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Showing papers on "Diabetes management published in 1987"


Journal ArticleDOI
TL;DR: The dietitian plays an integral role in identifying patterns in the blood glucose profile and assisting the patient in making intelligent dietary choices to improve diabetes control.
Abstract: The primary goal of diabetes management is to maintain blood glucose as near to normal as possible. Composition, size, and spacing of meals and snacks all have a substantial impact on blood glucose fluctuations and can be altered to improve glycemic control. Recent research studies focusing on the blood glucose response of various carbohydrate containing foods have found that responses vary considerably. Because the glucose response is influenced by numerous factors, it is difficult to predict how specific individuals will respond to a particular food. A technique known as self-blood glucose monitoring can be used by patients with diabetes to quantitate their own postprandial glucose rise from various foods. The technique itself is portable and relatively simple and is an accurate means of obtaining blood glucose values without using a clinical laboratory. Self-blood testing provides the patient with immediate feedback on the impact of dietary manipulation. Blood glucose records can be used in conjunction with diet records to make adjustments in the type and amount of food or insulin dose that would elicit the best glycemic response. The dietitian thus plays an integral role in identifying patterns in the blood glucose profile and assisting the patient in making intelligent dietary choices to improve diabetes control.

17 citations


Journal ArticleDOI
TL;DR: It appears prudent to prevent or reverse obesity, especially in individuals with a family history of diabetes, in the hope that the onset of diabetes may be prevented or postponed.
Abstract: Noninsulin-dependent diabetes mellitus is a major health problem, highly correlated with obesity and, therefore, overeating. Diet continues as the cornerstone of therapy, with oral hypoglycemic agents or insulin added, if needed, to maintain normal blood glucose values. The diet prescription should be implemented in stages, with caloric restriction the first priority, as weight loss itself diminishes hyperglycemia to or toward normal. Combinations of foods and even different processing or cooking of the same food may produce different glucose responses. These factors minimize the role of the glycemic index in overall diabetes management. Foods with high soluble fiber content may diminish glucose elevations after meals; however, high-fiber foods appear to be less important for the obese diabetic person than adhering to a calorie-restricted diet and achieving weight loss. Attempts should be made to alter life-style within an acceptable degree for any given patient to encourage weight reduction. For example, although exercise may have a small but transient direct effect in lowering blood glucose and insulin resistance, it can be considered an adjunct to decreased calorie diets for weight reduction. Finally, it appears prudent to prevent or reverse obesity, especially in individuals with a family history of diabetes, in the hope that the onset of diabetes may be prevented or postponed.

15 citations


Journal ArticleDOI
TL;DR: Diabetes and its management is described, a framework for conceptualizing diabetes compliance is proposed, and future directions for a comprehensive approach to diabetes management are suggested.

13 citations


Journal ArticleDOI
TL;DR: In view of the fact that perinatal results, such as the occurrence of malformations, mean gestational age, mean birth weight and neonatal complications were not significantly different in both groups, it is believed that both methods are equally effective.
Abstract: Preconceptional diabetes management is an important prerequisite for pregnancy planning and its value has been well-documented. Glucose control and the outcome of pregnancy, managed in the preconceptional period, with continuous subcutaneous insulin infusion therapy to those receiving insulin injections are compared. Fifty-two juvenile onset insulin dependent diabetic women contemplating pregnancy were regularly consulted by a diabetology team starting at least two months before conception. Glucose control was achieved by continuous subcutaneous insulin infusion pumps (CSIIP) in 18 patients, and 34 women received intensive insulin therapy (IIT). In both groups, normal glucose levels and normal HbA1 were achieved at conception, maintained during the period of organogenesis and throughout pregnancy. In view of the fact that perinatal results, such as the occurrence of malformations, mean gestational age, mean birth weight and neonatal complications were not significantly different in both groups, we believe that both methods are equally effective. Consequently, the less costly and yet effective IIT may be the method of choice, while the more expensive pump should be used mainly in selected cases.

10 citations


Journal ArticleDOI
TL;DR: Although over 85 % of the diabetic group members felt their knowledge had improved, only 35% were aware of improvements in their control, and these meetings proved an efficient means of improving patients' diabetes knowledge and control.
Abstract: Thirty patients with insulin- dependent diabetes and their relatives participated in monthly evening group meetings for six months. Questionnaires assessed knowledge before and after the group meetings; and the percent of HbA 1 was used to assess diabetes control. Knowledge improved significantly from a mean score of 59.7%±9.6% to 69.1 % ±8.2 %, p<0. 0005, and HbA1 level from 12.4%±2.9% to 10.3%±2.5%, p<0.001. A . well-matched control group showed no improvement in HbA1 over the study period, while the improvement seen in the self- help group was sustained for the next 12 months. Although over 85 % of the diabetic group members felt their knowledge had improved, only 35% were aware of improvements in their control. These meetings proved an efficient means of improving patients' diabetes knowledge and control. They were easy and inexpensive to organize and may prove to be a useful aid in diabetes management.

10 citations



Journal ArticleDOI
TL;DR: Consider the following reports: Patient1.—An 11-year-old boy with a three-year history of insulin-dependent diabetes mellitus was referred to the Children's Diabetes Management Center, Galveston, Tex, for a decreasing insulin dose and marked hypoglycemia with a recent onset of seizures.
Abstract: Consider the following reports: Patient1.—An 11-year-old boy with a three-year history of insulin-dependent diabetes mellitus was referred to the Children's Diabetes Management Center, Galveston, Tex, for a decreasing insulin dose and marked hypoglycemia with a recent onset of seizures. His metabolic control had always been good, with no episodes of Ketoacidosis; his mother rigidly controlled his insulin administration and food intake. The patient had a two-year history of mild hypoglycemia for which he received carbonated sugar-containing drinks and cake. Because of the increasing frequency of these hypoglycemic episodes, his insulin dosage was decreased from a total of 30 U/d to 8 U/d over the six-month period before admission. During a five-day evaluation, his blood glucose levels increased, as did his insulin requirements (0.8 U/kg/d). His mother continued to be reluctant to allow her son any freedom to manage his disease. Although the child admitted that he had occasionally given

8 citations


Journal ArticleDOI
TL;DR: The management of these young diabetic children with insulin pump therapy was thus not associated with an increased frequency or an accelerated rate of development of ketosis, however, the possible failures originating from the infusing device and the rapid increase ofketosis in young ages require special vigilance from the parents.
Abstract: The risk of ketosis and its relationship to the mode of insulin therapy were studied in a subset of pre-school-age diabetic children. These five children, who initially responded poorly to standard in-hospital diabetes management, were selected for a program of intensified therapy directed at achieving more stable blood glucose control. Optimized conventional therapy was first employed for 16 ± 5 mo and did not improve substantially blood glucose level or stability. During this period, there was an average of almost one episode of ketonuria per patient per month, and three diabetic ketoacidosis episodes were observed. Because of its limited efficacy, the treatment was then changed to continuous subcutaneous insulin infusion. This mode of therapy had a rapid favorable effect on blood glucose control, with no concomitant increase of the frequencies of ketonuria or diabetic ketoacidosis, most of which occurred during the first months of insulin pump therapy. Deliberate cessation of either conventional or subcutaneous insulin infusion therapy for 7 h under close in-hospital control resulted in similar metabolic changes: a slight nonconstant increase of blood glucose, and an abrupt rise of blood 3-hydroxybutyrate to 3 mM, with massive ketonuria. The management of these young diabetic children with insulin pump therapy was thus not associated with an increased frequency or an accelerated rate of development of ketosis. However, the possible failures originating from the infusing device and the rapid increase of ketosis in young ages require special vigilance from the parents, based on twice-daily urine testing for ketones and appropriate insulin supplementation.

7 citations


Book
01 Jan 1987

5 citations


Journal ArticleDOI
M. Dolan1, H. Clarke1, K Bulger1, A. Heffernan1, T. J. McKenna1 
TL;DR: It is clear that the nurses did not have adequate information to usefully or safely contribute in the management of diabetic patients, and deficits of 31% for IDD and 21.5% for NIDD in essential diabetes information were demonstrated.
Abstract: We have recently examined the diabetes-related information carried by hospital-based and community nurses. To do this we utilised questionnaires designed to assess patient knowledge of either IDD or NIDD. Identical questionnaires, covering only essential information required by patients to manage diabetes mellitus adequately, were answered before and following a half-day symposium for nurses on diabetes mellitus. Twenty-nine nurses answering the questionnaires on IDD responded correctly to 16.1 ± 3.2 questions out of a possible 24. After the symposium the score increased significantly to 19.7 ± 2.5, p < 0.001. Forty-five nurses responding to the NIDD questionnaires gave 15.7 ± 2.0 correct answers out of a possible 20. Following the symposium this score increased to 17.2 ± 1.9 correct responses, p < 0.001. Therefore, the nurse participants in this study demonstrated deficits of 31% for IDD and 21.5% for NIDD in essential diabetes information. Since only basic information was assessed, it is clear that the nurses did not have adequate information to usefully or safely contribute in the management of diabetic patients.

4 citations


Journal Article
TL;DR: It is concluded that intensification of therapy through conventional means, or pump treatment if necessary, allows a long term efficient control of blood glucose in preschool children.
Abstract: Before modern methods of diabetes management were available, the achievement of strict glycemic control was considered almost impossible in most children with early onset of the disease. The present results obtained over 2 years in 31 children aged 21 +/- 2 (SEM) months at the onset of the disease indicate the efficiency of intensive conventional therapy in 21 of them: glycosylated hemoglobin averaged 7.0 +/- 0.3% (N = 4.7 +/- 0.7%) during the observed 26 +/- 7 months, with only 0.02 +/- 0.01 hypoglycemic attack per patient-month and no diabetic ketoacidosis. In the remaining 10 children, who resisted intensive conventional therapy, we used insulin pumps to improve blood glucose control, with the following results over 21 +/- 4 months: Glycosylated hemoglobin decreased from 9.3 +/- 0.3% (before pump) to 8.0 +/- 0.4% (p less than 0.05). The frequency of hypoglycemia decreased dramatically from 1.7 +/- 0.7 to 0.03 +/- 0.01 episode per patient-month. The frequency of ketonuria and ketoacidosis was unchanged. We concluded that intensification of therapy through conventional means, or pump treatment if necessary, allows a long term efficient control of blood glucose in preschool children.


Journal ArticleDOI
TL;DR: Management of insulin-dependent (type I) diabetes mellitus has vastly changed over the past decade, with the development of an approach known as intensive therapy, which emphasizes patient self-direction under the guidance of a physician.
Abstract: Management of insulin-dependent (type I) diabetes mellitus has vastly changed over the past decade. New tools and updated philosophies have permitted the development of an approach known as intensive therapy, which emphasizes patient self-direction under the guidance of a physician. Current insulin regimens have multiple components and consist of several daily injections or the use of an insulin pump. Diets are flexible and individually tailored to the patient's needs. Self-monitoring of blood glucose, an integral component of management, guides decision making in an attempt to achieve defined blood glucose values. With this approach, many patients who have been educated and motivated in diabetes management attain meticulous control.




Journal ArticleDOI
TL;DR: It is concluded that all patients would benefit from the routine testing of diabetes management skills and such routine testing is needed to identify and rectify problem areas.
Abstract: Competence in various aspects of diabetes self-care was assessed in 125 patients attending the diabetic clinic at Royal Prince Alfred Hospital, Camperdown, Australia. Fifty patients were referred for review because poor management skills were suspected. Their performance was compared with that of 75 patients randomly selected for assessment. Whilst there was no difference in performance between these 2 groups, a significant determinant of competence in diabetes self-care was fluency in English. Non-English speaking patients scored significantly less in all aspects tested, except management of hypoglycaemia. Prior attendance at a diabetes education programme predicted better performance, but this was largely accounted for by better fluency in English. Re-testing of deficit areas at 6 months showed significant improvements in performance. We conclude that all patients would benefit from the routine testing of diabetes management skills and such routine testing is needed to identify and rectify problem areas. Particular groups such as migrants require intensive efforts, so that their inadequate knowledge and skills can be identified.