Diabetes Care: A Practical Manual

497 Pages·2015·4.11 MB·English

by  Rowan Hillson

OXFORD MEDICAL PUBLICATIONS
Diabetes Care
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Diabetes Care:
A practical
manual
Second Edition
Dr Rowan Hillson
MBE, MD, FRCP
National Clinical Director for Diabetes,
England 2008–2013
1
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3
Great Clarendon Street, Oxford, OX2 6DP,
United Kingdom
Oxford University Press is a department of the University of Oxford.
It furthers the University’s objective of excellence in research, scholarship,
and education by publishing worldwide. Oxford is a registered trade mark of
Oxford University Press in the UK and in certain other countries
© Rowan Hillson 2015
The moral rights of the author have been asserted
First Edition published 2008
Second Edition published 2015
Impression: 1
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, without the
prior permission in writing of Oxford University Press, or as expressly permitted
by law, by licence or under terms agreed with the appropriate reprographics
rights organization. Enquiries concerning reproduction outside the scope of the
above should be sent to the Rights Department, Oxford University Press, at the
address above
You must not circulate this work in any other form
and you must impose this same condition on any acquirer
Published in the United States of America by Oxford University Press
198 Madison Avenue, New York, NY 10016, United States of America
British Library Cataloguing in Publication Data
Data available
Library of Congress Control Number: 2014943832
ISBN 978–0–19–870563–5
Printed in Great Britain by
Ashford Colour Press Ltd, Gosport, Hampshire
Oxford University Press makes no representation, express or implied, that the
drug dosages in this book are correct. Readers must therefore always check
the product information and clinical procedures with the most up-to-date
published product information and data sheets provided by the manufacturers
and the most recent codes of conduct and safety regulations. The authors and
the publishers do not accept responsibility or legal liability for any errors in the
text or for the misuse or misapplication of material in this work. Except where
otherwise stated, drug dosages and recommendations are for the non-pregnant
adult who is not breast-feeding
Links to third party websites are provided by Oxford in good faith and
for information only. Oxford disclaims any responsibility for the materials
contained in any third party website referenced in this work.
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For Kay and Rodney Hillson
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vi
Acknowledgements
I wish to thank the following for their help.
This book would not have been possible without the support of my fam-
ily, my patients, my colleagues in Diabeticare, and my colleagues around The
Hillingdon Hospital, and nationally who have taught me so much.
I particularly wish to thank my family for their patience and encourage-
ment, and, alphabetically:
for the first edition Pat Bacon, Carol Candlish, Ruth Chalmers, Anne
Currie, Deb Datta, Mark Edwards, David Evans, Mary Jurd, Sandra Ross,
Gill Ruane, Pat Smith, Dai Thomas, and the anonymous but most helpful GP
reviewer, and the pharmacology reviewer engaged by OUP.
for the second edition Lisa Bradbury, Damian Fogarty, Donal
O’Donoghue, Debbie Hicks, June James, Christine Jones, Gerry Rayman,
Benjamin Wiles and the anonymous but very helpful and constructive
reviewers engaged by OUP.
I thank Helen Liepman, Eloise Moir-Ford, James Oates, Kate Wilson,
Janet Walker, Fiona Chippendale, and colleagues from Oxford University
Press.
I am grateful to the Diabetic Medicine, Wiley, the DVLA, eMIMS (elec-
tronic Monthly Index of Medical Specialties), NICE, and Springer-Verlag for
permission to use material.
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vii
Contents
Introduction ix
Symbols and abbreviations xi
1 Is it diabetes? 1
2 Assessing a person with diabetes 23
3 The aims of diabetes care 31
4 Diabetes education 55
5 Healthy eating and drinking (including
management of obesity) 67
6 Urine testing 87
7 Blood glucose and ketone testing 95
8 Non-insulin medications 113
9 Insulin 147
10 Low blood glucose: hypoglycaemia 181
11 High blood glucose: hyperglycaemia 201
12 Diabetic ketoacidosis (DKA) and hyperosmolar
hyperglycaemic states (HHS) 213
13 Exercise 233
14 Diabetic tissue damage 245
15 Diabetic foot problems 301
16 Diabetes in young people 315
17 Diabetes in women 333
18 Diabetes in men 351
19 Older people with diabetes 357
20 Diabetes in different ethnic groups 371
21 Work 383
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viii CONTENTS
22 Travel 393
23 Psychological and social aspects of diabetes 409
24 Diabetes care in hospital 417
25 Local diabetes care 445
26 Links 465
Index 471
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ix
Introduction
Who is this book for?
• All health care staff in any discipline, e.g. doctors, nurses, dietitians,
podiatrists, physiotherapists, occupational therapists, speech and
language therapists, psychologists, pharmacists, health care assistants,
medical secretaries, managers and care planners, and others
• Primary, community, secondary, NHS, or private care services
• Are you a person with diabetes who wants to learn more, or a family
member of a person with diabetes? This book is written for health staff
but many patients will find it of interest
For example:
• Do you see people with diabetes?
• Are you a GP or practice nurse working in primary care running your
own diabetic clinic?
• Do people with diabetes ask for your advice?
• Are you a diabetologist or a GP with a special interest in diabetes who
teaches other staff about diabetes?
• Are you a nurse working in A&E?
• Are you working on a hospital ward or clinic caring for diabetic
patients—often or sometimes?
• Are you a doctor admitting emergency patients?
• Have you just started work with a diabetes team in a hospital?
• Are you a student of medicine, nursing, dietetics, podiatry,
physiotherapy, occupational therapy, biochemistry?
Diabetes
Diabetes is a common long-term condition. Some numbers for 2012/2013:
• The International Diabetes Federation (IDF) estimated that there were
382 million people with diabetes worldwide
• Half were undiagnosed
• 56 million live in Europe, 20 million undiagnosed
• 3.2 million live in the UK
• 15 % of UK hospital beds occupied by people with diabetes
• Primary care prescriptions for glucose-lowering drugs in England cost
£764 million
• Nationally total UK expenditure on people with diabetes has been
estimated at ~ 10 % of national health expenditure
• Diabetes prevalence rises every year in every country
• Where 2013–14 information is available, numbers have already
increased
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