DOCSLIB.ORG

Diabetes Notebook TABLE of CONTENTS

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Diabetes Notebook TABLE of CONTENTS MOUNTAIN STATES MEDICAL GROUP-PEDIATRIC ENDOCRINOLOGY Pediatric Diabetes Notebook TABLE OF CONTENTS GETTING STARTED FOOD Discharge checklist ......................................................................... 3 What are carbohydrates?............................................................38 Mountain States Medical Group-Endocrinology References .......................................................................................39 contact information ........................................................................4 Reading the food label ................................................................. 40 Phone call guidelines for newly diagnosed A handy guide to portion sizes .................................................. 41 patients with diabetes .................................................................... 5 What if I don’t have a nutrition label? .....................................42 Campus map and driving directions ...........................................6 Portion sizes for 15 grams of carbohydrates...........................43 Diabetes “survival skills” ............................................................... 7 Favorite foods reference guide .................................................. 44 Let’s plan some meals! ................................................................ 46 DIABETES BASICS Carb counting for recipes ........................................................... 48 What is diabetes..............................................................................8 I’m hungry….but it’s not meal or snack time ......................... 50 The difference between type 1 and type 2 diabetes ............. 10 Ideas for 10 gram snacks ..............................................................51 Diabetes basics ............................................................................... 11 Ideas for 15 gram snacks ..............................................................51 Keeping in balance .........................................................................12 Ideas for 30 gram snacks ............................................................52 45 gram breakfast ideas ..............................................................53 RECORDS 60 gram breakfast ideas ..............................................................54 Blood sugar log sheet ....................................................................13 45-60 gram lunch and dinner ideas .........................................55 Happy Holidays! ............................................................................57 BLOOD SUGAR MEASUREMENT What’s on your plate? ..................................................................58 Measuring blood sugar ................................................................ 18 The A1C blood test ........................................................................ 19 EXERCISE Diabetes routine (Lantus & Humalog/ Novolog before meals) .......... 20 Physical activity ............................................................................ 60 Diabetes care record ....................................................................22 Carbohydrate replacement for activity .....................................61 INSULIN RESOURCES Insulin products .............................................................................23 Taking diabetes to school ............................................................62 More about insulin ........................................................................24 Resources for people with diabetes ..........................................63 Basal bolus regimen ......................................................................25 Pharmacy list ................................................................................. 64 Directions for drawing a single dose of insulin ......................26 Diabetes and driving .....................................................................65 Directions for giving insulin ........................................................27 Traveling with diabetes ................................................................66 Tips for family coping ...................................................................67 LOW BLOOD SUGAR Top 10 diabetes self-management strategies ....................... 68 Low blood sugar (hypoglycemia) ..............................................28 Diabetes glossary ..........................................................................69 Glucagon injection ....................................................................... 30 Alcohol and diabetes ....................................................................74 Diabetes identification ..................................................................31 Drug use and diabetes .................................................................75 HIGH BLOOD SUGAR High blood sugar (hyperglycemia) ...........................................32 Ketones/DKA .................................................................................33 Urine ketones .................................................................................34 Pediatric sick day guidelines .......................................................36 Sick days for older children .........................................................37 PEDIATRIC DIABETES NOTEBOOK | Mountain States Medical Group-Pediatric Endocrinology | 423-431-4946 | 2 DISCHARGE AND FOLLOWUP CHECKLIST DISCHARGE CHECKLIST Finished “Survival Skill” education Check take-home supplies against list Glucagon emergency kit is packed Next dose of insulin is written on record form or phone contact arranged before dose time Diabetes school orders prepared and signed if necessary Set up phone contact with Dr. _______________________________________ FOLLOW UP APPOINTMENTS WHAT TO BRING TO APPOINTMENTS Physician follow-up appointment Blood glucose management records with _____________________________________ Meter(s), including school meter on _______________________________________ A list of questions First education follow-up appointment A list of supplies you need with _____________________________________ Diabetes Notebook on _______________________________________ Diabetes ID and treatment for low blood sugar Second education follow-up appointment with _____________________________________ on _______________________________________ PEDIATRIC DIABETES NOTEBOOK | Mountain States Medical Group-Pediatric Endocrinology | 423-431-4946 | 3 HOW TO CONTACT US MOUNTAIN STATES MEDICAL GROUP PLEASE NOTE: Prescription refills and routine blood PEDIATRIC ENDOCRINOLOGY sugar check-in should be completed during normal Located on the third floor of the 408 building business hours. behind Niswonger Children’s Hospital 408 N. State of Franklin Road, Suite 31B EMERGENCY & AFTER HOURS: Phone: 423-431-4946 Call Niswonger after hours on the nursing line: Fax: 423-431-4947 423-431-4946 WHEN YOU NEED HELP: OUR PEDIATRIC ENDOCRINOLOGY PROVIDERS Call Morgan Armentrout Diabetes Educator, • George Ford, MD, MS at 423-431-2370 during office hours, • Evan Los, MD Monday–Friday, 8:30 a.m. – 4:30 p.m. • Alexis Duty, MSN, FNP-BC HOW TO MAKE AN APPOINTMENT: • Morgan Armentrout, RN-BSN, CDE The clinic is open Monday – Friday, 8:30 a.m. – 4:30 p.m. Please call 423-431-4946 for current available days and times. PEDIATRIC DIABETES NOTEBOOK | Mountain States Medical Group-Pediatric Endocrinology | 423-431-4946 | 4 PHONE CALL GUIDELINES FOR NEW PATIENTS You have learned a lot about diabetes during your child’s hospitalization and will continue to learn more over the next several months with the help of your diabetes team. We will talk with you often by phone after leaving the hospital and follow up in clinic within 2-4 weeks. ROUTINE BLOOD SUGAR MANAGEMENT PHONE CALLS EMERGENT PHONE CALLS Initially, you will be asked to call the diabetes educator or nurse practitioner daily 9 a.m. – 12 p.m. EMERGENT PHONE CALLS to speak with a diabetes provider. The purpose There may be times when you will need to of these phone calls are to review blood sugars reach the diabetes team urgently. There is and adjust insulin doses as needed. If your child’s always a pediatric provider available 24-hours provider is not available, your call will be sent to a day including weekends and holidays for the on-call pediatric diabetes provider. You should emergencies. Times that you may need to reach expect a call back by the end of the day. If you have a diabetes provider urgently would include: not heard back by 5 p.m., please call and ask to speak with the on-call provider. • Advice for managing sick days • Positive urine ketones with illness or THE PROVIDER YOU WILL BE CALLING IS moderate to large ketones without illness MORGAN ARMENTROUT, RN-BSN, CDE. • Recurrent low blood sugar that does not correct with usual oral treatment** EDUCATION PHONE FOLLOW-UP • If your child will be out of insulin for the next A diabetes educator will contact you about one scheduled injection week after discharge from the hospital. We will answer questions and discuss concerns you may **IF YOUR CHILD IS EXPERIENCING A SEIZURE have regarding your child’s diabetes, prescriptions, DUE TO LOW BLOOD SUGAR, CALL 911 school issues, low blood sugar management and IMMEDIATELY! follow-up visits. These phone calls may continue until your child’s first follow-up appointment at the Diabetes Center. PEDIATRIC DIABETES NOTEBOOK | Mountain States Medical Group-Pediatric Endocrinology | 423-431-4946 | 5 AERIAL CAMPUS
Load more

Recommended publications
  • PL5 Year Pediatric Endocrinology Goals and Objectives for Clinical Service Months
    University of Texas San Antonio Pediatric Endocrinology Fellowship Jane L. Lynch, MD, PD Elia Escaname MD, APD Fellowship Director 2020 PL 5 Year Pediatric Endocrinology Goals and Objectives for Clinical Service Months The goals for the clinical rotations at the Texas Diabetes Institute are to develop the knowledge, attitudes and skills necessary to evaluate, diagnose and manage endocrine conditions in pediatric patients in a manner commensurate with level of training. July 2020 Page 1 COMPETENCIES: PATIENT CARE: Develop proficiency in the care of infants, children, and adolescents with endocrine disorders. Practice the necessary skills for good patient care 1A Goal: Develop proficiency in respectfully gathering essential information through review of pertinent records, interviewing patients and caregivers/family members with particular attention to relevant history, systematic medical assessment and physical exam on a patient with concerns of an endocrine disorder. These skills apply to outpatient, inpatient and research patients. Objectives • Obtain appropriate history and perform a physical exam for patients referred with the following endocrine conditions • Generate a problem list and create an assessment of the patient using up to date nomenclature • Suggest and interpret appropriate laboratory tests and summarize pertinent positive and negative findings with a differential diagnosis. • Develop proficiency in developing a treatment plan based on the endocrine diagnosis • Carry out the care plan with follow-up clinic visits, lab study interpretation and timely review of the results with the attending endocrine physician Endocrine Conditions: 1. Short stature, including constitutional delay 2. Disorders of anterior pituitary hormone physiology, including growth hormone deficiency 3. Disorders of posterior pituitary hormone physiology, including diabetes insipidus 4.
    [Show full text]
  • Management of Diabetes Mellitus Standards of Care and Clinical Practice Guidelines
    WHO-EM/DIN6/E/G MANAGEMENT OF DIABETES MELLITUS STANDARDS OF CARE AND CLINICAL PRACTICE GUIDELINES Edited by Dr A.A.S. Alwan Regional Adviser, Noncommunicable Diseases WHO Regional Office for the Eastern Mediterranean WHO-EM/DIN6/E/G INTRODUCTION Available data from many countries of the Eastern Mediterranean Region (EMR) indicate that diabetes mellitus has become a problem of great magnitude and a major public health concern. Studies have demonstrated that, in some countries, diabetes affects up to 10% of the population aged 20 years and older. This rate may be doubled if those with impaired glucose tolerance (IGT) are also included. The manifestations of diabetes cause considerable human suffering and enormous economic costs. Both acute and late diabetic complications are commonly encountered. Long-term complications represented by cardiovascular diseases, cerebrovascular accidents, end-stage renal disease, retinopathy and neuropathies are already major causes of morbidity, disability and premature death in countries of this Region. The development of long-term complications is influenced by hyperglycaernia. Poor control of diabetes accelerates their progression. Thus, to prevent complications, good control of diabetes is essential and the management of diabetes should therefore aim to improve glycaemic control beyond that required to control its symptoms. Intensified therapy and maintaining near-normal blood glucose levels can result in considerable reduction in the risk of development of retinopathy, nephropathy and neuropathy. However, despite the high prevalence of diabetes and its complications and the availability of successful prevention strategies, essential health care requirements and facilities for self-care are often inadequate in this Region. Action is needed at all levels of health care and in the various aspects of diabetes care to bridge this gap and to improve health care delivery to people with diabetes.
    [Show full text]
  • Clinical Use of Hemoglobin A1c to Improve Diabetes Management
    PRACTICAL POINTERS Clinical Use of Hemoglobin A1c to Improve Diabetes Management Alan M. Delamater, PhD, ABPP or more than 25 years, the hemo- one recent study conducted in Norway6 A1C values. Only 14% of the youths globin A1c (A1C) test has been revealed that the majority (82.6%) of were able to accurately describe the A1C Fthe most widely accepted out- 201 adult patients with type 1 diabetes test. Just 11, 7.8, and 7.8% correctly come measure for evaluating glycemic knew what their last A1C was, and most identified the A1C ranges for good, fair, control in individuals with diabetes. patients (90%) knew what a satisfactory and poor glycemic control, respectively. The test provides an index of a patient’s A1C value would be. But a significant Very few youths (1.6–3.2%) knew the average blood glucose level during the number of patients (42%) reported they blood glucose values corresponding to past 2–3 months1 and is considered to had low knowledge of A1C testing in specific A1C results. Only a small num- be the most objective and reliable general. Furthermore, 25% of patients ber of youths correctly estimated the measure of long-term metabolic con- did not think that treatment intensifica- short- and long-term risks associated trol.2,3 The Diabetes Control and tion should occur at an A1C value of with A1C values of 7 and 12%. In this Complications Trial established that 10%. sample, there was a significant lack of maintaining A1C levels as close as pos- A recent cross-sectional study knowledge concerning the meaning and sible to the normal range results in con- examined the relationship between implications of the A1C test.
    [Show full text]
  • A History of Diabetes NYSNA Continuing Education the New
    A History of Diabetes NYSNA Continuing Education The New York State Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. This course has been awarded 1.2 contact hours. All American Nurses Credentialing Center (ANCC) accredited organizations' contact hours are recognized by all other ANCC accredited organizations. Most states with mandatory continuing education requirements recognize the ANCC accreditation/approval system. Questions about the acceptance of ANCC contact hours to meet mandatory regulations should be directed to the Professional licensing board within that state. NYSNA has been granted provider status by the Florida State Board of Nursing as a provider of continuing education in nursing (Provider number 50-1437). A History of Diabetes 1 © 2004 NYSNA, all rights reserved. Material may not be reproduced without written permission. How to Take This Course Please take a look at the steps below; these will help you to progress through the course material, complete the course examination and receive your certificate of completion. 1. REVIEW THE OBJECTIVES The objectives provide an overview of the entire course and identify what information will be focused on. Objectives are stated in terms of what you, the learner, will know or be able to do upon successful completion of the course. They let you know what you should expect to learn by taking a particular course and can help focus your study. 2. STUDY EACH SECTION IN ORDER Keep your learning "programmed" by reviewing the materials in order. This will help you understand the sections that follow.
    [Show full text]
  • Diabetes Is a Disease in Which the Body's Ability to Produce Or Respond
    Early Signs and Symptoms of diabetes: Early symptoms of diabetes, especially type 2 diabetes, can be subtle or seemingly harmless. Over time, however, you may Diabetes is a disease in which the develop diabetes complications, even if you body’s ability to produce or respond to haven't had diabetes symptoms. In the the hormone insulin is impaired, United States alone, more than 8 million resulting in abnormal metabolism of people have undiagnosed diabetes, Treatments: carbohydrates and elevated levels of according to the American Diabetes Association. Understanding possible glucose (sugar) in the blood. • Insulin therapy diabetes symptoms can lead to early • Oral medications diagnosis and treatment and a lifetime of Diabetes can be broken down into • better health. If you're experiencing any of Diet changes two types, Type 1 and Type 2. Type 1 • Exercise diabetes involves the the following diabetes signs and symptoms, see your doctor. body attacking itself by The medications you take vary by mistake, this then the type of diabetes and how well the causes the body to stop making insulin. With medicine controls you blood glucose levels. Type 2 diabetes the Type 1 diabetics must have insulin. Type 2 body does not respond may or may not include insulin and may just like it should to the be controlled with diet and exercise alone. insulin the pancreas is If you notice any of these changes notify making. Your body tells the pancreas that it needs to make more insulin since the your health care provider. The earlier • insulin that is already there is not working.
    [Show full text]
  • Prediabetes: What Is It and What Can I Do?
    Prediabetes: What Is It and What Can I Do? What is prediabetes? Weight loss can delay or prevent diabetes. Prediabetes is a condition that comes before Reaching a healthy weight can help you a lot. diabetes. It means your blood glucose levels are If you’re overweight, any weight loss, even higher than normal but aren’t high enough to be 7 percent of your weight (for example, losing called diabetes. about 15 pounds if you weigh 200), may lower your risk for diabetes. There are no clear symptoms of prediabetes. You can have it and not know it. If I have prediabetes, what does it mean? It means you might get type 2 diabetes soon or down the road. You are also more likely to get heart disease or have a stroke. The good news is that you can take steps to delay or prevent type 2 diabetes. How can I delay or prevent type 2 diabetes? You may be able to delay or prevent type 2 diabetes with: Daily physical activity, such as walking. Weight loss, if needed. Losing even a few pounds will help. Medication, if your doctor prescribes it. If you have prediabetes, these steps may bring your blood glucose to a normal range. But you are still at a higher risk for type 2 diabetes. Regular physical activity can delay or prevent diabetes. Being active is one of the best ways to delay or prevent type 2 diabetes. It can also lower your weight and blood pressure, and improve cholesterol levels. Ask your health care team about activities that are safe for you.
    [Show full text]
  • Handbook for Pediatric Endocrinology Rotation
    ENDOCRINOLOGY & DIABETES UNIT 4480 Oak Street, Ambulatory Care Building, Room K4-213, Vancouver, BC V6H 3V4 Endocrine Clinic: 604-875-3611 Diabetes Clinic: 604-875-2868 Reception: 604-875-2117 Administrative Secretary: 604-875-2624 Fax: 604-875-3231 http://endodiab.bcchildrens.ca HANDBOOK FOR PEDIATRIC ENDOCRINOLOGY ROTATION Dr. Shazhan Amed, Head Dr. Jean-Pierre Chanoine Dr. Daniel Metzger Dr. Laura Stewart Dr. Dina Panagiotopoulos Dr. Ralph Rothstein Dr. Brenden Hursh Dr. Danya Fox Dr. Trisha Patel Dr. Fatema Abdulhussein September 13, 2021 www.bcchildrens.ca/endocrinology-diabetes-site/documents/resmanual.pdf Page 1 of 45 September 13, 2021 www.bcchildrens.ca/endocrinology-diabetes-site/documents/resmanual.pdf Page 2 of 45 ENDOCRINOLOGY & DIABETES UNIT HANDBOOK FOR PEDIATRIC ENDOCRINOLOGY ROTATION TABLE OF CONTENTS EDU Rotation-Specific Goals and Objectives (by CanMEDS 2005 roles) Royal College of Physicians and Surgeons of Canada: Objectives of Training in Pediatrics (July 2008). Core Competencies for all Faculty Members in the Department of Pediatrics Grievance Procedures EDU Rotation Responsibilities EDU Paperwork, Guidelines & General Information for Students, Residents, & Fellows Orientation to Nutrition Management for Diabetes: Tips for the Doctor in Clinic and On-call Inpatient Consultations & Inpatient Admissions/Discharges Telephone Tips for On-call Residents & Fellows Diabetes Learning Resources & Links Guidelines for Peri-Procedural Management of Children and Adolescents with Diabetes Who Require General Anesthesia Articles Rose SR, Vogiatzi MG, Copeland KC. A general pediatric approach to evaluating a short child. Pediatrics in Review 26(11):410–420, 2005. Rosen DS. Physiologic growth and development during adolescence. Pediatrics in Review 25(6):194–200, 2004. Kaplowitz PB.
    [Show full text]
  • Glossary of Technical Terms
    THIS DOCUMENT IS IN DRAFT FORM, INCOMPLETE AND SUBJECT TO CHANGE AND THAT THE INFORMATION MUST BE READ IN CONJUNCTION WITH THE SECTION HEADED “WARNING” ON THE COVER OF THIS DOCUMENT. GLOSSARY OF TECHNICAL TERMS This glossary contains explanations of certain technical terms used in this Document in connection with our Company and its business. Such terminology and meanings may not correspond to standard industry meanings or usages of those terms. “acetaminophen” a non-opioid analgesic and antipyretic agent used to treat pain and fever “artificial pancreas” an integrated diabetes management system that tracks blood glucose levels using a continuous glucose monitor and automatically delivers the insulin when needed using an insulin pump according to its control algorithm “ascorbic acid” a potent reducing and antioxidant agent that functions in fighting bacterial infections, in detoxifying reactions, and in the formation of collagen in fibrous tissue, teeth, bones, connective tissue, skin, and capillaries “basal insulin” a small, continuous infusion of background insulin delivered automatically at a programmed rate, all day and night “BG Port” blood glucose strip port, the port that accepts and electrically connects a disposable blood glucose strip to the electronics “BGMS” blood glucose monitoring system “BLE” bluetooth low energy “blood glucose” blood glucose, also referred to as blood sugar, is the amount of glucose in your blood, an indicator of diabetes monitoring “bolus insulin” insulin that is taken to lower abnormally high blood glucose
    [Show full text]
  • Growth Hormone Deficiency and Excessive Sleepiness: a Case Report and Review of the Literature
    HHS Public Access Author manuscript Author ManuscriptAuthor Manuscript Author Pediatr Manuscript Author Endocrinol Rev. Manuscript Author Author manuscript; available in PMC 2020 September 01. Published in final edited form as: Pediatr Endocrinol Rev. 2019 September ; 17(1): 41–46. doi:10.17458/ per.vol17.2019.ge.ghdeficiencyandsleepiness. Growth Hormone Deficiency and Excessive Sleepiness: A Case Report and Review of the Literature Anisha Gohil, D.O., Indiana University School of Medicine, Riley Hospital for Children, Fellow, Endocrinology & Diabetes, 705 Riley Hospital Drive, Room 5960, Indianapolis, IN 46202 Erica Eugster, M.D. Indiana University School of Medicine, Riley Hospital for Children, Professor of Pediatrics, 705 Riley Hospital Drive, Room 5960, Indianapolis, IN 46202 Abstract The somatotropic axis is intricately involved in normal sleep, as evidenced by the fact that hypothalamic growth hormone-releasing hormone (GHRH) has sleep promoting effects and pituitary growth hormone (GH) release is strongly associated with slow-wave sleep (SWS). Abnormalities in the somatotropic axis, such as GH deficiency of hypothalamic or pituitary origin, result in an alteration of normal sleep patterns which may explain the fatigue reported in these individuals. Sleep disorders such as narcolepsy, in which individuals abnormally enter rapid eye movement (REM) sleep at sleep onset are also associated with an altered GHRH circadian rhythm and abnormal GH secretion. While few studies are available, this review explores what is known about sleep abnormalities in GH deficiency, the effect of treatment on sleep in patients with GH deficiency, and GH secretion in narcolepsy. Emerging evidence suggests a hypothalamic link between narcolepsy and GH secretion. We also describe the unique constellation of isolated idiopathic GH deficiency and severe excessive sleepiness in adopted Nicaraguan siblings, one of which has narcolepsy and the other idiopathic hypersomnia.
    [Show full text]
  • Low Blood Glucose (Hypoglycemia)
    Low Blood Glucose (Hypoglycemia) Hypoglycemia, also known as low blood Hunger, nausea glucose (blood sugar), is when your blood Color draining from skin (pallor) glucose levels have fallen low enough that you need to take action to bring them back Feeling sleepy to your target range. This is usually when your blood glucose is less than 70 mg/dL. However, Feeling weak, having no energy talk to your doctor about your own blood Blurred/impaired vision glucose targets, and what level is too low for you. Tingling or numbness in lips, tongue, cheeks Headaches When can it happen? Coordination problems, clumsiness Low blood glucose can happen if you’ve skipped a meal or snack, eaten less than usual, or been Nightmares or crying out in sleep more physically active than usual. If you don’t Seizures take steps to bring glucose levels back to normal, you could even pass out. What should you do? What are the symptoms? The 15-15 rule—have 15 grams of carbohydrate to raise your blood glucose and check it after Each person’s reaction to low blood glucose is 15 minutes. If it’s still below 70 mg/dL, have different. It’s important that you learn your own another serving. signs and symptoms when your blood glucose is low. Repeat these steps until your blood glucose is at least 70 mg/dL. Once your blood glucose is back Signs and to normal, eat a meal or snack to make sure it symptoms of doesn’t lower again. low blood glucose include: This may be: Feeling shaky Glucose tablets (see instructions) Being nervous Gel tube (see instructions) or anxious 4 ounces (1/2 cups) of juice or regular soda Sweating, chills, (not diet) clamminess 1 tablespoon of sugar, honey, or corn syrup Mood swings, irritability, impatience 8 ounces of nonfat or 1% milk Confusion Hard candies, jellybeans, or gumdrops—see Fast heartbeat food label for how many to consume Feeling light-headed or dizzy Continued » Visit diabetes.org or call 800-DIABETES (800-342-2383) for more resources from the American Diabetes Association.
    [Show full text]
  • Diabetic Ketoacidosis: Evaluation and Treatment DYANNE P
    Diabetic Ketoacidosis: Evaluation and Treatment DYANNE P. WESTERBERG, DO, Cooper Medical School of Rowan University, Camden, New Jersey Diabetic ketoacidosis is characterized by a serum glucose level greater than 250 mg per dL, a pH less than 7.3, a serum bicarbonate level less than 18 mEq per L, an elevated serum ketone level, and dehydration. Insulin deficiency is the main precipitating factor. Diabetic ketoacidosis can occur in persons of all ages, with 14 percent of cases occurring in persons older than 70 years, 23 percent in persons 51 to 70 years of age, 27 percent in persons 30 to 50 years of age, and 36 percent in persons younger than 30 years. The case fatality rate is 1 to 5 percent. About one-third of all cases are in persons without a history of diabetes mellitus. Common symptoms include polyuria with polydipsia (98 percent), weight loss (81 percent), fatigue (62 percent), dyspnea (57 percent), vomiting (46 percent), preceding febrile illness (40 percent), abdominal pain (32 percent), and polyphagia (23 percent). Measurement of A1C, blood urea nitro- gen, creatinine, serum glucose, electrolytes, pH, and serum ketones; complete blood count; urinalysis; electrocar- diography; and calculation of anion gap and osmolar gap can differentiate diabetic ketoacidosis from hyperosmolar hyperglycemic state, gastroenteritis, starvation ketosis, and other metabolic syndromes, and can assist in diagnosing comorbid conditions. Appropriate treatment includes administering intravenous fluids and insulin, and monitoring glucose and electrolyte levels. Cerebral edema is a rare but severe complication that occurs predominantly in chil- dren. Physicians should recognize the signs of diabetic ketoacidosis for prompt diagnosis, and identify early symp- toms to prevent it.
    [Show full text]
  • The Main Events in the History of Diabetes Mellitus
    Chapter 1 The Main Events in the History of Diabetes Mellitus Jacek Zajac, Anil Shrestha, Parini Patel, and Leonid Poretsky In Antiquity A medical condition producing excessive thirst, continuous urination, and severe weight loss has interested medical authors for over three millennia. Unfortunately, until the early part of twentieth century the prognosis for a patient with this condition was no better than it was over 3000 years ago. Since the ancient physicians described almost exclusively cases of what is today known as type 1 diabetes mellitus, the outcome was invariably fatal. Ebers Papyrus, which was written around 1500 BC, excavated in 1862 AD from an ancient grave in Thebes, Egypt, and published by Egyptologist Georg Ebers in 1874, describes, among various other ailments and their remedies, a condition of “too great emptying of the urine” – perhaps, the reference to diabetes mellitus. For the treatment of this condition, ancient Egyptian physicians were advocating the use of wheat grains, fruit, and sweet beer.1,2 Physicians in India at around the same time developed what can be described as the first clinical test for dia- betes. They observed that the urine from people with diabetes attracted ants and flies. They named the condition “madhumeha” or “honey urine.” Indian physicians also noted that patients with “madhumeha” suffered from extreme thirst and foul breath (probably, because of ketosis). Although the polyuria associated with diabetes was well recognized, ancient clinicians could not distinguish between the polyuria due to what we now call diabetes mellitus from the polyuria due to other conditions.3 Around 230 BC, Apollonius of Memphis for the first time used the term “diabetes,” which in Greek means “to pass through” (dia – through, betes – to go).
    [Show full text]