Practical diabetes care

483 Pages·2018·7.592 MB·English

by  Levy, David

Practical Diabetes Care

Practical Diabetes
Care
FOURTH EDITION
David Levy MD FRCP
Formerly Consultant Physician, Barts Health NHS Trust, Whipps Cross University Hospital, London
The London Diabetes Centre, Marylebone, London
This fourth edition first published 2018 © 2018 by John Wiley & Sons Ltd
Edition History
John Wiley & Sons Ltd (3e, 2011)
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Library of Congress Cataloging‐in‐Publication Data
Names: Levy, David, 1954– author.
Title: Practical diabetes care / by David Levy.
Description: Fourth edition. | Hoboken, NJ : Wiley, 2017. | Includes
bibliographical references and index. |
Identifiers: LCCN 2017040598 (print) | LCCN 2017041148 (ebook) | ISBN
9781119052234 (pdf) | ISBN 9781119052227 (epub) | ISBN 9781119052241 (pbk.)
Subjects: | MESH: Diabetes Mellitus–therapy | Diabetes Mellitus–diagnosis
Classification: LCC RC660 (ebook) | LCC RC660 (print) | NLM WK 815 | DDC
616.4/62–dc23
LC record available at https://lccn.loc.gov/2017040598
Cover design: Wiley
Cover image: Courtesy of David Levy
Set in 8.5/10.5pt Frutiger by SPi Global, Pondicherry, India
10 9 8 7 6 5 4 3 2 1
Contents
Acknowledgments, vii
Introduction, ix
Clinical trials and organizations: abbreviations and acronyms, xv
1 Classification, diagnosis and presentation, 1
2 Diabetes emergencies, 25
3 Infections and the diabetic foot, 49
4 Eyes and kidneys, 77
5 Neuropathy, musculoskeletal and skin, 115
6 Diabetes and the cardiovascular system, 141
7 Type 1 diabetes: glycaemic control, 171
8 Type 1 diabetes: technology and transplants, 197
9 Type 2 diabetes: weight loss, exercise and other ‘lifestyle’
interventions, 217
10 Type 2 diabetes: glycaemic control, 241
11 Hypertension, 315
12 Lipids, 359
13 Clinical aspects of the metabolic syndrome, 387
14 Youth and emerging adulthood; old age, 401
15 Psychological aspects of diabetes, 425
Index, 439
v

Acknowledgments
This book’s peer reviewers have added clarity, focus and critical detail and have been
astonishingly sweet and supportive. Without their clear advice I would have blundered
up several, possibly many, more medical garden paths leading to cul‐de‐sacs all named
Embarrassment Drive. I applaud their directionality and comradely scholarship.
My dear long‐time friend and colleague Dr Tore Julsrud Berg (Oslo University Hospitals)
reviewed Chapter 1 (Classification) and the two chapters on Type 1 diabetes (Chapters 7
and 8). Everything I have written over the years on Type 1 diabetes has been improved
by his patience and encouragement. I can only aspire to his intense pragmatism com-
bined with academic rigour (and to the wonderful modernist Oslo house meticulously
treasured and preserved by Tore and his wife, Anne Valle).
Dr Edouard Mills, a specialist registrar in endocrinology who previously worked with
me during his foundation training, meticulously and thoughtfully reviewed Chapter 2
(Diabetes emergencies) and Chapter 11 (Hypertension).
Dr Albert Mifsud gently chided and guided me about antibiotics in diabetic infections
(Chapter 3) with the same patience my late colleague Dr Louise Neville had shown in
earlier editions. I hope there are no remnants in the text of our intellectual fist‐fights on
the Whipps Cross wards (and many years ago at the Central Middlesex Hospital) – both
part of the great outer circle of University Hospitals in London whose heyday of teaching,
research and clinical care from the end of World War II up to the 1980s has been eclipsed
by progressive resource starvation and massively increased clinical stresses over the past
two decades.
Professor Miles Fisher, coiner of one of the great aphorisms of diabetes, reviewed
Chapter 6 (Diabetes and the cardiovascular system) with the same speed and efficiency
with which he no doubt traverses the glens of his native country by bike.
Helen Alston, specialist registrar in nephrology, brought me up to date on many renal secrets.
Carin Hume, a wonderfully practical dietician at London Medical who inhabits the real
world of dietetics, even allowed me to pursue higher protein, lower carbohydrate diets
in Chapter 8.
Professor Alan Sinclair, doyen of diabetes care in older people, forgave me the mere
hemi‐chapter I devoted to his critical subject (Chapter 14) and reminded me about the
pervasive impact of frailty in older people with diabetes.
Dr Nicoletta Dozio and Dr Marina Scavini of the Diabetes Research Institute of San
Raffaele Hospital in Milan helped with all the sections of the book relating to diabetes
and pregnancy. Wonderful stays at Nicoletta’s and Stefano’s beautiful palazzo in Merate
undoubtedly increased my retention rate of key facts in an area of diabetes practice that
continues to be neglected by clinicians in primary and secondary care.
Professor Karim Meeran (Imperial Centre for Endocrinology) kindly provided me with
access to the invaluable online manual of endocrine test protocols. He is happy to share
the intranet link with all readers:
http://imperialendo.co.uk
vii
viii Acknowledgments
Pretty well every paragraph of this book owes any breadth and new insight to Timo
Pilgram, Senior Library Assistant at Whipps Cross University Hospital. Every reference
I requested (and a lot of illustrations) pinged into my inbox in full text form within a few
hours, sometimes minutes; but more important, dozens of references that I would never
have found using my kindergarten skills in Boolean logic are here because of Timo’s pure
talents of modern librarianship, combined with curiosity and tenacity and seemingly
unlimited manoeuvrability around the internet, shared by few clinicians. Imagination and
new stories (as they now say everywhere) are possible only when these startling skills
combust slightly after catalysis by the tiniest addition of serendipity. He deserves to be a
co‐author. More generally, librarianship in hospitals, just like libraries in the community,
is inevitably an easy target of cost‐cutting. Ensure, at least, that before they disappear
from your own institution you understand their continuing centrality to the pursuit of
modern medical thinking.
Most of the writing was done during 2016. My wife, Laura Liew, left me during the
first nine months to gain a Grande Diplôme in cuisine and patisserie at the London
Cordon Bleu School in Bloomsbury Square. Most days I could sit and write for twelve
hours, by which time Laura had returned, usually exhausted, with a take-away box con-
taining a French dish of staggering complexity and subtlety that had been the product of
her industry and rigorous supervision and assessment by the teaching chefs. Practical
Diabetes Care by day, lobster Thermidor for dinner: the haute cuisine recipe for extracting
the best possible performance from an author. I thoroughly commend it.