Diabetes Secrets

1st Edition - November 25, 2021
Author: Michael T. McDermott
Editor: Jennifer M. Trujillo
Language: English
Paperback ISBN:
9 7 8 - 0 - 3 2 3 - 7 9 2 6 2 - 2
eBook ISBN:
9 7 8 - 0 - 3 2 3 - 7 9 2 6 3 - 9

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For more than 30 years, the highly regarded Secrets Series® has provided students and practitioners in all areas of health care with concise, focused, and engaging resources for quick reference and exam review. A new volume in this trusted series, Diabetes Secrets offers practical, up-to-date coverage of the full range of essential topics in this dynamic field. It features the Secrets’ popular question-and-answer format that also includes lists, tables, pearls, memory aids, and an easy-to-read style – making inquiry, reference, and review quick, easy, and enjoyable.

Cover image
Title page
Table of Contents
Any screen, Any time, Anywhere
Copyright
Dedication
Foreword
Top 100 Secrets
Abstract
Chapter 1. Diabetes Mellitus: Classification, Etiology, and Pathogenesis
Abstract
1 What are the diagnostic criteria for diabetes mellitus and prediabetes?
2 How common is diabetes mellitus?
3 What are the different types of diabetes mellitus?
4 What is type 1 diabetes mellitus? What is the etiology and pathogenesis?
5 Describe the development of type 1 diabetes mellitus
6 What tests are best to establish a diagnosis of type 1 diabetes mellitus?
7 What is type 2 diabetes mellitus? What are the etiology and pathogenesis?
8 Explain a recent classification suggesting that there are five main types of diabetes mellitus
9 What is prediabetes?
10 What is latent autoimmune diabetes of adults (LADA)?
11 What is ketosis-prone type 2 diabetes mellitus?
12 What is posttransplant diabetes mellitus?
13 What are the characteristics of diabetes caused by pancreatic insufficiency?
14 Describe diabetes related to cystic fibrosis (CF)
15 Explain mody
16 What is checkpoint inhibitor-associated autoimmune diabetes mellitus (CIADM)?
17 What is GDM?
Bibliography
Chapter 2. Comprehensive Medical Evaluation of Persons With Diabetes
Abstract
1 What are some important components of successful patient-centered collaborative care?
2 What are the key components of a diabetes assessment and treatment plan?
3 How do you calculate and interpret the ASCVD risk score?
4 What are the key components of the comprehensive diabetes medical evaluation?
5 What information should be gathered regarding past medical and family history?
6 What information should be gathered regarding lifestyle and social history?
7 What information should be gathered regarding medications and vaccinations?
8 What immunizations should be recommended?
9 What should be included in the assessment of treatment-associated hypoglycemia?
10 What information should be gathered regarding the use of diabetes-related technology?
11 What information should be gathered regarding psychosocial factors and diabetes self-management skills?
12 What components should be prioritized in the physical examination?
13 What labs should be ordered during a comprehensive diabetes evaluation?
14 What other common comorbidities should clinicians be aware of that could complicate diabetes management?
15 What referrals should be considered as part of the initial care management of PWD?
Bibliography
Chapter 3. Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Syndrome
Abstract
1 What are diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS)?
2 What is euglycemic DKA?
3 How common is DKA?
4 Do DKA and HHS ever occur simultaneously?
5 What are the most common situations or precipitants for DKA and HHS?
6 Explain the pathophysiology of DKA
7 Describe the pathophysiology of HHS and how it differs from DKA
8 What water and electrolyte deficits are typically present in DKA and HHS?
9 What equations are useful for diagnosing and monitoring treatment of DKA and HHS?
10 What are the key principles of treating DKA and HHS?
11 Give recommendations for IV fluid administration in DKA and HHS
12 How important is volume repletion in HHS?
13 How should insulin therapy be given during DKA and HHS?
14 When and how is potassium administered in DKA and HHS?
15 When should bicarbonate be given in the management of DKA and HHS?
16 When is phosphate replacement indicated in the treatment of DKA and HHS?
17 Are DKA and HHS considered hypercoagulable states?
18 What criteria are used to determine when DKA has resolved?
19 Why can ketones appear to worsen during the treatment of DKA?
20 What pitfalls may occur during the treatment of DKA and HHS?
21 What is the mortality rate of DKA and HHS?
Bibliography
Chapter 4. Diabetic Kidney Disease
Abstract
1 What is diabetic nephropathy (DN)?
2 What is the difference between albuminuria and proteinuria? How are they measured and interpreted?
3 What do macroalbuminuria and microalbuminuria refer to in DN?
4 What is diabetic kidney disease (DKD)?
5 Describe the features of NA-DKD
6 What are the incidence and prevalence of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) in diabetic nephropathy?
7 What are the cardiovascular and mortality outcomes in DN-associated CKD and ESKD?
8 What are the nonmodifiable risk factors contributing to DKD and its progression?
9 What are the modifiable risk factors contributing to DKD and its progression?
10 What are the pathophysiologic changes of DN?
11 What is the natural progression of DN?
12 What mechanisms contribute to glomerular hyperfiltration in DN?
13 How does DKD impair the autoregulatory capability of the kidney?
14 Can hyperfiltration and albuminuria regress?
15 What is the prevalence of diabetic retinopathy (DR) among individuals diagnosed with DN?
16 What are the required criteria to make a clinical diagnosis of DN?
17 What are the indications for biopsy in a patient with diabetes and renal dysfunction?
18 Discuss how worsening GFR affects the phenomenon of “burned-out diabetes” in DM2. What are the underlying mechanisms?
19 What are the main goals in the management of DKD?
20 How is RAAS inhibition effective in DN?
21 In people with advanced CKD initiated on RAAS inhibition, how are the associated declining GFR and hyperkalemia managed?
22 What is the mechanism of action of SGLT-2 inhibitors? How are they renoprotective?
23 What are the mortality, cardiovascular, and kidney outcomes with SGLT-2 inhibitors?
24 What are the adverse drug effects of SGLT-2 inhibitors?
25 Who are candidates for SGLT-2 inhibitors?
26 How do we interpret the ensuing drop in GFR after initiating SGLT-2 inhibitors?
27 Is there a role for GLP-1 receptor agonists in DKD?
28 Are there therapeutic interventions on the horizon that will benefit those with DKD?
Bibliography
Chapter 5. Diabetic Retinopathy
Abstract
1 What is diabetic retinopathy (DR)?
2 How common is DR?
3 Name the subtypes of DR
4 How common is blindness from DR?
5 Describe diabetic macular edema (DME)
6 What is neovascularization (NV)?
7 What are anterior-segment complications of diabetes?
8 How does DR cause retinal detachment?
9 What are the major risk factors for developing DR?
10 How is DR diagnosed?
11 How often should patients with diabetes see an eye doctor for an exam?
12 How is DR treated?
13 Discuss the risks of treatment
14 Does DR correlate to a patient’s overall health?
15 Can DR be cured?
Bibliography
Chapter 6. Diabetic Neuropathies
1 What is neuropathy?
2 What are the symptoms associated with neuropathy?
3 How common is diabetic neuropathy?
4 How does neuropathy present in diabetes?
5 What is distal symmetric polyneuropathy (DSP)?
6 What are the features of diabetic autonomic neuropathy (DAN)?
7 What is diabetic neuropathic cachexia?
8 What is DRPN?
9 What focal neuropathies are common in diabetes?
10 What cranial neuropathies (CNs) occur more commonly in diabetes?
11 What bloodwork is appropriate to evaluate diabetic neuropathy?
12 What other diagnostic tools should be utilized when working up diabetic neuropathy syndromes?
13 What are symptomatic treatment options for diabetic nerve pain?
14 What treatments are available for focal diabetic nerve symptoms?
15 How should DRPN be managed?
16 How does diabetes cause neuropathy?
17 Can prediabetes cause neuropathy?
18 What disease-modifying treatments are available for diabetic neuropathy?
19 What is treatment-induced neuropathy of diabetes (TIND)?
20 What are some future directions for the treatment of diabetic neuropathy?
Bibliography
Chapter 7. Prevention of Macrovascular Complications
Abstract
1 What are the incidence and prevalence of macrovascular complications in patients with diabetes?
2 What are the most common macrovascular complications associated with diabetes?
3 How does diabetes contribute to the pathophysiology of macrovascular disease?
4 What are the risk factors for the development of macrovascular complications in patients with diabetes?
5 How do I estimate a patient’s risk for developing macrovascular complications?
6 What are the dietary and exercise recommendations for mitigating CV risk in people with diabetes?
7 Does tobacco cessation mitigate CV risk?
8 Does the treatment of hyperglycemia improve CV risk?
9 What is the impact of antidiabetes medications on CV risk?
10 Which antidiabetes medications are preferred in patients with diabetes who have comorbid CV disease or who are at high risk of CV events?
11 What is the evidence that hypertension is a modifiable CV risk factor in patients with diabetes?
12 Who should be treated, and what are the goals of treatment, for hypertension in patients with diabetes to reduce CV risk?
13 What antihypertensive medications are preferred in patients with diabetes to reduce CV risk?
14 What is the evidence that dyslipidemia is a modifiable CV risk factor in patients with diabetes?
15 Who should be treated, and what are the goals of treatment, for dyslipidemia in patients with diabetes to reduce CV risk?
16 What lipid-lowering medications are preferred in patients with diabetes to reduce CV risk?
Bibliography
Chapter 8. Diabetes and Nonalcoholic Fatty Liver Disease
Abstract
1 What are nonalcoholic fatty liver disease (NAFLD), nonalcoholic steatohepatitis (NASH), and liver fibrosis?
2 What is the prevalence of NAFLD in the general population and in those with diabetes?
3 What are the risk factors for developing NAFLD?
4 Which genetic risk factors are linked to NAFLD and type 2 diabetes?
5 What is the natural progression of NAFLD, and what risk factors are linked to progressive disease?
6 What clues might alert the provider that a person has NAFLD?
7 What strategies are currently available to evaluate the presence and severity of NAFLD?
8 When is a biopsy clinically indicated?
9 What is the cornerstone of NAFLD treatment?
10 Are there any medications currently approved by the U.S. Food and Drug Administration (FDA) for NAFLD and NASH?
11 What role does bariatric surgery have in the management of NAFLD and NASH?
12 At what point should referral to a specialist be considered?
Bibliography
Chapter 9. Diabetes Management: Lifestyle Measures—Nutrition
Abstract
1 What are the goals for medical nutrition therapy (MNT) for those with diabetes?
2 What meal patterns should those with diabetes lean toward?
3 What is the simplest strategy to teach a person how to follow a meal plan?
4 What should be the initial weight-loss goal for people with diabetes who are overweight or obese?
5 What dietary fats should those with diabetes include in their dietary pattern?
6 Can alcohol be a part of a meal pattern for a person with diabetes?
7 What is the sodium goal for those with diabetes?
8 Can nonnutritive sweeteners be a part of the meal plan for those with diabetes?
9 How effective is MNT at lowering A1c?
10 How do social determinants of health (SDOH) affect nutrition?
11 What role does food insecurity play in nutrition?
Bibliography
Chapter 10. Exercise and Diabetes
Abstract
1 What is the difference between physical activity and exercise, and which has a greater impact on diabetes?
2 What are physical activity guidelines for people with DM?
3 How do demographic factors, such as gender, race, and ethnicity, affect the ability of people with dm to meet physical activity guidelines?
4 What is the role of sedentary time in T2DM?
5 What is the role of exercise in the prevention of T2DM?
6 Identify the benefits of physical activity/exercise in T2DM
7 What are the optimal duration and frequency of exercise in those with DM?
8 Review key strategies for increasing physical activity in adults with T2DM
9 What common barriers do people with DM encounter when exercising?
10 How do DM complications contribute to barriers to exercise in DM?
11 Identify the pathophysiological barriers to exercise in DM
12 Discuss the relationship between exercise and CRF in those with T2DM and the impact this relationship has on morbidity and mortality
13 How does exercise affect micro- and macrovascular outcomes in people with T2DM?
14 Discuss exercise as a therapeutic adjunct to pharmacologic therapy in T2DM
15 How does exercise affect glycemic control in those with DM?
16 What exercise modality produces optimal results in individuals with DM?
17 Discuss the advantages of using an insulin pump compared with multiple daily injections for insulin users who exercise
18 What specific safety measures regarding hypoglycemia should be advised for those with DM who exercise?
19 What other safety measures should be recommended for those with DM who exercise?
20 Are there any contraindications to exercise in DM?
Bibliography
Chapter 11. Diabetes Management: Insulin Therapy
Abstract
1 How do the pharmacokinetic (PK) and pharmacodynamic (PD) properties of insulin products compare?
2 What factors can affect the PK/PD properties of insulin?
3 What is bolus insulin?
4 What is basal insulin?
5 What is the difference between basal and bolus insulin coverage?
6 How is insulin used in the treatment of T1D?
7 How is insulin used in the treatment of T2D?
8 How should insulin be intensified in the treatment of T2D?
9 What are the most common adverse effects of insulin?
10 What insulin products are currently available in the United States?
11 What education tips should be included when counseling a patient on the appropriate use of insulin?
12 When should bolus insulin be taken?
13 When should basal insulin be taken?
14 How do you switch from one insulin product to another?
15 What is U-500 insulin, and when should it be considered?
16 What is inhaled insulin, and when should it be considered?
17 What is mixed insulin, and when should it be considered?
18 What is the cost of insulin?
Bibliography
Chapter 12. Diabetes Management: Noninsulin Therapies
Abstract
1 What noninsulin medication classes are used to treat type 2 diabetes (T2D)?
2 How do the noninsulin medication classes compare with respect to efficacy, safety, and ease of use?
3 How are noninsulin oral medications dosed?
4 How can the adverse effects of metformin be minimized?
5 What other noninsulin therapies are available to treat T2D?
6 Which noninsulin medication classes are used to treat type 1 diabetes?
7 Which medications should not be used (or require dose adjustments) in patients with renal dysfunction?
8 What is the impact on weight of the different diabetes medications?
9 Which medications confer the highest risk of hypoglycemia?
10 Which agents have evidence of CV benefit in patients with T2D?
11 Which agents have evidence of renal benefit in patients with T2D?
12 Which agents have evidence of heart failure benefit in patients with T2D?
13 Which medication classes should not be used in combination?
14 What are the relative costs of noninsulin therapies for diabetes?
Bibliography
Chapter 13. Carbohydrate Counting and Precise Insulin Dosing
Abstract
1 Define and explain the carbohydrate-to-insulin (C:I) ratio
2 How do you determine if the current C:I ratio is correct?
3 What is a high-BG correction factor (CF)?
4 How do you calculate and use the insulin bolus on board (BOB) and duration of insulin action (DIA) estimates?
5 Do people who take basal-bolus insulin need to do these calculations before every meal and correction dose?
6 Explain what additional information is provided by a continuous glucose monitor (CGM)
7 What basic carbohydrate-counting skills should every patient with diabetes and their providers know?
8 Practice with carbohydrate counting and precise insulin dosing
9 Here are my answers. Yours may be slightly different if you disagree with the carbohydrate contents I have listed. This is OK as long as you follow sound principles of carbohydrate counting and do accurate math
10 How do you assess if your patients are counting their carbohydrates accurately?
Bibliography
APPS
Chapter 14. Type 2 Diabetes Management: Selecting Glycemic Targets and Choosing the Right Therapy
Abstract
1 What are the general glycemic targets for people with type 2 diabetes?
2 When is it appropriate to set less stringent glycemic targets?
3 What is the recommended first-line treatment for people with type 2 diabetes?
4 How long should metformin be used in people with type 2 diabetes?
5 Is initial combination therapy ever appropriate in people with type 2 diabetes?
6 When is the early use of insulin therapy appropriate for people with type 2 diabetes?
7 Are additional glucose-lowering medications only added to metformin in response to an elevated A1c?
8 What glucose-lowering medications are preferred in people with predominant atherosclerotic cardiovascular disease (ASCVD)?
9 Which glucose-lowering medications are preferred in patients with comorbid heart failure?
10 Are there any glucose-lowering medications that should be avoided in people with heart failure?
11 Are any glucose-lowering therapies specifically recommended in people with type 2 diabetes and chronic kidney disease (CKD)?
12 Which glucose-lowering medications are recommended where there is a compelling need to minimize hypoglycemia?
13 Are there any glucose-lowering medications that can help with weight loss?
14 Which glucose-lowering medications are recommended for use when cost is a major barrier?
15 Are there any glucose-lowering combinations that should be avoided?
16 If a person with type 2 diabetes requires the greater efficacy of an injectable glucose-lowering agent, which class of medications is recommended by the ADA for initial consideration?
17 How is basal insulin typically initiated and titrated in a person with type 2 diabetes?
18 If the fasting blood glucose is at goal but the A1c remains elevated after titrating a patient’s basal insulin, what is recommended next?
Bibliography
Chapter 15. Diabetes Prevention
Abstract
1 What is prediabetes?
2 Why is the prevention of T2D important?
3 What are the risk factors for developing T2D in adults?
4 What are the risk factors for developing T2D in children and adolescents?
5 Should asymptomatic people be screened for T2D?
6 How should people be screened for T2D?
7 Describe lifestyle interventions to prevent diabetes
8 What medications have been studied to prevent diabetes?
9 What is the preferred treatment for prediabetes?
Bibliography
Chapter 16. Diabetes and Pregnancy
Abstract
Key Points 1: Preconception Counseling in Diabetes
Key Points 2: Pregestational Diabetes in Pregnancy
Key Points 3: GDM
Key Points 4: Postpartum Care in Diabetes
Bibliography
Chapter 17. Diabetes Management in Patients With Cancer
Abstract
1 Is diabetes associated with cancer risk?
2 Do people with diabetes and cancer have a worse prognosis?
3 What factors may contribute to the increased cancer mortality risk in people with diabetes?
4 Why is glycemic control important in the cancer population?
5 What are appropriate glycemic targets for cancer patients?
6 List available antidiabetic therapies for oncology patients and special considerations when selecting an optimal therapy
7 Explain how metformin may improve cancer outcomes
8 What cancer therapies are associated with an increased risk for hyperglycemia in patients with cancer with or without underlying diabetes?
9 Explain how ICIs work and how they cause autoimmune diabetes
10 Have CTLA-4 inhibitors been associated with CIADM?
11 What is the incidence of CIADM?
12 How do people with CIADM typically present?
13 What are risk factors for the development of CIADM?
14 How is CIADM different from T1DM?
15 How do you monitor for CIADM?
16 What is the recommended treatment for CIADM?
17 Explain how PI3K-Akt-mTOR inhibitors cause hyperglycemia
18 What is the recommended diabetes therapy for hyperglycemia secondary to PI3K-Akt-mTOR inhibitors?
19 Describe how certain diabetes therapies may affect the efficacy of PI3K pathway inhibitors
20 How do you monitor for steroid-induced hyperglycemia?
21 When should you initiate additional antidiabetic therapies for steroid-induced hyperglycemia?
22 Discuss treatment strategies for steroid-induced hyperglycemia
23 How do you manage hyperglycemia in terminal illness?
Bibliography
Chapter 18. Diabetes in Older Adults
Abstract
1 What are the recommended glycemic targets in older adults?
2 Why are glycemic targets often relaxed in older adults?
3 Why is hypoglycemia concerning in older adults?
4 Can diabetes complications contribute to functional impairment in older adults?
5 How can cognitive impairment affect diabetes management?
6 Should older adults with diabetes exercise?
7 What is first-line medication therapy for type 2 diabetes in older adults?
8 Should sliding-scale insulin be used in older adults?
9 Are any other diabetes medications listed in the AGS Beers Criteria?
10 Name two diabetes medication classes that may worsen bone health
11 Can SGLT-2 inhibitors be used safely in older adults?
12 Is weight loss recommended in older adults with diabetes?
13 What types of functional abnormalities in older adults might affect medication choice?
14 What resources are available for patients who require insulin but are not able to safely self-administer it?
15 What is deprescribing?
16 How can complex insulin regimens be simplified?
17 What is an appropriate blood pressure target in older adults with diabetes?
18 Are statins recommended in older adults with diabetes?
19 What is the role of aspirin in older adults with diabetes?
20 How should diabetes be managed in patients at the end of life?
Bibliography
Chapter 19. Diabetes Management During Exercise, Sports, and Competition
Abstract
1 Describe normal energy metabolism during exercise
2 What are the main types of exercise?
3 Is there a difference in the effects of aerobic and anaerobic exercise on glucose levels?
4 Does it make any difference in which order aerobic and anaerobic exercises are performed?
5 What is the effect of short, high-intensity exercise on BG levels?
6 How does intermittent high-intensity exercise affect BG levels?
7 Does the time of day exercise is done affect glucose levels?
8 What is the impact of the initial BG level on the glucose response to aerobic exercise?
9 How many grams of carbohydrate are used during various types of exercise?
10 What are the primary drivers of hypoglycemia during exercise?
11 How do BG levels affect performance during exercise and sports?
12 What factors affect BG levels during exercise?
13 What are the key elements of diabetes management during exercise and sports?
14 How often should BG levels be tested during exercise and sports?
15 How should a person respond to BG values prior to exercise?
16 What are general recommendations for nutritional intake during and after exercise?
17 Do nutritional recommendations vary with exercise intensity and duration?
18 How should bolus insulin doses be adjusted during aerobic exercise?
19 Does continuous glucose monitoring reduce the hypoglycemia risk during exercise?
20 Does insulin pump therapy improve glucose outcomes with exercise?
Bibliography
Chapter 20. Diabetes Management in Hospitalized Patients
Abstract
1 How common is diabetes and/or hyperglycemia in the inpatient setting?
2 What is considered hyperglycemia in the inpatient setting, and why is it a concern?
3 What are the glycemic targets for the critically ill and noncritically ill inpatient population?
4 What are the inpatient glycemic targets for pregnant patients?
5 When should point-of-care (POC) BG testing be performed in the hospital setting?
6 Should a hemoglobin A1c level be checked in hospitalized patients?
7 What causes hyperglycemia in hospitalized patients with diabetes?
8 What causes stress hyperglycemia?
9 What is the best way to manage diabetes in hospitalized patients?
10 Does evidence support intensive management of BG in the hospital setting?
11 What is an IV insulin infusion, and why is it used in critically ill patients?
12 How should the IV insulin infusion rate be started and adjusted?
13 How do I transition a patient off an insulin Infusion?
14 How should you select a basal insulin dose if a patient is not on an insulin infusion?
15 How should you select a prandial dose for patients on insulin?
16 How should you adjust insulin dosages?
17 Is “sliding-scale” insulin still used?
18 What is hypoglycemia, and what contributes to it?
19 How should hypoglycemia be treated?
20 Are oral agents or noninsulin injectables appropriate to use in hospitalized patients?
21 What is the best treatment for steroid-induced hyperglycemia?
22 What is the best treatment for hyperglycemia with parenteral nutrition (PN)?
23 What is the best treatment for hyperglycemia with enteral nutrition (EN)?
24 Can concentrated insulins be used in the hospital?
25 Can a continuous subcutaneous insulin infusion be used in the inpatient setting?
26 Can a CGM be used in the inpatient setting?
27 How do you adjust diabetes medications prior to surgery?
28 How do I decide what home regimen to order at discharge?
29 What is unique about treating patients with diabetes with COVID-19?
Websites
Bibliography
Chapter 21. Continuous Glucose Monitoring
Abstract
1 What is the perfect glucose sensor?
2 Is there a correlation between the number of fingerstick BG tests done per day and glucose control?
3 What is a continuous glucose monitor (CGM)?
4 What is a professional CGM?
5 What is a personal CGM?
6 How accurate are CGM devices?
7 What are the features of the various personal CGM devices, and how do they differ?
8 What information do people receive from a personal CGM?
9 What information do providers get from a professional or personal CGM?
10 What is the AGP?
11 What are the TIR targets for people using personal CGM devices?
12 Is there a standardized approach for interpreting CGM downloads?
13 How are CGM trend arrows used to help with optimal insulin dosing decisions?
14 How do CGM devices integrate with insulin pumps?
15 Is there evidence that CGM improves glycemic control in people with type 1 diabetes?
16 Does CGM improve glycemic control in people with type 2 diabetes?
17 Can CGM be used in hospitalized patients, including those in intensive care?
18 Let’s practice some CGM interpretations
Bibliography
Websites
Chapter 22. Continuous Glucose Monitoring Interpretation: Practice Cases
Abstract
Continuous Glucose Monitor Interpretation Cases
Continuous Glucose Monitor Interpretation Cases—My Best Answers
Chapter 23. Insulin Pumps and Integrated Systems
Abstract
1 What is an insulin pump?
2 How does an insulin pump deliver insulin?
3 What type of insulin is used in insulin pumps?
4 What are the benefits of using insulin pump therapy?
5 How do you determine initial basal rates and bolus dosing when starting insulin pump therapy?
6 Let’s look at an example of calculating initial basal rates, the C:I ratio, and the CF
7 How are basal insulin infusion rates evaluated and adjusted in standard insulin pumps?
8 How are the bolus insulin doses evaluated and adjusted in standard insulin pumps?
9 What input, knowledge, and skills are required for using a standard insulin pump?
10 What are the potential causes of a sudden deterioration in glucose control in a person on insulin pump therapy?
11 A woman with type 1 diabetes, well controlled on insulin pump therapy, calls you from her beach vacation to inform you that her insulin pump fell into the ocean and no longer works; she called the help-line, and a new pump will be mailed to her within 48 hours. You learn that her total basal insulin dose is 21.2 units per day, her C:I ratio is 15:1, and her CF is 50:1 to a target of 120 mg/dL. What actions should be taken now?
12 What insulin pumps are currently available in the United States?
13 What is a hybrid closed-loop system?
14 Describe the Medtronic MiniMed 670 G and 770 G hybrid closed-loop systems
15 What features are available on the Tandem t:slim X2 hybrid closed-loop systems?
16 What automated insulin delivery systems that are in development are anticipated to be available soon?
17 What other types of automated insulin delivery systems are in development?
18 What is a bihormonal pump?
19 What is Tidepool Loop?
20 What is looping?
Bibliography
Websites
Chapter 24. Looping
Abstract
Introduction
Bibliography
Chapter 25. Hypoglycemia
Abstract
1 How is hypoglycemia defined?
2 What are the symptoms of hypoglycemia?
3 What are the health implications of hypoglycemia?
4 Does hypoglycemia affect quality of life?
5 What causes hypoglycemia?
6 Are there any nonmedication causes of hypoglycemia?
7 Who is most at risk of hypoglycemia?
8 What is the physiologic mechanism that occurs during hypoglycemia?
9 How common is hypoglycemia?
10 Can we eliminate hypoglycemia?
11 Why is it so challenging to eliminate hypoglycemia?
12 What is impaired awareness of hypoglycemia?
13 Are there certain drugs that can mask the symptoms of hypoglycemia?
14 What should a person do if they think they are experiencing symptoms of hypoglycemia?
15 How is hypoglycemia treated?
16 Why shouldn’t chocolate be used to treat hypoglycemia?
17 What is the role of glucagon?
18 When should glucagon be prescribed?
19 What types of glucagon are available to treat hypoglycemia?
20 Are there advantages of one glucagon formulation over another?
21 What are the side effects of glucagon?
22 Are there any warnings to using glucagon?
23 What are important educational points about hypoglycemia treatment?
24 What is the preferred treatment for hypoglycemia in the inpatient setting?
25 What is the role of technology in preventing hypoglycemia?
26 What is the role of diabetes self-management in hypoglycemia?
Bibliography
Chapter 26. Weight Management in Patients With Type 2 Diabetes
Abstract
1 Explain body mass index and how it is used to categorize overweight and obesity
2 What is the prevalence of obesity and type 2 diabetes in the United States?
3 What impact does weight loss have on people with prediabetes?
4 How much weight loss is needed to modify outcomes in people with type 2 diabetes?
5 Describe the routine clinical assessment of the individual with overweight or obesity
6 What strategies are available for weight loss?
7 Is the individual taking medications that tend to cause weight gain?
8 What antidiabetes medications are associated with weight gain?
9 Why do people often gain weight after initiating antidiabetes medications such as insulin?
10 What antidiabetes medications are weight neutral or associated with weight loss?
11 How do GLP-1 RAs and SGLT-2 inhibitors help with weight loss?
12 What dietary approaches are recommended by the American Diabetes Association (ADA) for people with type 2 diabetes?
13 How much of a calorie deficit is needed for weight loss?
14 What does the ADA recommend regarding the use of weight-loss medications in people with type 2 diabetes?
15 What antiobesity medications are available and approved by the U.S. Food and Drug Administration (FDA) for long-term use?
16 Discuss phentermine and its role in weight management
17 Explain the expected weight loss, side effects, and costs associated with antiobesity medications
18 What is the typical course of weight loss for someone on a weight-loss medication?
19 Explain the use of orlistat for weight management
20 Explain the use of phentermine plus topiramate extended-release (PHEN/TPM) for weight management
21 Discuss the use of naltrexone plus bupropion sustained-release for weight management
22 Explain the use of liraglutide 3.0 mg for weight management
23 What is the role of metabolic surgery in the management of people with type 2 diabetes?
24 How effective is metabolic surgery for the treatment of type 2 diabetes?
25 What other weight-management therapies are emerging or under development for people with type 2 diabetes?
Bibliography
Chapter 27. Identifying and Overcoming Barriers to Achieving Glucose Control
Abstract
1 What are the main barriers to achieving glucose control?
2 What can you do to overcome therapeutic inertia?
3 What factors are associated with nonadherence?
4 How can you screen for nonadherence?
5 What are methods to overcome nonadherence?
6 How does the patient–provider relationship affect adherence? What communication strategies can support adherence?
7 How can the healthcare team enhance patients’ motivation to improve their diabetes?
8 How do SDOH affect glucose control?
9 How do you identify or screen for SDOH?
10 How do you identify or screen for limited health literacy?
11 What are methods to overcome SDOH barriers to glucose control?
12 What are tips to overcome cost-related barriers to accessing medications?
13 What strategies are helpful when communicating with patients who have lower health literacy?
14 How do psychosocial factors affect glucose control?
15 How do you identify and screen for psychosocial barriers to glucose control?
16 What are methods to overcome psychosocial barriers to glucose control?
Bibliography
Chapter 28. Diabetes in Africa
Abstract
1 How prevalent is diabetes in Africa?
2 What are the peculiarities seen among Africans with type 1 diabetes?
3 What is MRDM?
4 What are the features of MRDM in Africa?
5 Discuss ketosis-prone type 2 diabetes
6 How is a hyperglycemic crisis diagnosed and treated in resource-limited settings?
7 How prevalent is gestational diabetes in Africa?
8 What is the most common cause of hospital admission for people with type 2 diabetes in Africa?
9 How is diabetes care organized in Africa, and what are the care gaps?
10 What options are there to manage diabetes in areas of the world where there are few endocrinologists/diabetologists?
11 What cultural backgrounds must be considered for people with diabetes in Africa?
12 How do cultural beliefs and practices affect diabetes care in Africa?
13 How does diabetes in Africa fit into the Universal Health Coverage (UHC) model of WHO health prioritization?
14 What are the challenges of implementing standard comprehensive care interventions in Africa?
15 What is the prevalence of acute and chronic complications of diabetes in Africa?
Bibliography
Chapter 29. Diabetes Diagnosis and Management in New Zealand
Abstract
1 How is diabetes defined in New Zealand?
2 What is the virtual diabetes register?
3 What is the prevalence of diabetes in NZ?
4 How is diabetes healthcare organized in NZ?
5 Who decides what diabetes pharmaceuticals and medical devices are funded by the NZ public system?
6 What sort of technology is available to support NZ people with diabetes?
7 Are there any limitations to access to the latest pharmaceutical diabetes therapies in NZ?
8 Are there any ethnic differences in outcomes for people with diabetes in NZ?
9 Are there any unusual patterns of complications in Maori people with diabetes?
Bibliography
Index
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Jennifer M. Trujillo

Michael T. McDermott