Howorka Functional Insulin Treatment

Principles, Teaching Approach and Practice
1991
ISBN: 978-3-642-97298-0
Verlag: Springer
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 213 Seiten, eBook

Functional Insulin Treatment (FIT) is the most effective
method of treatmentfor type 1 (insulin-dependent) diabetes
available today. Whether with an insulin pump or with mul-
tiple daily injections, the diabetic patient trained in FIT
is able to dose his insulin on the basis of actual fuction
so that he achieves near-normoglycemia and the freedom to
eat when, what and how much he wants.
Previous diabetes eduction programs have adaped the
patient's lifestyle to the conditions of therapy. The goal
ofFIT is to adapt the therapy to the lifestyle of the pa-
tient. Combined withthe opportunity for active and respon-
sible patient participation, this flexibility has an enor-
mous positive effect on the patient's long-term motivation.
This book creates a common basis for communication among
therapists (physicians, nurses, dietitians, diabetes educa-
tors) and patients involved in FIT. It clearly defines the
principles of the treatment and describes the contents,
media and techniques of a practical program for training
patients to carry it out. The reader is given a clear
pictureof just what knowledge and skills the patient needs -
and how to help him acquire them - in order to attain the
twin goals of excellent metabolic control and flexible life-
style.

Zielgruppe

Professional/practitioner

Autoren/Hrsg.

Howorka, Kinga

Weitere Mitwirkende

Berger, M.

Nelson, Kathrin M.

Skyler, J.S.

Inhaltsverzeichnis

1 Introduction.- 2 Overview of the Phases of Rehabilitation in Persons with Type I (Insulin-Dependent) Diabetes.- 2.1 Intermezzo 1: A Strategy for Failure — or How Not to Educate Patients.- 3 Basic Diabetes Education (Phase I of Rehabilitation).- 3.1 Insulin Action in Healthy Persons; Insulin Deficiency.- 3.2 Diet.- 3.2.1 Goals of Dietary Counseling.- 3.2.2 Estimating the Carbohydrate Content of Food.- 3.2.3 Prandial Insulin Requirement in Relation to Type and Quantity of Food.- 3.2.4 Counting Calories and Maintaining Body Weight.- 3.2.5 Teaching Tips.- 3.2.6 Problems in Dietary Counseling.- 3.3 Self-monitoring.- 3.3.1 Self-monitoring of Blood Glucose.- 3.3.2 Self-monitoring of Urine Glucose.- 3.3.3 Determination of Acetone in Urine.- 3.4 Strategies for Insulin Treatment.- 3.5 Insulin.- 3.5.1 Pharmacokinetics.- 3.5.2 Insulin Delivery.- 3.5.3 Special Aspects of the Practicability of Insulin Delivery.- 4 FIT Training (Phase II of Rehabilitation).- 4.1 Initial Algorithms, “K” and the Blood Glucose Target Value.- 4.2 Intermezzo 2: A Strategy for Failure — or How to Demotivate Even the Most Convinced Enthusiast.- 4.3 Introducing FIT in Practice.- 4.4 Pedagogical Aspects of Insulin Substitution: Transactional Analysis and “Insulin Games”.- 4.5 Is “Yielding to Temptation” All Bad?.- 4.6 Testing Algorithms for Correcting Blood Glucose (and Determining the Kidney Threshold for Glucose). Why?.- 4.7 Why Fast?.- 5 Criteria for Functional Insulin Treatment.- 5.1 Basal Substitution.- 5.1.1 Basal Insulin.- 5.1.2 Fasting Hyperglycemia and Compensation of Circadian Variation in Insulin Requirements.- 5.2 Prandial Insulin Substitution — Problems in Dosing Regular Insulin.- 5.3 Self-monitoring and Glycemic Control — Why Keep Records?.- 5.3.1 Record Keeping, Analysis and Evaluation of the Daily Net Result.- 5.3.2 Coping with Practical Problems.- 5.3.3 Frequency of Acute Complications.- 5.3.4 Contingence of Insulin Dose and Carbohydrate Intake on Measured Blood Glucose Level.- 6 Hypoglycemia.- 6.1 Definition of Hypoglycemia.- 6.2 Increased Probability of Severe Hypoglycemia.- 6.3 Causes of Hypoglycemia.- 6.4 Prevention of Hypoglycemia.- 6.5 Treatment of Hypoglycemia.- 7 Hyperglycemia.- 8 Rules for Algorithm Modification.- 8.1 Global Changes in Insulin Requirement.- 8.1.1 Global Decrease in Insulin Requirement.- 8.1.2 Global Increase in Insulin Requirement.- 8.2 Modification of Individual Algorithms.- 8.2.1 Modifying the Algorithm for Basal Insulin.- 8.2.2 Modifying the Algorithms for Prandial Insulin.- 8.2.3 Modifying the Algorithms for Correcting Blood Glucose Excursions.- 8.2.4 Modifying the Target Value for Blood Glucose.- 8.2.5 Interdependence of Algorithms.- 9 Physical Activity.- 9.1 Short, Sporadic Periods of Physical Activity.- 9.1.1 Physical Activity Not Preceded by a Recent Injection of Regular Insulin.- 9.1.2 Physical Activity After Regular Insulin.- 9.2 Prolonged Periods of Physical Activity.- 10 Pregnancy in Type I (Insulin-Dependent) Diabetes.- 10.1 Patient Education Concerning Diabetes and Pregnancy.- 10.2 Consequences for Treatment.- 10.3 Interdisciplinary Care for Pregnant Diabetic Women.- 10.3.1 Diabetological Care: FIT.- 10.3.2 Obstetrical Care.- 10.3.3 Ophthalmological Care.- 10.3.4 Neonatal Care.- 10.4 Special Aspects of Secondary Adjustment of Insulin Dosage During Pregnancy and Childbirth.- 11 Coping with Special Situations.- 12 Frequent Patient-Related Problems.- 12.1 Grief-Work in Persons with Diabetes.- 12.2 Inadequate Information.- 12.3 Failure to Adjust to the Realities of Diabetes.- 13 Frequent Physician-Related Problems.- 13.1 Communication Problems.- 13.2 Inability to Understand What Life Is Like for the Patient.- 13.3 Inadequate Information.- 14 The “Contras”.- 14.1 Contraindications for Functional Insulin Treatment.- 14.2 “Difficult” Patients.- 14.3 Intermezzo 3: A Strategy for Failure or How to Mess Things Up in the Outpatient Phase.- 15 Checklist for Continuing Care of FIT Patients (Phase III of Rehabilitation).- 15.1 The Patient’s Knowledge.- 15.2 Applying Knowledge; Practicability of Therapeutic Measures.- 15.3 Motivation.- 15.4 Acceptance of Diabetes.- 15.5 Metabolic Status.- 15.6 Late Complications.- 15.7 Comorbidity.- 15.8 Social Environment.- 15.9 The Patient’s Contact with the Diabetes Treatment Center, Physician or Diabetes Counselor..- 15.10 Humor.- 16 Review of Results and Experience.- 16.1 Patients.- 16.2 Follow-up.- 16.3 Results.- 16.3.1 Acceptance of FIT.- 16.3.2 Metabolic Control.- 16.3.3 Acute Complications.- 16.4 Experience with FIT in Special Situations.- 17 Open Questions, Unsolved Problems and Limits of FIT.- 18 Epilogue.- 19 References.- Appendix 1: Didactic Aspects of the FIT Training Program.- Appendix 2: FIT — Initial Information for Patients.- Appendix 3: Nomogram for Generating the Initial Algorithms for FIT Coauthors: H. Eggerand H.Thoma.- Appendix 4: Selection of Available Human Insulins.- Appendix 5: Examples of Carbohydrate Units.