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Atlas of DIABETES MELLITUS Scobie Chapter Prelims 28/7/06 11:00 Page Ii Scobie Chapter Prelims 28/7/06 11:00 Page Iii Scobie Chapter Prelims 28/7/06 11:00 Page i Atlas of DIABETES MELLITUS Scobie Chapter Prelims 28/7/06 11:00 Page ii Scobie Chapter Prelims 28/7/06 11:00 Page iii Atlas of DIABETES MELLITUS Third Edition Ian N Scobie MD FRCP Consultant Endocrinologist Medway Maritime Hospital Gillingham, Kent UK Scobie Chapter Prelims 28/7/06 11:00 Page iv © 2007 Informa UK Ltd First published in the United Kingdom in 1998 by Parthenon Publishing Third edition published in 2007 by Informa Healthcare, 4 Park Square, Milton Park, Abingdon, Oxon OX14 4RN. Informa Healthcare is a trading division of Informa UK Ltd. Registered Office: 37/41 Mortimer Street, London W1T 3JH. Registered in England and Wales Number 1072954. Tel.: +44 (0)20 7017 6000 Fax: +44 (0)20 7017 6699 E-mail: [email protected] Website: www.informahealthcare.com All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of the publisher or in accordance with the provisions of the Copyright, Designs and Patents Act 1988 or under the terms of any licence permitting limited copying issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1P 0LP. Although every effort has been made to ensure that all owners of copyright material have been acknowledged in this publication, we would be glad to acknowledge in subsequent reprints or editions any omissions brought to our attention. A CIP record for this book is available from the British Library. Library of Congress Cataloging-in-Publication Data Data available on application ISBN10: 0-415-37649-1 ISBN13: 978-0-415-37649-5 Distributed in North and South America by Taylor & Francis 6000 Broken Sound Parkway, NW, (Suite 300) Boca Raton, FL 33487, USA Within Continental USA Tel.: 1(800)272 7737; Fax: 1(800)374 3401 Outside Continental USA Tel.: (561)994 0555; Fax: (561)361 6018 E-mail: [email protected] Distributed in the rest of the world by Thomson Publishing Services Cheriton House North Way Andover, Hampshire SP10 5BE, UK Tel.: +44 (0)1264 332424 E-mail: [email protected] Composition by Parthenon Publishing Printed and bound in India by Replika Press Pvt. Ltd. Scobie Chapter Prelims 28/7/06 11:00 Page v Contents Foreword – Robert A Rizza vii Preface ix Acknowledgments x 1. Introduction 1 2. Pathogenesis 9 3. Treatment 33 4. Treatment of children and adolescents with diabetes 59 5. Diabetes and surgery 61 6. Acute complications of diabetes 63 7. Chronic complications of diabetes 69 8. Diabetic dyslipidemia 109 9. Diabetes and pregnancy 111 10. Living with diabetes 115 11. Future developments in diabetes 117 Index 121 v Scobie Chapter Prelims 28/7/06 11:00 Page vi Scobie Chapter Prelims 28/7/06 11:00 Page vii Foreword Diabetes mellitus is likely to become one of the most the multitude of highly informative illustrations which prevalent and economically important diseases of the follow. Most specialists in diabetes have seen real-life 21st century largely owing to an increasing incidence examples of the disease processes presented in of type 2 diabetes mellitus (DM) in the developed this book but some may be very unfamiliar to the nations and many of the developing nations. Every generalist. physician will encounter a patient who has diabetes. For specialists, however, many years of practice are Multiple factors, both environmental and genetic, con- required to accumulate this experience. How often tribute to the pathogenesis of the disease. Type 2 DM does a non-specialist see a patient with Prader–Willi is particularly common in obese sedentary popula- syndrome, acromegaly or Rabson–Mendenhall syn- tions, while type 1 DM can have a dramatic onset and drome? A quick glance at Figures 9, 12 and 18 will help be a major therapeutic challenge. to imprint the appearances of each of these syndromes. Rarer conditions such as acromegaly, Cushing’s dis- Many physicians caring for people with type 1 DM ease and hemochromatosis may cause or exacerbate know of autoimmune destruction of the β-cell, but diabetes. If the hyperglycemia of diabetes is not ade- what exactly does this mean? Figures 27–35 and their quately treated, potentially devastating micro- and legends take the reader through this topic. What is the macrovascular complications might ensue. It follows best way to treat patients with type 1 DM? An impor- that all physicians need to be familiar with this condi- tant step is to attempt to reproduce the normal fasting tion and its array of complications and associations. and post-prandial insulin profiles. How is this done and However, owing to the sheer volume of information what insulin preparations are available to achieve it? related to this area of medicine, it is difficult for the Figures 50–62 provide a step-by-step overview aimed busy practitioner to keep up to date. at helping the practitioner learn, rather than simply The third edition of Ian Scobie’s Atlas of Diabetes memorize, the requisite information. Mellitus, building on the success of the two previous Every patient with diabetes should undergo exam- editions, goes a long way towards making this task ination of the fundus at least once a year by a physi- easier and remains a testimonial to the fact that a pic- cian who is familiar with the manifestations of diabet- ture is indeed worth at least a thousand words. This ic retinopathy. This is not always an easy task. How Atlas begins with a brief overview of the diagnosis, does one distinguish early background retinopathy pathogenesis and treatment of diabetes with special from the more serious high-risk retinopathy? Figures reference to the complications of diabetes and the 81–102, to a large extent, constitute a user’s guide to treatment of children and adolescents. Specific examination of the diabetic fundus. Similarly, Figures chapters cover diabetic dyslipidemia, diabetes and 104–34 show excellent examples of other common pregnancy and what it is like to live with this chronic and not-so-common manifestations of diabetic condition. These, and other sections, set the stage for microvascular and macrovascular complications. A vii Scobie Chapter Prelims 28/7/06 11:00 Page viii ATLAS OF DIABETES MELLITUS wide array of skin and other manifestations and asso- wonderful and successful Atlas and more than delight- ciations of diabetes is demonstrated. ed to keep my own personal copy. I have no doubt that Many excellent and comprehensive textbooks of both my students and I will continue to find this book diabetes are available, but I am unaware of any useful for many years to come. I suspect that those of other illustrated text with the scope and breadth of you who choose to add this excellent Atlas to your Dr Scobie’s Atlas of Diabetes Mellitus.I am delight- library will find that you will also share my enthusiasm ed to write a foreword to the third edition of this for this delightful book. Robert A Rizza, MD Rochester, MN viii Scobie Chapter Prelims 28/7/06 11:00 Page ix Preface The world is witnessing an increase in new cases of The third edition of this book continues to build on diabetes, in both the developed and the developing the previous two editions in providing a clinical and nations, of near epidemic proportion. This ubiquitous scientific background to the diagnosis, clinical presen- condition will have an ever-increasing impact on all tations and treatment of diabetes mellitus with a fur- aspects of medicine and public health. It follows that ther aim of portraying the wide and varied expressions all practicing physicians must seek to gain at least a of diabetes and its complications as an aid to their basic knowledge and understanding of this important more ready recognition in clinical practice. It also aims global health problem that is so closely linked to the to illustrate the breathtaking developments that are increasing prevalence of obesity. taking place in the field of new therapies for diabetes. Diabetes is the paradigm of a condition that neces- This Atlas should, therefore, be of interest to all those sitates a multidisciplinary approach to its management who are involved in the provision of diabetic health and treatment. Primary care physicians, hospital physi- care and should provide some insight into the fruits of cians, surgeons, nurses, dieticians, psychologists, podia- the explosion of basic science and clinical research trists and ophthalmologists are all drawn into this that has been conducted in an attempt to further our process. In addition, medical students and postgradu- understanding of diabetes and to care better for our ate doctors need to learn about diabetes and its pro- diabetic patients. tean manifestations. Ian N Scobie MD FRCP Gillingham, Kent ix Scobie Chapter Prelims 28/7/06 11:00 Page x Acknowledgments I wish to extend great thanks to Professor Peter (Figures 52, 53 and 55); MiniMed, Ashtead, UK (Fig- Sönksen and Dr Clara Lowy formerly of St Thomas’ ures 62 and 69); MediSense, Maidenhead, UK (Figure Hospital, London, UK, who kindly supplied many of 67); CDX Diagnostics, Sunderland, Tyne and Wear, the slides in this Atlas. I am greatly indebted to Dr UK (Figure 68); Dr David Kerr, Royal Bournemouth Tom Barrie, of The Glasgow Eye Infirmary, Glasgow, Hospital, Dorset, UK (Figures 65, 70–72); Dr William UK, who provided a splendid set of eye slides (Figures Campbell, Royal Victorian Eye & Ear Hospital, Mel- 82, 87, 97 and 99–101), Dr Alan Foulis, of The Royal bourne, Australia (Figures 90–92); Professor Stephanie Infirmary in Glasgow, UK, who supplied some magnif- Amiel, King’s College Hospital, London, UK (Figures icent pathology slides (Figures 23–26, 29–33, 35–39, 77, 152 and 153); Professor Peter Thomas, Royal Free 41) and Eli Lilly and Company for providing Figures School of Medicine, Hampstead, London, UK (Figure 1–3, 46–49, 51, 54 and 56–60.
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