Switching from the pump in special cases

There will be times when your child needs to use a syringe and needles (or another injection method) instead of the pump. For example, if the pump breaks down, if it's lost or stolen, or if he runs out of supplies for it. How do you figure out how much insulin he should take to replace the insulin in the pump Assuming your child's using rapid-acting insulin in the pump, the doses before meals remain the same with injections as they were in his boluses. The basal insulin is replaced by glargine...

Disorders of movement mononeuropathy

Diabetic neuropathy can affect nerves to individual muscles. The result is a sudden inability to move or use those muscles, called mononeuropathy. These disorders are believed to originate as a result of a sudden closing of a blood vessel supplying the nerve. The clinical picture depends on which nerve or nerves are affected. For example, if one of the nerves to the eyeball is damaged, the patient can't turn his eye to the side that nerve is on. If a nerve to the face is affected, the eyelid...

Glyco Mark

In contrast to the traditional hemoglobin A1c test, changes occur rapidly in the GlycoMark test. Like the hemoglobin A1c, it's a blood test, but a better result in the GlycoMark test is a higher value, not a lower one. The GlycoMark test takes advantage of the fact that the compound 1,5-anhydroglucitol (or 1,5 AG) is normally found in healthy people. It's filtered by the kidneys and reabsorbed into the blood. However, when a lot of glucose is present in the urine, reabsorption is blocked, and...

Using a typical data management system

You can use a data management system on just about any home blood glucose meter to plot your child's blood glucose and determine where changes need to be made. Figure 7-3 plots the results before changes were made in the treatment, and Figure 7-4 shows the results after those changes. You can see the difference very clearly. Here are the elements of each figure i The Trendgraph at the top of each page shows the individual blood glucose values. The horizontal or x-axis represents the days, and...

Surveying potential issues with the test

One problem with the hemoglobin A1c test is the slowness with which it changes when major changes are occurring in treatment. Despite marked improvement in the blood glucose levels, the hemoglobin A1c changes slowly. Obtaining a hemoglobin A1c more often than every three months is of little value in showing improved glucose control. Another problem with the hemoglobin A1c measurement is the difference in how the test is performed in different labs. Because each insurance company mandates it, I...

Coz More Insulin Technology System

This system consists of the Deltec Cozmo insulin pump and the CoZmonitor Blood Glucose Monitor, which attaches to the pump in the back and communicates with the pump via infrared technology to display the result on the pump screen. Some of this pump's features include 1 The smallest bolus is 0.05 units. i It alerts you of a missed bolus before a meal. 1 It holds 300 units of insulin. i It alert you to test blood glucose. 1 It has a site change alert to notify you to change the infusion set. 1...

Insulin pens

An insulin pen consists of a device filled with insulin that allows you to dial the dose shown in a window with audible clicks and make the injection by pushing in a plunger. Pens come in two different styles i The pen contains the insulin already and is discarded when you use up the insulin. 1 You put a cartridge of 1.5 or 3 ml of insulin in the pen as needed and reuse the pen. Also, some pens allow you to dial back down if you dial too much insulin. Check out an insulin pen in Figure 10-3....

Distinguishing the severity levels of hypoglycemia

Hypoglycemia is divided into three levels of severity, depending on the symptoms and how difficult it is to get the patient to take some treatment I discuss treatment in more detail later in this chapter i Mild hypoglycemia, which is marked by a blood glucose of about 75 mg dl, is easily treated by the patient or caretaker if the patient is a child . Glucose levels come back to normal with small amounts of carbohydrate. Mild hypoglycemia is usually well-tolerated, and the person can go on with...

Determining the cause

There are many possible causes for hypoglycemia in T1DM, but it all really comes down to too much insulin from an external source and too little glucose in the blood. Even if there's plenty of glucose inside the cells that require insulin, a problem still exists because the brain gets its glucose passively when the glucose in the blood is higher than the glucose in brain cells. If insulin has driven most of the blood glucose into cells that don't receive glucose passively, hypoglycemia is...

What are the different types of external insulin

The person with T1DM is entirely dependent upon an external source of insulin. Since it was originally extracted from the pancreas of fetal calves in 1921, scientists have attempted to alter external insulin's activity so that it can duplicate the activity of native insulin, the insulin in the bodies of people who don't have T1DM. And researchers have come pretty close to that goal. External insulin comes in several forms, and each one has a different purpose I Rapid-acting insulin Taken before...

Eating wisely

If you're a parent of a child with T1DM, you need to make sure that your child gets the right nutrients for proper growth and that he balances the food intake with insulin at all times. If you're meticulous about the food your child eats, you'll find that controlling his blood glucose is much easier. I have numerous patients whose blood glucose levels improved dramatically after I sent them to a dietitian. Chapter 8 discusses how to count carbohydrates so that your child takes the right amount...

The effects of uncontrolled diabetes on the kidneys

Structure Kidney Glomerular

Glomerulous Incoming arteriole Outgoing arteriole Glomerulous Incoming arteriole Outgoing arteriole As diabetes proceeds, if control of the blood glucose is poor, the glomerular basement membrane and other nearby structures begin to thicken and take up the space occupied by the capillaries see Figure 5-4 . The tight quarters mean that the capillaries can't filter as much blood as they should. The rate of filtration, or glomerular filtration rate, begins to fall. glomerulus in uncontrolled...

Encourage Your Child to Play Video Games Really

Video games are a favorite pursuit of today's kids, and they have so many different games to choose from. Now there are video games that teach about T1DM Two of the top games are Starbright Life Adventure Series Diabetes and Packy and Marlon. 1 Starbright Life Adventure Series Diabetes comes from the Starbright Foundation, a nonprofit organization that develops programs to help seriously ill children cope with the challenges of their illnesses. This particular program uses interactive...

The pros and cons of an islet transplant

The advantages of the islet transplantation include 1 Freedom from the need for insulin injections 1 Reversal of long-term diabetic complications 1 An end to hypoglycemia and hyperglycemia 1 A return of hypoglycemic awareness Several risks are associated with islet transplantation. They include the following 1 Danger of bleeding because heparin is given to prevent clotting of the portal vein for the injection 1 All the risks of the antirejection drugs used for intact pancreas transplantation...

Jet injectors

Jet Injector Insulin

Jet injectors use a puff of air under pressure to release a jet stream of insulin that's forced through the skin by the pressure of the air. There's no needle involved. You simply draw up the amount of insulin needed, and you can use the device again and again. Figure 10-4 shows a typical jet injection device. Although jet injection devices avoid the use of a needle, they still cause some bruising. For many patients, they're a satisfactory substitute for a syringe and needle. Jet injectors may...

Insulin infusers

Insulin infusers are needles or catheters placed in the tissue under the skin and taped there for two to three days. When insulin needs to be given, the syringe is attached to the infusion set and injected into it by you or your child. An infuser is useful when your child just hates the idea of three or four needle sticks a day and prefers to have something already under the skin into which you inject the insulin. The downside is that the infusion site sometimes gets infected, in which case you...

Disorders of automatic autonomic nerves

Disorders of automatic or autonomic nerves often go unrecognized even though they may have a profound effect on the patient's quality of life and even survival. As you're reading this page, many movements are going on in your body, but you're unaware of them. Your heart muscle is squeezing down and relaxing. Your diaphragm is rising up to empty the lungs of air and then relaxing to draw air in. Your esophagus is carrying saliva or food, if you're a multitasker who's eating and reading from your...

Busting myths about having a chronic disease

Neither you nor your child or anyone else is to blame for your child's diabetes. As I explain in Chapter 2, T1DM occurs in a susceptible individual who comes in contact with a virus that shares tissue similarities with the person's beta cells. As your child's body attempts to reject the virus, it destroys his beta cells, the ones that make insulin. As a parent, you're not responsible if your child gets diabetes you certainly had nothing to do with that villainous virus. Help your child remember...

The real risk of hypoglycemia in the workplace

A study in Diabetes Care in June 2005 represents an important accomplishment for people who take insulin. In this study, researchers looked at 243 employees ranging in age from 20 to 69 who were taking insulin for diabetes. Over a 12-month period, researchers recorded the frequency, severity, and consequences of hypoglycemia occurring at work or elsewhere. They focused on hypo-glycemia because it's the most common complication that employers point to as the reason they don't want to hire people...

Syringes and needles

More and more, people are using insulin pens to administer their insulin I discuss these devices later in this chapter . Compared to a syringe and needle, the pen is just more convenient and easier to determine the correct dose. However, you and your child still need to know how to measure and deliver insulin with a syringe and needle the oldest and still most common method for delivering insulin in case you run out of pens or pen refills. Numerous different brands of syringes and needles are...

Emphatic Exercising

As evidenced in a survey article, the fortunate folks who have received medals from the Joslin Diabetes Center for having lived with diabetes on insulin for 50 years or more have several things in common see Chapter 17 for the full story . One is that they exercise more than most other people at their age. The authors conclude that exercise may be an important protective factor. You can say that again The T1DM patients in my practice with the lowest hemoglobin A1c, the least need for insulin,...

Macrovascular Complications Protecting Your Heart

Macrovascular complications are the complications involving the large blood vessels of the body, particularly the coronary arteries in the heart. In this section, I discuss how diabetes can lead to damage to the heart by causing blockage of these arteries. Heart disease and heart attacks are the major macrovascular complications found in people with T1DM. How does heart disease lead to a heart attack Coronary artery disease CAD , which is also known as atherosclerotic heart disease, is the...

Bentover rowing

Dumbbell Good Morning

To do bent-over rowing, follow these instructions and see Figure 9-5 1. Hold a dumbbell in each hand, arms hanging down, with your legs straight and back parallel to the floor. 2. Raise the dumbbells to your chest. 3. Lower the dumbbells back toward the floor. To do good mornings, follow these instructions and refer to Figure 9-6 1. Hold the ends of one dumbbell above your head, arms straight. 2. Lower the dumbbell forward as you bend forward so that your back is parallel to the floor. 3. Stand...

Deciphering lipid panel results

If your doctor wants to know the levels of all the fat particles in your child's bloodstream, your child has to fast for 12 hours before undergoing a test known as a lipid panel, but if he is satisfied with the results of a total cholesterol and the good cholesterol, no fasting is required before the test. Make sure that the doctor performs a lipid panel on your child once a year or more often if the results aren't normal . A lipid panel is done with a blood specimen in which the various types...

Taking the right doses

Some people recently diagnosed with T1DM can use a pump immediately, but most people who decide to start using a pump are switching from the following routine i Long-acting insulin once or twice a day, which corresponds with the basal insulin of the pump i Multiple daily injections with rapid-acting insulin before meals, which corresponds to the boluses given by the pump The total insulin dose from a pump is about 20 percent less than the amount of rapid-acting plus long-acting insulin from...

Preventing and treating hypoglycemia

Preventing hypoglycemia may be time-consuming, but it's possible and entirely worth the effort Even if prevention doesn't work and your child still has episodes of hypoglycemia, you can treat it in several different ways, as you find out in the following sections. The best way to prevent hypoglycemia is to be constantly aware of your child's blood glucose. Meters are being developed that can measure glucose every five minutes and beep if it falls below a set level. See Chapter 7 for more on...

Adjusting insulin intake in a different time zone

The old saying, Go West, young man could be altered to Go West, young person with type 1 diabetes. When T1DM is involved, it's a lot easier to travel west than east over several time zones. Here are the differences in insulin intake depending on your child's time zone changes i You add hours to your day when you head west, so all your child has to do is check his blood glucose an extra time or two and add short-acting insulin to cover those hours. He doesn't change the long-acting insulin but...

The pros and cons of a pancreas transplant

Are you nervous at the thought of undergoing a pancreas transplant Fret not here are several advantages of receiving a new pancreas i The benefit of needing no insulin injection and no dialysis after a combined kidney and pancreas transplant is enormous. Your quality of life improves tremendously. i With a combination kidney and pancreas transplant, your new kidney doesn't suffer the same deterioration as the original, damaged kidney. Without the healthy pancreas, the new kidney would...

Accu Chek Spirit Insulin Pump System

The Accu-Check Spirit insulin pump is made by Diesetronic, which is owned by Roche Diagnostics. Here's a rundown of this pump's the specific features and requirements 1 The reservoir holds 315 units of insulin. 1 You can set up to 24 basal hourly rates in five different patterns. You also can set temporary rates. 1 The basal rates range from 0.1 to 25 units per hour. 1 The smallest bolus dose is 0.1 units. 1 It can recall the last 30 boluses, daily insulin totals, and temporary rate increases...