Functional Insulin Treatment: Principles, Teaching Approach and Practice

ISBN-13: 9783540603528 / Angielski / Miękka / 1996 / 218 str.

K. Howorka; Kinga Howorka; K. M. Nelson

Opis

Functional Insulin Treatment (FIT) is the most effective method of treatment for type 1(insulin-dependent) diabetes available today. Whether with an insulin pump or with multiple daily injections, the diabetic patient trained in FIT is able to dose his insulin on the basis of actual fuction so that he achieves near-normoglycemia and the freedom to eat when, what and how much he wants. The goal of FIT is to adapt the therapy to the lifestyle of the patient. This book creates a common basis for communication among therapists (physicians, nurses, dietitians, diabetes educators) and patients involved in FIT. It clearly defines the principles of the treatment and describes the contents, media and techniques of a practical program for training patients to carry it out.

Spis treści

1 Introduction.- 2 Overview of the Phases of Rehabilitation in Persons with Type I (Insulin-Dependent) Diabetes.- 2.1 Intermezzo 1: A Strategy for Failure — or How Not to Educate Patients.- 3 Basic Diabetes Education (Phase I of Rehabilitation).- 3.1 Insulin Action in Healthy Persons; Insulin Deficiency.- 3.2 Diet.- 3.2.1 Goals of Dietary Counseling.- 3.2.2 Estimating the Carbohydrate Content of Food.- 3.2.3 Prandial Insulin Requirement in Relation to Type and Quantity of Food.- 3.2.4 Counting Calories and Maintaining Body Weight.- 3.2.5 Teaching Tips.- 3.2.6 Problems in Dietary Counseling.- 3.3 Self-monitoring.- 3.3.1 Self-monitoring of Blood Glucose and Targets for Glycemic Control.- 3.3.2 Self-monitoring of Urine Glucose.- 3.3.3 Determination of Acetone in Urine.- 3.3.4 Targets for Glycemic Control.- 3.4 Strategies for Insulin Treatment.- 3.5 Insulin.- 3.5.1 Pharmacokinetics.- 3.5.2 Insulin Delivery.- 3.5.3 Special Aspects of the Practicability of Insulin Delivery.- 4 FIT Training (Phase II of Rehabilitation).- 4.1 Initial Algorithms, “K” and the Blood Glucose Target Value.- 4.2 Intermezzo 2: A Strategy for Failure — or How to Demotivate Even the Most Convinced Enthusiast.- 4.3 Introducing FIT in Practice.- 4.4 Pedagogical Aspects of Insulin Substitution: Transactional Analysis and “Insulin Games”.- 4.5 Is “Yielding to Temptation” All Bad?.- 4.6 Testing Algorithms for Correcting Blood Glucose (and Determining the Kidney Threshold for Glucose). Why?.- 4.7 Why fast?.- 5 Criteria for Functional Insulin Treatment.- 5.1 Basal Substitution.- 5.1.1 Basal Insulin.- 5.1.2 Fasting Hyperglycemia and Compensation of Circadian Variation in Insulin Requirements.- 5.2 Prandial Insulin Substitution — Problems in Dosing Regular Insulin.- 5.3 Self-monitoring and Glycemic Control — Why Keep Records?.- 5.3.1 Record Keeping, Analysis and Evaluation of the Daily Net Result.- 5.3.2 Coping with Practical Problems.- 5.3.3 Frequency of Acute Complications.- 5.3.4 Contingence of Insulin Dose and Carbohydrate Intake on Measured Blood Glucose Level.- 6 Hypoglycemia.- 6.1 Definition of Hypoglycemia.- 6.2 Increased Probability of Severe Hypoglycemia.- 6.3 Causes of Hypoglycemia.- 6.4 Prevention of Hypoglycemia.- 6.5 Treatment of Hypoglycemia.- 7 Hyperglycemia.- 8 Rules for Algorithm Modification.- 8.1 Global Changes in Insulin Requirement.- 8.1.1 Global Decrease in Insulin Requirement.- 8.1.2 Global Increase in Insulin Requirement.- 8.2 Modification of Individual Algorithms.- 8.2.1 Modifying the Algorithm for Basal Insulin.- 8.2.2 Modifying the Algorithms for Prandial Insulin.- 8.2.3 Modifying the Algorithms for Correcting Blood Glucose Excursions.- 8.2.4 Modifying the Target Values for Current Blood Glucose and Target Range for Mean Blood Glucose.- 8.2.5 Interdependence of Algorithms.- 9 Physical Activity.- 9.1 Short, Sporadic Periods of Physical Activity.- 9.1.1 Physical Activity not Preceded by a Recent Injection of Regular Insulin.- 9.1.2 Physical Activity after Regular Insulin.- 9.1.3 Further Influences.- 9.2 Prolonged Periods of Physical Activity.- 10 Pregnancy in Type I (Insulin-Dependent) Diabetes.- 10.1 Patient Education Concerning Diabetes and Pregnancy.- 10.2 Consequences for Treatment.- 10.3 Interdisciplinary Care for Pregnant Diabetic Women.- 10.3.1 Diabetological Care: FIT.- 10.3.2 Obstetrical Care.- 10.3.3 Ophthalmological Care.- 10.3.4 Neonatal Care.- 10.4 Special Aspects of Secondary Adjustment of Insulin Dosage During Pregnancy and Childbirth.- 11 Functional Insulin Treatment for Type II Diabetes.- 11.1 Characteristics of Treatment of Type II Diabetes.- 11.2 Covering Basal Insulin Requirements in Insulin-Treated Type II Diabetic Patients.- 11.3 Special Aspects of the FIT Training Program for Type II Diabetic Patients.- 11.4 How Can Weight Loss Be Reached with Type II Diabetes During Functional Insulin Treatment.- 12 Coping with Special Situations.- 13 Frequent Patient-Related Problems.- 13.1 Grief-Work in Persons with Diabetes.- 13.2 Inadequate Information.- 13.3 Failure to Adjust to the Realities of Diabetes.- 14 Frequent Physician-Related Problems.- 14.1 Communication Problems.- 14.2 Inability to Understand What Life Is Like for the Patient.- 14.3 Inadequate Information.- 15 The “Contras”.- 15.1 Contraindications for Functional Insulin Treatment.- 15.2 “Difficult” Patients.- 15.3 Intermezzo 3: A Strategy for Failure or How to Mess Things Up in the Outpatient Phase.- 16 Checklist for Continuing Care of FIT Patients (Phase III of Rehabilitation).- 16.1 The Patient’s Knowledge.- 16.2 Applying Knowledge; Practicability of Therapeutic Measures.- 16.3 Motivation.- 16.4 Acceptance of Diabetes.- 16.5 Metabolic Status.- 16.6 Late Complications.- 16.7 Comorbidity.- 16.8 Social Environment.- 16.9 The Patient’s Contact with the Diabetes Treatment Center, Physician or Diabetes Counselor.- 16.10 Humor.- 17 Review of Results and Experience.- 17.1 Patients.- 17.2 Follow-up.- 17.3 Results.- 17.3.1 Acceptance of FIT.- 17.3.2 Metabolic Control.- 17.3.3 Acute Complications.- 17.4 Experience with FIT in Special Situations.- 18 Open Questions, Unsolved Problems and Limits of FIT.- 19 Epilogue.- References.- Appendix 1: Didactic Aspects of the FIT-Training Program.- Appendix 2: FIT — Initial Information for Patients.- Appendix 3: Nomogram for Generating the Initial Algorithms for FIT/Coauthors: H. Egger and H. Thoma.- Appendix 4: Selection of Available Human Insulins.- Appendix 5: Examples of Carbohydrate Units.

Blurb

The functional use of insulin is the most effective method of treatment of diabetes requiring insulin available today. This book of Functional Insulin Treatment, FIT, shows how to put it into practice. Previous diabetes education programs have adapted the patient's life style to the conditions of therapy. The goal of FIT is to avoid/delay late complications while tailoring the therapy to the life of the patient: whether with multiple daily injections or with controllable infusion, the diabetic person trained in FIT is able to dose her/his insulin according to its actual function, i.e., either for eating or for fasting or for correction of hyperglycemia, so that she/he achieves both, the target glycemic control and the freedom to fast or to eat whenever, whatever and how much she/he wants. Included are new strategies for patient motivation, new insulin analogs, management of nutrition in overweight, easy estimations of algorithms for starting functional use of insulin and everything that makes flexible treatment an indispensable solution for every interested self-responsible person who needs insulin.