ABC of Diabetes 6th ed. - T. Holt, S. Kumar (Wiley-Blackwell, 2010) WW

116 Pages·2010·13.18 MB·English

Diabetes

Sixth Edition

Tim Holt

Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, UK

Sudhesh Kumar

Clinical Sciences Research Institute, Warwick Medical School, University of Warwick; and WISDEM, University Hospital, Coventry, UK

A John Wiley & Sons, Ltd., Publication

Diabetes

Sixth Edition

Diabetes

Sixth Edition

Tim Holt

Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, UK

Sudhesh Kumar

Clinical Sciences Research Institute, Warwick Medical School, University of Warwick; and WISDEM, University Hospital, Coventry, UK

A John Wiley & Sons, Ltd., Publication

This edition first published 2010,  2010 by Tim Holt and Sudhesh Kumar
Previous editions: 1983, 1988, 1993, 1998, 2003

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Library of Congress Cataloging-in-Publication Data

Holt, Tim A.
ABC of diabetes. – 6th ed. / by Tim Holt and Sudhesh Kumar.
p. ; cm.
Rev. ed. of: ABC of diabetes / Peter J. Watkins. 5th ed. 2003.
Includes bibliographical references and index.
ISBN 978-1-4051-7784-9
1. Diabetes – Popular works. I. Kumar, Sudhesh. II. Watkins, Peter J. ABC of diabetes. III. Title.
[DNLM: 1. Diabetes Mellitus. WK 810 H758b 2010]
RC660.4.H65 2010
616.4′62 – dc22
2009013393

ISBN: 978-1-4051-7784-9

A catalogue record for this book is available from the British Library

Set in 9.25/12 Minion by Laserwords Private Limited, Chennai, India
Printed and bound in Malaysia

1
2010

Contents

Foreword, vi
Preface, vii
Acknowledgements, viii

1 Diagnosing Diabetes, 1

2 Types of Diabetes, 5

3 Helping People Live with Diabetes, 8

4 Early Detection and Prevention of Diabetes, 12

5 Cardiovascular Disease, 19

6 Management of Blood Glucose in Type 2 Diabetes, 25

7 Hyperglycaemic Emergencies and Management of Diabetes in Hospital, 31

8 Insulin Therapy, 34

9 Hypoglycaemia, 37

10 Self-Management of Diabetes, 40

11 Surveillance for Complications, 47

12 Kidney Disease in Diabetes, 51

13 Eye Disease in Diabetes, 58

14 The Diabetic Foot, 64

15 Diabetic Neuropathy, 72

16 Psychological Issues Related to Diabetes Care, 75

17 Diabetes and Pregnancy, 80

18 Organisation of Diabetes Care in General Practice, 88

19 New and Emerging Therapies for Diabetes, 93

20 Support for People Living with Diabetes, 97

Index, 101

v

Foreword

The prevalence of diabetes has exploded over the past two decades.
In 2000 there were an estimated 151 million people with diabetes
worldwide. The latest estimates for 2010 are 285 million, with a
conservative estimate that this number will rise to 438 million over
the next 20 years. By far the majority of these are people with
type 2 diabetes but the numbers with type 1 diabetes are also rising.
This is placing an ever increasing burden on health services and,
obviously, prevention at the population level is vital. But the needs
of the individual with diabetes are also of paramount importance.
Good care is vital to slow down and prevent the development
of both microvascular and macrovascular complications. This is
crucial both for the individual and for the long-term costs of care.
One result of this increase is that it has become obvious that
care of people with diabetes is the responsibility of all parts of the
health-care system with the biggest impact on primary care – both
medical and other professionals. Systematic care is vital – and

complex algorithms are not the answer. Education is also vital and
needs to be targeted, particularly at primary care workers.
The present text fits the bill admirably. It is targeted at primary
care practitioners andnurses. Itcouldbe calledthe AtoZofdiabetes
rather than the ABC! It goes systematically through all stages of
diabetes – from diagnosis to a lucid discussion of the complications
aswellasprovidingausefulguidetotheorganisationofdiabetescare
in general practice. It should also be an obligatory text for medical
students who receive woefully little diabetes teaching. Overall, this
book fills a yawning gap and should have a place in every general
practice and on every diabetes nurse practitioner’s shelves.

Professor Sir George Alberti
Senior Investigator, Imperial College, London
Emeritus Professor of Medicine,
University of Newcastle upon Tyne

vi

Preface

Building on the established reputation of the ABC of Diabetes
series, this completely rewritten sixth edition contributes insights
and materials from the Diabetes educational programme of War-
wick Medical School. Originating in a primary care context,
the Warwick teaching programme draws equally on secondary
care expertise based at the Warwickshire Institute for Diabetes,
Endocrinology and Metabolism (WISDEM), hosted by University
Hospital, Coventry. The wider metabolic context in which diabetes
occurs is an important research interest at Warwick and this will
hopefully be reflected through the pages of this book.
Newtechnologiescreateopportunitiesfordiagnostic,therapeutic
and organisational innovation. The development of an increasingly
integrated software environment through the UK National Health
Service provides means of organising and monitoring diabetes care
that were not available to previous generations of health profes-
sionals. This book explains how organisational infrastructure is as
important as any other aspect in ensuring high quality diabetes care.
Whilst using UK examples to illustrate these principles, we hope
that readers in other countries may recognise this common need.
The interaction between primary and secondary care, including
criteria for cross-referral is of central importance in developing
services based on locally available resources.
The book promotes the patient-centred approach throughout. It
responds to the increasing importance of the primary care setting,

whilst also covering the hospital management of emergencies.
People living with diabetes in the twenty-first century generally
expect to be involved in treatment decisions, if not to lead them,
but they equally expect their health care professionals to be well
informed and to provide authoritative guidance, particularly when
things don’t go to plan. We hope that the insights offered by this
book will equip practitioners for both circumstances – managing
the routine ‘surveillance’ scenarios when risk factor control and
quality of life issues are the priorities, whilst retaining the ability to
respond to acute situations of metabolic instability or fulminating
complications.
These are exciting times, as new discoveries and technologies
are making significant improvements in outcomes for people with
diabetes. Thus, new developments in diabetes care can easily over-
take current policy. We have attempted to incorporate all recent
developments, for example, the diagnostic criteria for diabetes,
as discussed in the first chapter. Whilst we would advise readers
to keep a watchful eye on new developments, we feel confident
that this book will provide a sound understanding of the guiding
principles of diabetes management.

Tim Holt
Sudhesh Kumar

vii