by having a high HbA1c 164
Teenager, high HbA1c and overweight — what can I do? 164
Does alcohol contain calories? 165

Eating disorders 166

Physical exercise 168

Can the blood glucose level increase from exercise? 170
Hypoglycemia after exercise 170
Physical education 171
Camps and ski trips 172
Top level competitive sports 172
Marathon run!? 173
Anabolic steroids 174

Diving 174

Stress 176

Fever and sick days 178

Nausea and vomiting 179
Gastroenteritis 181
Wound healing 182
Surgery 182
Teeth 182
Vaccinations 183

Smoking 185

Passive smoking 186
How do you quit smoking? 186
Snuff 186

Alcohol 187

The liver is blocked 187
Basic rules 188
Can you drink at home? 189
Narcotics 189

Pregnancy 191

Will the child have diabetes? 193
Menstruations 194
Is the need for insulin changed during menstruations? 194
Sexuality 194

Contraceptives 195
"Morning-after pills" 196

Social issues 197

School 197
Day-care centers 198
Choice of profession 199
Driver’s license 199
Traffic and diabetes 199
Adoption 201
Insurance policy 201
Diabetes ID 201
Sponsor family 201
The Diabetes Association 202
The International Diabetes Federation (IDF) 202
The St. Vincent Declaration 202
Diabetes camps 202
Diabetes and Internet 203

Travel tips 205

Ill while abroad? 206
Travelers’ diarrhea 206
Travel pharmacy 207
Passing time zones 208

Associated diseases 209

Celiac disease 209
Thyroid diseases 209
Skin diseases 209
Infections 210
Fungal infections 210

Complications 211

Large blood vessels 212
Small blood vessels 212
Eyes 213
Disturbed vision at unstable blood glucose levels 214
Glasses 214
Contact lenses 214
Kidneys 215
Nerves 216

Will a better blood glucose control really lessen the risk of complications? 219

The Oslo study 219
The Stockholm study 220
The DCCT study 220
The Berlin eye study 222
What HbA1c is it possible to achieve in a diabetes clinic? 222

Research 223

Implantable insulin pump 223
Glucose sensor 223
C-peptide 224
Vaccination 224
Salicylic acid 224

What is diabetes caused by? 225
An autoimmune disease 225
Heredity 226
Cow’s milk 227
Climate 227

Blocking the immune process 227
Light treatment 228
Diazoxid 228
Nicotinamide 228

Transplantation 229
Pancreas 229
Islet transplantation 229

Other ways of administering insulin 230
Nasal spray 230
Tablets 230
Insulin as suppositories 230
Inhalation of insulin 230
Chemical alteration of the insulin molecule 230

Psychology 231

Onset of diabetes 231
Diabetes rules or family rules? 232
To make friends with your diabetes 233
Being a relative or friend of someone with diabetes 235
Tell your friends? 236
How do you change life style? 236
Daddies, are they needed? 236

Diabetes in different developmental ages 237
Healthy siblings 242
Divorced families 243
Brittle diabetes 244

Needle-phobia 245

Well-known persons with diabetes 246

Glossary 251

References 257

Further reading about diabetes 267

Index 268



                 
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Last Updated: Thursday February 27, 2014 19:28:20
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