Type 1 Diabetes For Dummies

Alan L. Rubin, MD, is a physician in private practice and the author of the bestselling Diabetes For Dummies, Diabetes Cookbook For Dummies, and Thyroid For Dummies.

Introduction 1

About This Book 1

Conventions Used in This Book 2

What You’re Not to Read 3

Foolish Assumptions 3

How This Book Is Organized 4

Part I: Defining Type 1 Diabetes 4

Part II: Considering the Consequences of Type 1 Diabetes 4

Part III: Treating Type 1 Diabetes 5

Part IV: Living with Type 1 Diabetes 5

Part V: The Part of Tens 6

Part VI: Appendixes 6

Icons Used in This Book 7

Where to Go from Here 7

Part I: Defining Type 1 Diabetes 9

Chapter 1: Dealing with Type 1 Diabetes 11

Understanding What Type 1 Diabetes Is (and Isn’t) 12

Handling the Physical and Emotional Consequences of Type 1 Diabetes 13

Treating Type 1 Diabetes Effectively 14

Undergoing regular testing 14

Eating wisely 15

Exercising for more control 15

Taking insulin 16

Using other medications and treatments 16

Deciding to transplant 16

Living Well with Type 1 Diabetes 17

Handling school, work, and other daily activities 17

Adjusting to sick days and travel 17

Getting through pregnancy and menopause 18

Aging with type 1 diabetes 18

Chapter 2: Recognizing Type 1 Diabetes 19

Understanding How Type 1 Diabetes Works 19

Distinguishing between controlled and uncontrolled glucose 21

Triggering type 1 diabetes 24

Checking Out the Statistics on Who Gets Type 1 Diabetes 25

Rates among different places and races 25

Rates in children versus adults 26

Rates in families with members who have type 1 diabetes 26

Making a Diagnosis of Type 1 Diabetes 27

Surveying the symptoms and undergoing testing 27

Gathering a group of the right doctors 28

Developing key skills after the diagnosis 29

Chapter 3: Excluding Other Types of Diabetes 31

Distinguishing Type 2 and Latent Autoimmune Diabetes from Type 1 Diabetes 31

Type 2 diabetes 32

Latent Autoimmune Diabetes in Adults (LADA) 35

Delving into Diabetes Caused by Other Diseases and Agents 36

Considering hormone-induced causes of diabetes 36

Examining diabetes caused by destructive diseases of the pancreas 40

Discovering drugs and chemicals that may cause or worsen diabetes 42

Part II: Considering the Consequences of Type 1 Diabetes 43

Chapter 4: Overcoming Short-Term Complications 45

Managing Low Blood Glucose: Hypoglycemia 46

Determining the cause 46

Recognizing the symptoms 48

Distinguishing the severity levels of hypoglycemia 49

Understanding hypoglycemic unawareness 51

Preventing and treating hypoglycemia 52

Dealing with Very High Blood Glucose: Diabetic Ketoacidosis 55

Considering some potential causes 56

Surveying the symptoms 57

Preventing and treating diabetic ketoacidosis 58

Chapter 5: Preventing Long-Term Complications 61

Focusing on Eye Disease 62

Background retinopathy 64

Proliferative retinopathy 65

Coping with Kidney Disease 66

The effects of uncontrolled diabetes on the kidneys 67

Preventing kidney disease 69

Treating kidney disease if prevention fails 70

Knowing about Nerve Disease 71

Disorders of sensation 72

Disorders of movement (mononeuropathy) 74

Disorders of automatic (autonomic) nerves 75

Macrovascular Complications: Protecting Your Heart 76

Considering Associated Diseases 78

Hyperthyroidism and hypothyroidism 78

Skin disease 80

Celiac disease 81

Chapter 6: Handling Emotional Effects 83

Coming to Terms with the Diagnosis 83

Knowing that your child is in good company 84

Encouraging positive coping skills 85

Realizing that Type 1 Diabetes Is a Family Disease 87

Getting a grip on general guidelines for parents 87

Caring for children of all ages 89

Helping siblings be understanding 92

Handling Issues of Self-Esteem 93

Busting myths about having a chronic disease 93

Clearing up fears about having special needs 94

Maintaining a High Quality of Life 95

Part III: Treating Type 1 Diabetes 97

Chapter 7: Undergoing Essential Tests and Monitoring Blood Glucose 99

Doing Key Tests at the Doctor’s Office 100

Foot problems 101

Blood pressure 102

Weight and height 103

Hemoglobin A1c 105

GlycoMark 108

Thyroid functions 109

Microalbuminuria 110

Eye problems 111

Cholesterol 111

The Basics of Testing Blood Glucose at Home 113

Deciding on the frequency of testing 114

Performing the test 115

Testing away from the finger 116

Selecting a Home Blood Glucose Meter 116

Considering a few factors when choosing a meter 117

Using a typical data management system 118

Surveying standard blood glucose meters 120

Checking out meters for continuous glucose monitoring 124

Chapter 8: Eating a Healthy Diet 127

Carbohydrates: The Energy Source with the Biggest Impact on Blood Glucose 128

Getting a grip on the glycemic index 129

Filling up with fiber 132

Carbohydrate counting 132

Other tips for managing carbohydrate intake 134

Looking at Other Sources of Energy 135

Protein 135

Fat 136

Getting Enough Vitamins, Minerals, and Water 137

Vitamins 138

Minerals 139

Water 140

Understanding Diet Challenges at Every Age 140

Focusing on Other Food Factors 141

Using sugar substitutes 142

Considering fast food 143

Choosing a vegetarian diet 146

Handling Eating Disorders 146

Different types of disorders 147

Sources of help 149

Chapter 9: Exercising to Improve Control of Type 1 Diabetes 151

The Benefits of Exercise for People with Type 1 Diabetes 152

Taking Care Before Starting an Exercise Program 153

Talking to the doctor 153

Deciding to devote an hour each day 154

Determining how hard to exercise 154

Adjusting insulin usage and following other precautions 155

Developing (And Sticking to) an Exercise Plan 156

Encouraging exercise at all ages 156

Choosing an activity 160

Competing against others 162

A good pick for everyone: Walking 10,000 steps a day 163

Training with weights 164

Chapter 10: Understanding the Basics of Using Insulin 171

The Purpose and Types of Insulin 172

What does insulin do? 172

What are the different types of external insulin? 173

The Details of Insulin Doses 175

Calculating the bolus dose 176

Adjusting the basal dose 178

Injecting Insulin 178

Before you begin: Selecting an injection site 179

Syringes and needles 180

Taking (or giving) a shot 181

Insulin pens 184

Insulin infusers 185

Jet injectors 186

Avoiding side effects, no matter the method 187

A Major Advance: Inhaled Insulin 187

The limits on potential patients 188

Determining the dose 188

Inhaling the insulin 190

A few notes on inhaler maintenance and usage 191

Chapter 11: Delivering Insulin with a Pump 193

Keeping a Few Considerations in Mind before Using an Insulin Pump 193

Using an Insulin Pump Properly 195

Taking the right doses 195

Setting temporary doses 197

Changing the needle and insulin 198

Living comfortably with the pump 199

Switching from the pump in special cases 200

Checking Out Various Insulin Pumps 201

MiniMed Paradigm pumps 201

Accu-Chek Spirit Insulin Pump System 203

Animas pumps 203

CozMore Insulin Technology System 204

Dana Diabecare II pump 204

OmniPod Insulin Management System 205

Choosing the right pump 206

Chapter 12: Getting a Grip on Other Drugs and Treatments 207

Boosting Insulin’s Effect: Pramlintide 207

Surveying Different Treatments 209

Acupuncture 209

Biofeedback 210

Chromium 210

Cinnamon 211

Ginseng 211

Vanadium 211

Drinking Alcohol Safely 212

The maximum amount of alcohol allowed 212

The dangers of excess alcohol 213

Finding help 214

Avoiding Dangerous Drugs 215

Prescription medications 215

Tobacco 216

Illegal drugs 218

Chapter 13: Surveying Kidney, Pancreas, and Pancreatic Islet Transplants 221

Receiving a New Kidney 222

Recognizing when you need a new kidney 222

Knowing when you can’t have a kidney transplant 222

The pros and cons of a kidney transplant 223

Understanding the costs 223

Undergoing an evaluation 224

Finding a donor, living or deceased 224

The process of surgery and recovery 225

Getting a New Pancreas (Alone or with a New Kidney) 225

Recognizing when you need a new pancreas 226

Knowing when you can’t have a pancreas transplant 226

The pros and cons of a pancreas transplant 226

Looking at the costs 227

Finding a pancreas donor 227

The process of surgery and recovery 228

On the Cutting Edge: Pancreatic Islet Transplantation 229

Recognizing when you need islet transplantation 229

Knowing when you can’t have an islet transplant 230

The pros and cons of an islet transplant 230

Considering the costs 231

The donation of islets 231

The process of surgery and recovery 232

Dealing with Continuing Issues after Any Transplant 232

Following up and treating your diabetes 233

Checking for long-term complications 233

Avoiding infections 233

Being careful with conception 234

Watching out for cancer 234

Finding More Information Online 234

Part IV: Living with Type 1 Diabetes 237

Chapter 14: Adjusting to School, Work, and Other Activities 239

Dealing with Diabetes in School 240

Developing a Section 504 Plan 240

Considering an individualized education program 242

Handling diabetes in college 242

Living with Diabetes as a Working Adult 243

Understanding limits and protections 243

The real risk of hypoglycemia in the workplace 244

Taking action if you suspect discrimination related to diabetes 245

Working together: Helping employers integrate employees with diabetes 245

Driving Safely with Type 1 Diabetes 247

Tackling Insurance Issues 248

Health insurance 248

Life insurance 250

Chapter 15: Managing Illness and Travel 251

Dealing with Sick Days 251

Monitoring the blood glucose 252

Measuring blood ketones 253

Modifying the diet 254

Taking medications 255

Traveling with Type 1 Diabetes 256

Carrying the necessities 256

Adjusting insulin intake in a different time zone 257

Eating sensibly 258

Ensuring a smooth journey 259

Chapter 16: Going through Pregnancy and Menopause 261

Understanding Normal Female Sexual Development 262

Starting before birth 262

Continuing at puberty and adolescence 262

Controlling Type 1 Diabetes before Conception 263

Handling blood glucose during your menstrual periods 263

Dealing with sexual dysfunction 264

Getting a few tests if you’re thinking of getting pregnant 264

The risks of conceiving before you have control of T1DM 265

Using contraception until you’re under control 268

Ensuring a Safe Pregnancy and Delivery 269

Using insulin during and after pregnancy 270

Managing your diet 271

Adding exercise 272

Monitoring your baby 272

Dealing with Type 1 Diabetes during Menopause 272

Sticking to good habits 273

Considering hormone replacement therapy 274

Chapter 17: Controlling Type 1 Diabetes in the Elderly 277

Making a Diagnosis 278

Surveying symptoms 279

Conditions connected to the onset of type 1 diabetes 280

Confirming the diagnosis with testing 280

Recognizing the Challenges of Managing Type 1 Diabetes in the Elderly 281

Realizing how the elderly differ from other patients 281

Determining an elderly patient’s ability to treat his own type 1 diabetes 282

Effectively Treating Type 1 Diabetes in the Elderly 283

Medications 284

Nutrition 285

Exercise 286

Checking Out Resources for the Elderly with Type 1 Diabetes 287

Government help 287

Drug company resources 288

Part V: The Part of Tens 291

Chapter 18: Ten Ways to Involve Kids in Their Own Diabetes Care 293

Set Some Goals for Care with Your Child 294

Show Your Child How to Test His Blood Glucose 294

Shop for Food Together 295

Plant a Garden Together 296

Have Your Child Help with the Cooking 296

Exercise as a Family 297

Show Your Child How to Administer Insulin 297

Plan a Trip Together 298

Have Your Child Do Household Chores 298

Encourage Your Child to Play Video Games (Really!) 299

Chapter 19: Ten Commandments for Good Diabetes Management 301

An Affirmative Attitude 302

Total Testing 302

Extraordinary Eye Care 303

Foolproof Foot Care 303

Mega-Monitoring 304

Dedicated Dieting 305

Emphatic Exercising 306

Mindful Medicating 306

Planning for Potential Problems 307

Lifelong Learning 308

Chapter 20: Ten Myths about Type 1 Diabetes 309

No Symptoms of Type 1 Diabetes Appear before Damage Has Occurred 310

Type 1 Diabetes and Type 2 Diabetes Are the Same 310

You Can’t Eat Sugar with Type 1 Diabetes 311

You Have to Eat Special Foods When You Have Type 1 Diabetes 312

If You Take Insulin, You Must Have Type 1 Diabetes 312

Insulin Causes Atherosclerosis 313

Insulin Cures Type 1 Diabetes 313

You’re More Prone to Illness When You Have Type 1 Diabetes 314

Women with Type 1 Diabetes Shouldn’t Get Pregnant 314

Doctors Are Hiding the Cure for Type 1 Diabetes So They Can Make More Money 315

Chapter 21: Ten of the Latest Discoveries in Type 1 Diabetes 317

The Development of the GAD Vaccine 318

The Possible Prevention of Type 1 Diabetes with Oral Insulin 319

The Possible Prevention of Type 1 Diabetes with Intranasal Insulin 319

The Study of Continuous Glucose Monitoring 320

Contact Lenses That Indicate Your Glucose Level 320

A Drug to Fight Diabetic Neuropathy 321

Drugs to Block the Immunity That Kills Beta Cells 321

The Regeneration of Beta Cells with a Protein 322

The Infusion of Stem Cells 322

The Use of Cord Blood to Regenerate Beta Cells 323

Part VI: Appendixes 325

Appendix A: Glossary 327

Appendix B: Resources for the Latest Information 335

My Web Site 335

General Web Sites 336

Government Web Sites 337

Companies That Make Diabetes Products 338

Glucose meters 338

Lancing devices 339

Insulin 339

Insulin syringes 339

Insulin jet injection devices 339

Insulin pumps 340

Recipes for People with Diabetes 340

Web Sites for Diabetes Complications 341

Vision 341

Kidneys 342

Diabetic neuropathy 342

Heart disease 342

Index 343