Tag Archives: NPH

Psychological Aspects Of Type 1 Diabetes In Adults

  By admin | November 3, 2011 - 1:02 pm | Type 1 diabetes
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When considered from an experiential perspective, type 1 diabetes (Type 1 diabetes mellitus) represents a significant stressor for individuals and their families. A comprehensive understanding of psychological factors related to Type 1 diabetes mellitus requires investigation of (/) the impact of Type 1 diabetes mellitus upon psychological adjustment and (ii) the impact of psychological adjustment upon medical outcomes for diabetes mellitus 1. Both of these directions of influence are reviewed below regarding each of the most prevalent and/or problematic psychological adjustment problems for adults with Type 1 diabetes mellitus. When comparing with other chronic health conditions, from an experiential perspective, it is important to consider: •   disease factors, including … Continue reading →

Insulin Therapy In Adults With Type 1 Diabetes Mellitus

  By admin | November 3, 2011 - 12:50 pm | Type 1 diabetes
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Insulin is the cornerstone of pharmacotherapy for the estimated 0.73 to 1.46 million persons with type 1 diabetes mellitus in the United States. While the peak incidence … Continue reading →

Potential Complications Of Insulin Therapy

  By admin | November 3, 2011 - 12:48 pm | Type 1 diabetes
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Potential complications directly related to insulin itself which both the health-care provider and the patient should be aware of are hypoglycemia, weight gain, exacerbation of retinopathy, insulin allergy, and lipodystrophy, each of which will now be discussed. Hypoglycemia The normal physiologic response to hypoglycemia includes early suppression of insulin secretion, release of glucagon and catecholamines, and later release of cortisol and growth hormone. It is important to understand that persons with Type 1 diabetes mellitus have alterations in the physiologic suppression of insulin and release of glucagon expected in response to low blood glucose, which impairs ability to return blood glucose levels to normal. … Continue reading →

Physiologic Replacement Therapy Insulin Regimens

  By admin | November 3, 2011 - 12:47 pm | Type 1 diabetes
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Conventional Insulin Therapy Conventional insulin therapy is used to describe simpler, usually fixed dose insulin regimens, such as single daily injections, or two injections per day of regular and NPH insulin, either mixed together in the same syringe or provided as a premix of insulins, which are given in prespecified doses before breakfast and dinner. Such regimens are based on the concept that each of the insulin components in the two doses is covering insulin needs for … Continue reading →

Insulin Dosing Adjustments And Pattern Management

  By admin | November 3, 2011 - 12:45 pm | Type 1 diabetes
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With experience and close observation of blood glucose results and insulin doses, the health-care provider and the patient can identify patterns that will suggest a need for adjustment in insulin doses to enable attainment of blood glucose targets and Ale goals in the adult Type 1 diabetes mellitus patient who is on an intensive insulin therapy regimen, whether it be with multiple daily insulin or CSII. Pattern management refers to the practice of reviewing a patient’s blood glucose logs, identifying patterns, and/or trends where blood glucose is outside or might be expected to deviate from designated target ranges, and taking … Continue reading →

Travel

  By admin | November 3, 2011 - 12:31 pm | Type 1 diabetes
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Traveling with diabetes is always an adventure. Many people have a job that requires travel and many others travel for pleasure. If a patient is traveling on an airplane, he or she needs to do the following according to the American Diabetes Association and the Transportation Security Administration: Notify the screener that you have diabetes and are carrying your supplies with you. Please note that while Transportation Security Administration is not currently requiring a prescription label, it recommends having the label available to identify the medication in order to expedite the security checkpoint screening process. The following diabetes-related supplies and equipment are allowed through the checkpoint once they have been … Continue reading →

Patient recommendations for the perioperative period

  By admin | June 22, 2011 - 10:51 am | Diabetes and Lifestyle
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Ideally, a patient with diabetes who is scheduled for surgery should discuss their perioperative management with the diabetes care provider prior to the surgical preparation. Often, patients receive insufficient or inaccurate recommendations from the anesthesia and/or operative team. Many times older patients with type 1 diabetes are assumed to have type 2, and are thought to be safe temporarily without basal insulin. Iatrogenic diabetic ketoacidosis is fairly common due to omission of insulin during the perioperative period. In contrast, if hospital professionals have a poor understanding of the differences in insulin requirements between insulin-resistant patients with type 2 diabetes (very large doses) and insulin-sensitive type 1 patients … Continue reading →

Patient guide to sick day management

  By admin | June 22, 2011 - 10:47 am | Diabetes and Lifestyle
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Type 1 Diabetes What is a sick day? Any day that you are not feeling well, having trouble eating your usual meals, or are experiencing a medical procedure or extreme emotional upset. Why are sick days important? Diabetes is affected not only by what you eat and the insulin you take, but also by other hormones in the body. Hormones that work against insulin usually increase during illness or stress, causing the insulin you take to work less effectively. This is why illness and stress cause the blood sugar to rise. Diabetic ketoacidosis is a severe, life-threatening complication of diabetes that commonly occurs during illness or severe stress. This develops due … Continue reading →

Insulin and insulin analogs

  By admin | June 22, 2011 - 9:37 am | Diabetes in Elderly
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Insulin is frequently initiated when maximum dose of single or combined oral agents fail to control glucose levels. Diabetes is a progressive disease with continuing loss of β-cell function — patients should be informed that this is the natural history and they have not personally failed. Insulin and insulin analogs are available in a number of long-, intermediate-, and short-acting preparations and in an inhaled form, recently approved by the FDA for use in patients with type 1 or type 2 diabetes. When initiating the older patient on insulin, the advantages and concerns of treatment need to be reviewed. Aspects such as physical, mental, and visual problems must be carefully assessed; … Continue reading →

DIABETES MELLITUS AND DEPRESSION

  By admin | June 22, 2011 - 8:55 am | Diabetes in Elderly
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Depression is a highly prevalent and chronically relapsing illness among patients with diabetes mellitus. A recent meta-analysis of 42 studies suggested that the odds of major depression among people with diabetes mellitus were roughly twice that of those without. The chronic, relapsing nature of depression in diabetic patients has been suggested by a five-year follow-up study with 25 diabetic patients with depression. In that study, Lustman et al. found that recurrence or persistence of depression occurred in 92% of the patients with an average of … Continue reading →