Diabetes

Learning Objectives

Upon completing the course, you will be able to:

  1. Classify various types of diabetes and their prevalence in the general population.
  2. Describe the prevalence of diabetes among people under 20 years of age, among people 20 years or older, and in various ethnic population groups.
  3. Identify various complications of diabetes and cite mortality figures from the complications.
  4. Cite statistics illustrating the magnitude of diabetes among African Americans.
  5. Discuss genetics and medical and lifestyle risk factors that increase the chance of developing type 2 diabetes among African Americans.
  6. Describe how diabetes complications affect African Americans.
  7. Discuss various epidemiology studies about diabetes in Hispanic Americans.
  8. Discuss lifestyle and medical risk factors for diabetes in Asian and Pacific Islander Americans.
  9. Describe the new nomenclature and the criteria for the diagnosis of diabetes.
  10. Discuss with the patient how a diagnosis of diabetes is made.
  11. Identify 7 risk factors for diabetes.
  12. Define and answer prediabetes questions, such as the need for testing.
  13. Discuss the results of the Diabetes Prevention Program (DPP) study in preventing or delaying the development of type 2 diabetes.
  14. List 7 signs and symptoms of type 2 diabetes.
  15. Provide an overview of the three main kinds of diabetes–type 1, type 2 and gestational diabetes.
  16. Identify 7 factors that increase a person’s risk for type 2 diabetes
  17. Advise a patient on the steps he or she can take to reduce the risk of getting diabetes.
  18. Describe how the body controls glucose and list various symptoms of hypoglycemia.
  19. Describe certain rare causes of hypoglycemia.
  20. Describe the pancreatic islet transplantation and explain the benefits and risks of transplantation.
  21. Teach a patient about the importance of eating to control diabetes.
  22. Explain the food pyramid and prescribe proper servings of starches, vegetables, fruit, milk and yogurt, meat, and fats and sweets.
  23. Help a diabetic patient with his or her meal plan.
  24. Describe the course of kidney disease through five stages.
  25. Advise a patient in ways of preventing and slowing kidney disease.
  26. Teach a patient about kidney problems caused by diabetes.
  27. Explain to a patient three treatment choices when kidneys fail.
  28. Advise a patient who is on hemodialysis about proper diet.
  29. Describe for a patient hemodialysis and peritoneal dialysis and their relative advantages and disadvantages.
  30. Describe kidney transplantation as a treatment of choice for ESRD.
  31. Describe the causes, symptoms and types of diabetic neuropathy.
  32. Describe how autonomic neuropathy affects the nerves in lungs, heart, stomach, intestines, bladder, and sex organs.
  33. Explain to a patient various tests that are done to diagnose neuropathy.
  34. Describe gastroparesis, its symptoms, complications and treatment.
  35. Define impotence and explain what causes impotence.
  36. Explain how an erection occurs.
  37. Describe the treatment for impotence, including psychotherapy, drug therapy, and surgery.
  38. Teach a diabetic patient about keeping his heart and blood vessels healthy.
  39. Discuss with a patient the importance of keeping the hemoglobin A1c number under control.
  40. Enunciate 7 principles of quality diabetes treatment.
  41. Explain to a patient why he or she needs to take medicines for diabetes.
  42. List various types of diabetic pills that help lower blood glucose and identify their mode of action.
  43. Teach a patient how to recognize symptoms of hypoglycemia and what to do if the blood glucose is low.
  44. Discuss various alternative therapies, such as acupuncture, biofeedback, chromium, magnesium and vanadium for the treatment of diabetes.
  45. Discuss the findings of the Diabetes Control and Complications Trial (DCCT).
  46. Discuss various clinical studies initiated to determine the feasibility and benefit of various strategies to prevent or delay the onset of type 2 diabetes.
  47. On the basis of these clinical studies, identify potential candidates for screening and intervention, compare lifestyle modification with pharmacological interventions, and evaluate various strategies to prevent diabetes.
  48. Describe the results of the Diabetes Prevention Program (DPP) trial and compare the relative benefits of lifestyle modification, treatment with metformin and standard medical advice.
  49. Answer specific questions posed by a patient about diabetes: its prevalence, diagnosis, prevention, importance of diet and exercise.
  50. Describe the pathogenesis of gestational diabetes.
  51. List factors indicative of women who might develop gestational diabetes during pregnancy.
  52. Explain the 50-gram and 3-hour glucose tests for tolerance gestational diabetes.
  53. Explain how gestational diabetes affects pregnancy and how it may affect the baby.
  54. Answer the question often asked by pregnant women: How much weight should I gain?
  55. Provide guidance to a pregnant woman about the optimal intake of six food groups during pregnancy.
  56. Describe various tests done to assess the condition of the fetus before birth.
  57. Advise a pregnant woman about the importance of diet and exercise to control her blood sugars.
  58. Explain the pathophysiology of diabetes mellitus.
  59. Describe the blood glucose regulation by insulin in healthy people and in people with type 1 or type 2 diabetes.
  60. Describe the effects of alcohol consumption on blood sugar levels of diabetics.
  61. Contrast the effects of alcohol consumption in the fed and fasting states of diabetics.
  62. Describe the alcohol’s effects on complications of diabetes, such as diabetic ketoacidosis, lipid metabolism, cardiovascular disease, peripheral neuropathy and retinopathy.

Course Outline

Chapter 1:  National Diabetes Statistics

What Is Diabetes?

Types of Diabetes

Treatment of Diabetes

Impaired Glucose Tolerance and Impaired Fasting Glucose

Prevention of Diabetes

Prevention of Diabetes Complications

Glucose Control

Blood Pressure Control

Control of Blood Lipids

Preventive Care Practices For Eyes, Kidneys, and Feet

Methods

Prevalence of Diabetes

Prevalence of Diabetes Among People Under 20 Years of Age

Prevalence of Diabetes Among People 20 Years or Older

Prevalence of Diabetes by Race/Ethnicity Among People 20 Years or Older

Incidence of Diabetes

Deaths Among People With Diabetes

Complications of Diabetes

Stroke

High Blood Pressure

Blindness

Kidney Disease

Nervous System Disease

Amputations

Dental Disease

Complications of Pregnancy

Other Complications

Cost of Diabetes in the United States

Heart Disease

Acknowledgments

Chapter 2: Diabetes in African Americans

How Many African Americans Have Diabetes?

What Risk Factors Increase the Chance of Developing Type 2 Diabetes?

Genetic Risk Factors

Medical Risk Factors

Figure 1. Prevalence of diagnosed and undiagnosed diabetes in African Americans, U.S., 1988-94.

Gestational Diabetes (GDM)

Hyperinsulinemia and Insulin Resistance

Obesity

Physical Activity

How Does Diabetes Affect African American Children?

How Does Diabetes Affect African American Women During Pregnancy?

Figure 2. Time trends in the percentage of adolescents and adults in the U.S. who are overweight, U.S., 1988-94

How Do Diabetes Complications Affect African Americans?

Eye Disease

Kidney Failure

Amputations

Does Diabetes Cause Excess Deaths in African Americans?

How Is NIDDK Addressing the Problem of Diabetes in African Americans?

Prevention

Figure 3. Mortality rates in African American and white diabetic men and women in a sample of the U.S. population, 1971-1993.

National Diabetes Education Program

          Points to Remember

References

Chapter 3: Diabetes in Hispanic Americans

Major Studies of Diabetes in Hispanic Americans

How Many Hispanic Americans Have Diabetes?

Table 1. Hispanic American Populations in the United States and Percentage With Diabetes

Figure 1. Prevalence of diagnosed and undiagnosed diabetes in Mexican Americans, U.S., 1988-94

What Factors Increase the Chance of Developing Type 2 Diabetes?

Genetic Risk Factors

Figure 2. Genetic origins of the major Hispanic subgroups in the United States

Medical and Lifestyle Risk Factors

Prediabetes (Impaired Glucose Tolerance and Impaired Fasting Glucose)

Gestational Diabetes

Hyperinsulinemia and Insulin Resistance

Obesity

Physical Activity

Figure 3. Prevalence of overweight individuals among whites, blacks, and Mexican Americans in the population, 1988-91

How Does Diabetes Affect Hispanic Young People?

How Does Diabetes Affect Hispanic Women During Pregnancy?

How Do Diabetes Complications Affect Hispanic Americans?

Eye Disease

Kidney Disease

Nerve Disease

Peripheral Vascular Disease

Heart Disease

How Is NIDDK Addressing the Problem of Diabetes in Hispanic Americans?

Diabetes Prevention Program

National Diabetes Education Program

Points to Remember

References

Chapter 4: Diabetes in American Indians and Alaska Natives

How Many American Indians and Alaska Natives Have Diabetes?

Type 2 Diabetes

Table 1. Age-adjusted prevalence of diagnosed diabetes among American Indians/ Alaska Natives, age 20 and older, by group of tribes–United States, 1997

Table 2. Prevalence of diagnosed diabetes among American Indians/Alaska Natives and non-Hispanic whites, age 20 and older, by age and sex– United States, 1997.

Type 1 Diabetes

What Risk Factors Increase the Chance?

Genetic Risk Factors

Medical and Lifestyle Risk Factors

Obesity

Diet and Physical Inactivity

Prediabetes (Impaired Glucose Tolerance and Impaired Fasting Glucose)

Hyperinsulinemia and Insulin Resistance

How Does Diabetes Affect American Indian and Alaska Native Women During Pregnancy?

How Does Diabetes Affect Cardiovascular Health in American Indians and Alaska Natives?

Ischemic Heart Disease

Stroke

Hypertension

How Do Diabetes Complications Affect American Indians and Alaska Natives

Diabetic Retinopathy

Cataracts

Diabetic Nephropathy

Lower Extremity Amputation

Periodontal Disease

Infections

Does Diabetes Cause an Inordinate Number of Deaths in American Indians and Alaska Natives?

How Is NIDDK Addressing the Problem of Diabetes in American Indians?

Diabetes Prevention Program

Points to Remember

References

Chapter 5: Diabetes in Asian and Pacific Islander Americans

Table 1. Asian and Pacific Islander ethnicities in the United States.

How Many Asian and Pacific Islander Americans Have Diabetes?

Type 2 Diabetes

Table 2. Prevalence of diabetes in the United States in non-Hispanic white people, Asian Americans, and Native Hawaiians.

Type 1 Diabetes

What Risk Factors Increase the Chance That Asian and Pacific Islander Americans Will Develop Type 2 Diabetes?

Genetic Risk Factors

Lifestyle and Medical Risk Factors

Obesity

Diet and Physical Inactivity

Prediabetes (Impaired Glucose Tolerance and Impaired Fasting Glucose)

Hyperinsulinemia and Insulin Resistance

How Does Diabetes Affect Asian and Pacific Islander American Women During Pregnancy?

How Does Diabetes Affect Cardiovascular Health in Asian and Pacific Islander Americans?

How Do Diabetes Complications Affect Asian and Pacific Islander Americans?

Diabetic Retinopathy

Diabetic Nephropathy

Lower Extremity Amputation

Does Diabetes Cause an Inordinate Number of Deaths in Asian and Pacific Islander Americans?

How Is NIDDK Addressing the Problem of Diabetes in Asian and Pacific Islander Americans?

Diabetes Prevention Program

Points to Remember

References

Chapter 6: Diabetes Diagnosis

Questions to Ask Your Doctor About Blood Sugar

Chapter 7: About Pre-Diabetes

How Do You Tell If You Have Pre-Diabetes?

What You Can Do

Frequently Asked Questions

Q: What is pre-diabetes and how is it different from diabetes?

Q: Is pre-diabetes the same as Impaired Glucose Tolerance or Impaired Fasting Glucose?

Q: Why do we need to give it a new name? Has the condition changed?

Q: How do I know if I have pre-diabetes?

Q: How does the FPG test define diabetes and pre-diabetes?

Q: How does the OGTT define diabetes and pre-diabetes?

Q: Which test is better?

Q: Why do I need to know if I have pre-diabetes?

Q: Will my insurance cover testing and treatment?

Q: What is the treatment for pre-diabetes?

Q: Who should get tested for pre-diabetes?

Q: How often should I be tested?

Q: Could I have pre-diabetes and not know it?

Q: Should children be screened for pre-diabetes?

Chapter 8: Am I At Risk For Type 2 Diabetes?

What Is Type 2 Diabetes?

How Can Type 2 Diabetes Be Prevented?

What Are the Signs and Symptoms of Type 2 Diabetes?

Types of Diabetes

Type 1 Diabetes

Type 2 Diabetes

Gestational Diabetes

Should I Be Tested For Diabetes?

What Does It Mean to Have Pre-Diabetes?

Besides Age and Overweight, What Other Factors Increase My Risk For Type 2 Diabetes?

What Can I Do About My Risk?

Doing My Part: Getting Started

Reach and Maintain a Reasonable Body Weight

Make Wise Food Choices Most of the Time

Be Physically Active Every Day

Take Your Prescribed Medications

Chapter 9: Hypoglycemia

How Does the Body Control Glucose?

What Are the Symptoms of Hypoglycemia?

Hypoglycemia in Diabetes

Managing Hypoglycemia in Diabetes

Other Causes of Hypoglycemia

Diagnosis

Reactive Hypoglycemia

Rare Causes of Hypoglycemia

Resources on Hypoglycemia

Additional Readings

Chapter 10: What I Need to Know About Eating and Diabetes

How Food Affects Your Blood Glucose

Blood-glucose Levels

Noninvasive Blood Glucose Monitors

How Can I Keep My Blood Glucose at a Health Level?

Why Should I Eat About the Same Amount at the Same Times Each Day?

Your Diabetes Medicines

Your Exercise Plan

Hypoglycemia

The Food Pyramid

Starches

Vegetables

Fruit

Milk and Yogurt

Meat and Meat Substitutes

Fats and Sweets

Alcohol

Your Meal Plan

Measuring Your Food

When You Are Sick

Points to Remember

How to Find More Help

Chapter 11: Kidney Disease of Diabetes

Prevent Diabetes Problems: Keep Your Kidneys Healthy

The Course of Kidney Disease

Five Stages

Effects of High Blood Pressure

Preventing and Slowing Kidney Disease

Blood Pressure Medicines

Low-Protein Diets

Intensive Management of Blood Glucose

Dialysis and Transplantation

Good Care Makes a Difference

Looking to the Future

References

Chapter 12: Prevent Diabetes Problems: Keep Your Kidneys Healthy

What are diabetes problems?

What should I do each day to stay healthy with diabetes?

What do my kidneys do?

How can I prevent diabetes kidney problems?

Is there a medicine to slow down kidney damage?

How can my doctor protect my kidneys during special x-ray tests?

How can diabetes hurt my kidneys?

What can I do if I have diabetes kidney problems?

How will I know if my kidneys fail?

What happens if my kidneys fail?

Will I know if I start to have kidney problems?

How can I find out if I have kidney problems?

Will my doctor do other kidney tests?

Chapter 13: End-Stage Renal Disease: Choosing a Treatment That’s Right For You

When Your Kidneys Fail

Treatment Choice: Hemodialysis

Purpose

How It Works

Getting Ready

Who Performs It

The Time it Takes

Possible Complications

Your Diet

Pros and Cons

Working With Your Health-Care Team

Treatment Choice: Peritoneal Dialysis

Purpose

How It Works

Getting Ready

Types of Peritoneal Dialysis

Possible Complications

Your Diet

Pros and Cons

Working With Your Health-Care Team

Dialysis Is Not a Cure

Treatment Choice: Kidney Transplantation

Purpose

How It Works

Getting Ready

The Time It Takes

Possible Complications

Your Diet

Pros and Cons

Working With Your Health-Care Team

Conclusion

Paying for Treatment

Medicare

Private Insurance

Medicaid

Veterans Administration (VA) Benefits

Social Security Income (SSI) and Social Security Disability Income (SSDI)

Organizations That Can Help

Additional Reading

Chapter 14: Diabetic Neuropathies: The Nerve Damage of Diabetes

Causes

Symptoms

Types of Diabetic Neuropathy

Neuropathy Affects Nerves Throughout the Body

Peripheral Neuropathy

Autonomic Neuropathy

Proximal Neuropathy

Focal Neuropathy

Peripheral Neuropathy

Autonomic Neuropathy

Unawareness of Hypoglycemia

Heart and Circulatory System

Digestive System

Urinary Tract and Sex Organs

Sweat Glands

Eyes

Proximal Neuropathy

Focal Neuropathy

Preventing Diabetic Neuropathy

Diagnosis

Treatment

Foot Care

Pain Relief

Gastrointestinal Problems

Dizziness and Weakness

Urinary and Sexual Problems

Points to Remember

Hope Through Research

For More Information

Chapter 15: Gastroparesis and Diabetes

What Is Gastroparesis?

Symptoms

Complications of Gastroparesis

Major Causes of Gastroparesis

Diagnosis

Treatment

Insulin For Blood Glucose Control in People With Diabetes

Medication

Meal and Food Changes

Feeding Tube

Parenteral Nutrition

Points to Remember

Chapter 16: Impotence

How Does an Erection Occur?

What Causes Impotence?

How Is Impotence Diagnosed?

Patient History

Physical Examination

Laboratory Tests

Other Tests

Psychosocial Examination

How Is Impotence Treated?

Psychotherapy

Drug Therapy

Vacuum Devices

Surgery

What Will the Future Bring?

Points to Remember

Resources for More Information

Chapter 17: Keep Your Nervous System Healthy

What Are Diabetes Problems?

What Can I Do Each Day to Stay Healthy With Diabetes?

What Can I Do to Prevent Diabetes From Damaging My Nervous System?

What Can I Do to Take Care of My Feet?

What Does My Nervous System Do?

How Can Diabetes Hurt My Nervous System?

How Can Diabetes Damage to The Peripheral Nerves Affect Me?

How Can Diabetes Damage to the Autonomic Nerves Affect Me?

How Can Diabetes Damage to the Cranial Nerves Affect Me?

How Do I Know if I Have Nerve Damage?

For More Information

Chapter 18: Keep Your Heart and Blood Vessels Healthy

What Are Diabetes Problems?

What Should I Do Each Day to Stay Healthy With Diabetes?

What Do My Heart and Blood Vessels Do?

What Damages My Heart and Blood Vessels?

What Can I Do to Prevent Heart and Blood Vessel Problems?

How Do My Blood Vessels Get Clogged?

What Heart Problems Can Unhealthy Blood Vessels Cause?

How Does Heart Disease Cause High Blood Pressure?

What Are the Warning Signs of a Stroke?

How Can Clogged Blood Vessels Hurt My Legs and Feet?

What Can I Do to Prevent or Control Peripheral Vascular Disease?

Which Medical Tests Will Help Me Keep Track of Any Heart or Blood Vessel Problems?

For More Information

Chapter 19: Keep Your Feet and Skin Healthy

What Are Diabetes Problems?

What Should I Do Each Day to Stay Healthy With Diabetes?

How Can Diabetes Hurt My Feet?

What Can I Do To Take Care of My Feet?

How Can I Get My Doctor to Help Me Take Care of My Feet?

What Are Common Diabetes Foot Problems?

How Can Special Shoes Help My Feet?

How Can Diabetes Hurt My Skin?

What Can I Do to Take Care of My Skin?

Take Care of Your Feet for a Lifetime

Tips For Proper Footwear

Steps For Preventing Foot Problems

Annual Comprehensive Diabetes Foot Exam

Chapter 20: Keep Your Teeth and Gums Healthy

What Are Diabetes Problems?

What Should I Do Each Day to Stay Healthy With Diabetes?

How Can Diabetes Hurt My Teeth and Gums?

How Do I Know If I Have Damage to My Teeth and Gums?

How Can I Keep My Teeth and Gums Healthy?

How Can My Dentist Take Care of My Teeth and Gums?

For More Information

Chapter 21: Keep Your Diabetes Under Control

What Are Diabetes Problems?

Will I Have Diabetes Problems?

What Should My Blood Sugar Numbers Be?

How Can I Find Out What My Average Blood Sugar Is?

Check Your Hemoglobin Alc I.Q.

Answers to the Hemoglobin A1c I.Q. Quiz

What Should I Do About Blood Pressure?

What Should I Know and Do About Smoking?

What Else Can I Do to Prevent Diabetes Problems?

Things to Check For Good Diabetes Care

How to Use the Daily Diabetes Record Page

Blood sugar checks

Medicines

Notes

Chapter 22: Guiding Principles for Diabetes Care: For Health-Care Providers

Introduction

Principle 1: Screening High-Risk People and Diagnosing Diabetes

Principle 2: On-Going Care

Principle 3: Diabetes Education

Principle 4: Treating Hyperglycemia

Principle 5: Self-Monitoring of Blood Glucose Control and Hemoglobin A1c (HbA1c)

Principle 6: Preventing and Diagnosing Long-Term Diabetes Problems

Principle 7: Screening For and Treating Long-Term Diabetes Problems

Chapter 23: Medicines for People With Diabetes

Do I Need to Take Diabetes Medicine?

What if I have type 1 diabetes?

What if I have type 2 diabetes?

Why do I need medicines for type 1 diabetes?

Specific insulin

Why Do I Need Medicines for Type 2 Diabetes?

What Do I Need to Know About Diabetes Pills?

Specific Pills

Oral Drugs

What Do I Need to Know About Insulin?

Can insulin be taken as a pill?

How does insulin work?

How often should I take insulin?

When should I take insulin?

Are there several types of insulin?

Does insulin work the same all the time?

Where on my body should I inject insulin?

How should I store insulin?

What are possible side effects of insulin?

Might I Take More Than One Diabetes Medicine at a Time?

What Should I Know About Hypoglycemia (low blood sugar)?

How Do I Know If My Diabetes Medicines Are Working?

Chapter 24: Alternative Therapies for Diabetes

Acupuncture

Biofeedback

Chromium

Magnesium

Vanadium

Additional Information on Alternative Therapies for Diabetes

Chapter 25: Diabetes Control and Complications Trial (DCCT)

What Is the DCCT?

DCCT Study Findings

How Did Intensive Treatment Affect Diabetic Eye Disease?

How Did Intensive Treatment Affect Diabetic Kidney Disease?

How Did Intensive Treatment Affect Diabetic Nerve Disease?

How Did Intensive Treatment Affect Diabetes-Related Cardiovascular Disease?

Elements of Intensive Management in the DCCT

What Are the Risks of Intensive Treatment?

Chapter 26: The Prevention or Delay of Type 2 Diabetes

Introduction

Should We Attempt To Prevent Diabetes?

Who Are Potential Candidates For Screening and Intervention?

Choice of Screening Test

Age Considerations and Screening Frequency

How Should Diabetes Prevention Be Performed?

How Should Diabetes Prevention Be Performed?

Lifestyle Modification

Pharmacological Interventions

Lifestyle or Medication?

How Do Strategies to Prevent Diabetes Differ From Those to Treat Diabetes?

What Additional Research Is Needed?

Conclusions

References

Chapter 27: Diet and Exercise Delay Diabetes and Normalize Blood Glucose

Chapter 28: Diabetes Prevention Program: Questions & Answers

What Is Impaired Glucose Tolerance (IGT)?

How does the fasting blood glucose test differ from the oral glucose tolerance test?

For a person with IGT, what is the risk of developing type 2 diabetes?

How many people in the U.S. have IGT? Would the DPP interventions benefit all of them?

How do the DPP results compare to the findings of other type 2 diabetes prevention studies?

How do diet and physical activity work to prevent diabetes?

What were the goals of DPP’s lifestyle intervention arm?

What dietary advice did participants receive?

Lifestyle intervention more effectively reduced diabetes risk than metformin

Within each arm, did certain groups of DPP participants benefit more from the intervention than other groups?

Did the DPP volunteers in the lifestyle group benefit more from one lifestyle change than the other, e.g., more from exercise than from diet or vice versa?

Lifestyle changes with diet and exercise reduced diabetes risk, as did treatment with metformin. By combining these interventions, could diabetes risk be reduced even further?

Would the new formulation of metformin, Glucophage XR, be helpful to people with IGT?

Do the DPP interventions affect the risk of cardiovascular disease, an important cause of mortality in people with type 2 diabetes?

Are there any plans to get information about the DPP to the public and health- care professionals?

What is the estimated cost of the DPP interventions?

Were there any deaths or serious injuries in the study resulting from metformin treatment or the lifestyle changes?

Were there adverse effects associated with the interventions?

What will happen to the volunteers who took part in the DPP?

What happened to the DPP volunteers who developed diabetes?

Are diet and exercise beneficial even after diabetes develops?

Chapter 29: Understanding Gestational Diabetes A Practical Guide to a Healthy Pregnancy

What is gestational diabetes and what causes it?

How does gestational diabetes differ from other types of diabetes?

Who is at risk for developing gestational diabetes and how is it detected?

How does gestational diabetes affect pregnancy and will it hurt my baby?

What can be done to reduce problems associated with gestational diabetes?

Diet and Weight Gain

Why is a special diet recommended?

How much weight should I gain?

How should I eat during my pregnancy?

Other Nutritional and Nonnutritional Considerations

Alcohol

Salt

Caffeine

Megavitamins

Smoking

What food patterns help keep blood sugar levels normal?

How do I plan meals?

What can be done to slow weight gain during pregnancy?

Is breast-feeding recommended?

Glucose Monitoring

What is self-blood glucose monitoring?

How often and when should I test?

How should I record my test results?

Are there any other tests I should know about?

How do I test for ketones?

When do I test for ketones?

Is it ever necessary to take insulin?

Will my baby be healthy?

Does gestational diabetes affect labor and delivery?

Should I expect my baby to have any problems?

Will I develop diabetes in the future?

Exercise

Should I exercise?

What happens if diet and exercise fail to control my blood sugars?

Can my blood sugar level go too low, and if so, what do I do?

Glossary

Chapter 30: Consequences of Alcohol Use in Diabetics

Pathophysiology of Diabetes Mellitus

The Pancreas and Its Hormones

Alcohol’s Effects on Blood Sugar Levels of Diabetics

Effects of Alcohol Consumption in the Fed State

Effects of Alcohol Consumption in the Fasting State

Alcohol’s Effects on Complications of Diabetes

Diabetic Ketoacidosis

Alterations of Lipid Metabolism

Elevated Triglyceride Levels.

Reduced LDL Cholesterol Levels.

Elevated HDL Cholesterol Levels.

Cardiovascular Disease

Peripheral Neuropathy

Retinopathy

Medication Interactions

Summary

References

 

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