The Diabetes
Ready Reference for
Health Professionals
2nd edition
Kathryn Mulcahy, RN, MSN, CDE Terry Lumber, APRN, CNS, MSN, BC-ADM, CDE
Director, Book Publishing, John Fedor; Associate Director, Professional Books, and Editor, Christine B. Charlip; Associate Director, Book Production, Peggy M. Rote; Composition, Circle Graphics, Inc.; Cover Design, Mac Designs; Printer, Port City Press / Science Press.
©2004 by the American Diabetes Association, Inc. All Rights Reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including duplication, recording, or any information storage and retrieval system, without the prior written permission of the American Diabetes Association.
Printed in the United States of America
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The suggestions and information contained in this publication are generally consistent with the Clinical Practice Recommendations and other policies of the American Diabetes Association, but they do not represent the policy or position of the Association or any of its boards or committees. Reasonable steps have been taken to ensure the accuracy of the information presented. However, the American Diabetes Association cannot ensure the safety or efficacy of any product or service described in this publication. Individuals are advised to consult a physician or other appropriate health care professional before undertaking any diet or exercise program or taking any medication referred to in this publication. Professionals must use and apply their own professional judgment, experience, and training and should not rely solely on the information contained in this publication before prescribing any diet, exercise, or medication. The American Diabetes Association—its officers, directors, employees, volunteers, and members—assumes no responsibility or liability for personal or other injury, loss, or damage that may result from the suggestions or information in this publication.
ADA titles may be purchased for business or promotional use or for special sales. To purchase this book in large quantities, or for custom editions of this book with your logo, contact Lee Romano Sequeira, Special Sales & Promotions, at the address below, or at [email protected] or call 703-299-2046.
American Diabetes Association
1701 North Beauregard Street
Alexandria, Virginia 22311
Library of Congress Cataloging-in-Publication Data Mulcahy, Kathryn, 1947-
Diabetes ready reference guide for health professionals / Kathryn Mulcahy, Terry Lumber.—2nd ed.
p.; cm.
Rev. ed. of: The diabetes ready reference guide for health care professionals.
Includes bibliographical references.
ISBN 1-508040-202-X (spiral : alk. paper)
1. Diabetes—Handbooks, manuals, etc. I. Lumber, Terry, 1957- II. American Diabetes Association. III. Diabetes ready-reference guide for health care professionals. IV. Title.
[DNLM: 1. Diabetes Mellitus—Handbooks. 2. Diabetes Mellitus—Outlines. WK 39 M954d 2004]
RC660.M855 2004
616.4’62—dc22
2004045070
eISBN: 978-1-58040-351-1
CONTENTS
MEDICATION EFFECTS ON GLUCOSE CONTROL
HYPOGLYCEMIA AND HYPERGLYCEMIA
CHRONIC COMPLICATIONS OF DIABETES
MANAGEMENT OF GLYCEMIA DURING HOSPITALIZATION AND SURGERY
ONGOING DIABETES SELF-MANAGEMENT EDUCATION (DSME)
ONGOING MEDICAL NUTRITION THERAPY (MNT)
ABOUT THE AUTHORS
KATHRYN MULCAHY, RN, MSN, CDE, is a Diabetes Clinical Liaison with Amylin Pharmaceuticals and founder and former Director of the Inova Diabetes Center at the Inova Health System from 1986 to 2003 in Fairfax, Virginia. She has over 25 years of experience in diabetes education and care and has held many volunteer positions, including serving on the American Diabetes Association’s Scientific Sessions Planning Committee from 2000 to 2003 and as President of the American Association of Diabetes Educators (AADE) 1998–1999. Kathy was awarded AADE’s Distinguished Service Award in 2003.
TERRY LUMBER, APRN, CNS, MSN, BC-ADM, CDE, is Director of the Inova Diabetes Center, a service of the Inova Health System, in Fairfax, Virginia. She has worked for the past 20 years as a diabetes educator. In 2000, Terry was diagnosed with type 2 diabetes.
PATHOPHYSIOLOGY OF DIABETES
I. DEFINITION OF DIABETES
A. Diabetes is a chronic metabolic disorder in which the body cannot metabolize carbohydrates, fats, and proteins because of defects in insulin secretion and/or action. B. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels.
C. Diabetes is classified into three primary types, which are different disease entities but share the symptoms and complications of hyperglycemia (high blood glucose).
D. Pre-diabetes, once called “borderline