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HAAF syndrome (see Hypoglycemia-associated autonomic failure and Hypoglycemia unawareness) Hemoglobin A,r (HbAlc) lo assess glycemic control, 5-6, 1516, 114 in children. 133 in pregnancy, 148 contribution of fasting and postprandial glucose level to, 7-10 guideline for optimal glycemic control, 5-6, 15-16. 114 lack of use for the diagnosis of diabetes, 15 methods to measure, 7 Honeymoon effect on insulin requirements, 129-130 Honolulu heart study, 9 Hospi tali zed patients with diabetes, 153-171 blood glucose monitoring in, 156-157 dosing adjustment of insulin by algorithm, 160-161 lack of effectiveness of sliding scales, 158-160 guidelines for glucose control in, 157-158

insulin infusion, 160-161, 163-164 insulin programs for, 161-169 acute myocardial infarction (Dl-

GAMJ protocol), 170 glargine use in, 162 intravenous infusion, 160-161,

163-164 lispro use in, 162

patient who is eating, 161-163 patient receiving enteral nutrition,

164-166

patient receiving parenteral nutrition, 166 preoperative patient, 166-169 nutrition needs in, 155-156 preoperative diabetes management, 166-169

sliding scales and lack of effectiveness in, 158-160 Humalog (see Insulin analogs, lispro)

Hyperglycemic emergencies (see Diabetic ketoacidosis and Nonketotic hyperosmolar syndrome) Hypertension (see Blood pressure guidelines in diabetes) Hypoglycemia and insulin therapy, 5758, 92-94, 193-222 avoidance strategies of, 214-217, 234 in children with diabetes, 135-136 in combination insulin and oral hypoglycemic pills, 217-218 counterregillation in type 2 diabetes,

199-200 and dawn phenomenon, 213-214 in elderly, 19 with exercise, 207

factors that impair hypoglycemia defenses, 202 and gaslroparesis, 216 hypoglycemia unawareness, 92-94 HAAF syndrome, 200-201 insulin pump therapy in, 240 management of, 201, 202-203 reversibility of, 200-202 self-blood glucose monitoring in, 208 incidence of: in Diabetes Control and Complications Trial <DCCT), 195-196 in type 1 and type 2 diabetes, 116,

193-195, 198-200 with insulin pump therapy, 224,233 lispro versus Regular insulin, 7778, 98-100 in insulin pump therapy, 224, 233 prevention and treatment in adults,

233-234 prevention and treatment in children, 236-237 neurological dysfunction from, 197-198 nocturnal hypoglycemia, 201 with commercial premixed insulin, 212

with insulin pump therapy, 233 with NPH insulin, 212 with Ultralenie insulin, 99 risk factors for severe, 195, 199

[Hypoglycemia and insulin therapy] risk with intensive insulin therapy, 92-94 role in causing hypoglycemia un-

awareness, 200-202 and sudden death, 198 symptoms of, 196-197 treatment of. 57-58, 203-205 Hypoglycemia-associated autonomic failure (HAAF syndrome), 200-202 Hypoglycemia unawareness, 92-94 factors that impair hypoglycemia defenses. 202 insulin pump therapy in, 240 management of, 201. 202-203 reversibility of, 200-202 self-blood glucose monitoring in, 208

Inhaled insulin, 252-256

in children, 132 Inpatient insulin use (see Hospitalized patients with diabetes) Insulin analogs, 75, 211-212 aspan, 77-78

in insulin pump, 77-78, 227 detemir, 82 glargine, 80-81 cannot be mixed with other insulins, 30, 81. 101 in children, 132 in hospitalized patients, 162 intensive insulin program with pre-meal short-acting insulin analog, 100-102

not proven for use in pregnancy, 144 lispro, 76-78 caution with gas tro pares is, 216 in hospitalized patients, 162 in insulin pump, 77-78, 227 less hypoglycemia than Regular insulin. 77-78, 98-100 in pregnancy, 142-145 premixed commercial insulin preparations, 80

Insulin injection technique, 29-30 assistance devices, 33-34 difficulties with, 31-33

Insulin infusions (see Intravenous insulin infusion) insulin pens, 25-28

manufacturer phone numbers, 26 Insulin pharmacokinetics, 73-85, 91 intermediate-acting insulins, 78-80 long-acting insulins, 80-81 short-acting insulins, 76-78 variable day-to-day profiles, 75 Insulin programs, 96-106 bedtime insulin in type 2 diabetes, protocol for, 123 bedtime NPM and pre-meal Regular,

102-103 daytime NPH. 103-106, 212 glargine with pre-meal short-acting analog, 100-102 premixed commercial preparations, 79-80, 212-213

Ultraleme with pre-meal short-acting analog, 98-100 Insulin pump therapy, 223-244 blood glucose guidelines with, 229 hypoglycemia unawareness, 234 in children, 130-131, 234-238 diabetic ketoacidosis and prevention of. 233

dosing adjustments with, 230-231 effectiveness at achieving glycemic control with, 224 in gastroparesis, 240-241 and hypoglycemia: lowered incidence with, 224 prevention and treatment in adults,

233-234 prevention and treatment in children, 236-237 in hypoglycemia unawareness, 240 in pregnancy, 143-144, 238-240 in renal disease, 240 sandwich technique for skin irritation, 232

troubleshooting high blood glucose level: in adults, 232 in children, 236-237

[Insulin pump therapyl in type 1 diabetes, 228-234 in type 2 diabetes, 238 use of insulin analogs lispro and aspan, 77-78, 227 Insulin secretion and regulation of the blood glucose level, 63-65, 8891

and dawn phenomenon, 90 Insulin storage, 28-29 Insulin therapy: absorption of insulins and factors that affect, 33,75, 95 in acute myocardial infarction based on the DIGAMI study, 157, 170

bedtime insulin in type 2 diabetes, protocol for, 123 benefits of, 117-118 BIDS-bedtime insulin, daytime sulfonylurea, 1)8-119 concerns over insulin use, 116-117 hypoglycemia, 116 cardiovascular disease, 116 weight gain, 116 dawn phenomenon, 90, 213-214 in diabetic ketoacidosis, 183-190 and diet therapy, 47-59

ADA recommendations, 48-49 dosing adjustments in, 107-109, 208-210 insulin pumps, 230-231 rule of 1500 or 1800, 108-109,

209, 230-231 sliding scales in hospitalized patients, 158-160 sliding scales in outpatients, 107109, 208 equipment: injection aids, 33-34 injection technique, 29-30 insulin storage, 28-29 pens, 25-28 pump, 223-244 syringes, 24-25 syringe reuse and disposal, 25

[Insulin therapy) glucose metabolism in fasted and fed state for insulin replacement, 65-69

glucotoxicity and reversal by, 118 in hospitalized patients, 153-171 insubn infusion, 160-161, 163-164 preoperative, 166-169 receiving enteral nutrition, 164-166 receiving meals, 161-163 receiving parenteral nutrition, 166 in hyperglycemic emergencies, 173192

and hypoglycemia, 57-58, 193-222 inhaled insulin, 252-256

in children. 132 injection aid devices, 33-34 injection anxiety, 117, 247 injection difficulties, 31 -33 injection technique, 29—30 insulin infusion, 160-161, 163-164 insulin storage, 28-29 intensive basal-bolus, 87-112 dosing adjustments in, 107-109 eligibility for, 91-92 goals and risks of, 92-94 how to, 95-102 hypoglycemia wiih, 92-94 insulin programs, 96-106 normal insulin secretion profile,

63-65, 88-91, 205-206 self-blood glucose monitoring in, 109 24-hour insulin dose calculation, 96 in type 2 diabetes, I 19-120 weight gain with, 94 in labor, 148-149 mixing insulins, 30-31 microprecipitation changing insulin absorption, 30, 79 in nonketotic hyperosmolar syndrome, 173-192 noninvasive insulin delivery, 245 -260 inhaled insulin, 252-256 intranasal insulin delivery, 251 jet injectors, 249-250 oral insulin, 251-252

[insulin therapy] patient education in, 23-24, 95, 117 pens, 25-28

manufacturer phone numbers, 26 pharmacokinetics, 73-85, 91

intermediate-acting insulins, 78—80 long-acting insulins, 80-81 short-acting insulins, 76-78 variable day-to-day profiles, 75 postpartum, 149 in pregnancy, 139-151 premixed commercial insulin preparations, 79-80, 212-213 preoperative, 166-169 programs, 96-106 basal insulin strategies, 214 bedtime insulin in type 2 diabetes, protocol, 123 bedtime NPH and pre-mea) Regular, 102-103 bolus insulin strategies, 214-217 daytime NPH, 103-106, 212 glargine with pre-meal short-acting analog, 100-102 premixed commercial insulin preparations, 79-80, 212-213 Ultralente with pre-meal short-acting analog, 98-100 that do not promote macrovascular disease based on results of UKPDS in type 2 diabetes, 5,116 pump, 223-244 rotating sites, 32-33 self-blood glucose monitoring, 34—43 sick day management, 43-44 syringes, 24-25

timing of short-acting insulin to avoid hypoglycemia, 214-215 24-hour insulin dose calculation, 96 in type I diabetes, 87-112 (see also Insulin therapy. Intensive basal-bolus)

in type 2 diabetes. 113-125 bedtime insulin, protocol for, 123 BIDS, bedtime insulin, daytime sulfonylurea, 118-119

[Insulin therapy)

indications for, 114-115 intensified insulin regimens, 119-120 treatment of, 120-123 urine ketone testing, 44 Intranasal insulin delivery, 251 Intravenous insulin infusion, 160-161, 163-164

Jet insulin injectors, 249-250

Ketone measurements. 181-182 Kumamoto Study in type2 diabetes, 3-4

Labor, insulin therapy in, 148-149 Lantus (see Insulin analogs. Glargine) LADA, latent autoimmune diabetes in adults. 115, 154-155, Lente insulin, 78-79

microprecipitation of Regular insulin when mixed with, 30, 79 Lipid guidelines in diabetes, 16-17 cholesterol guidelines, 2, 16-17 Lipoatrophy, 31-32 Lipohypertrophy, 32-33 Lispro (see Insulin analogs)

Macrosomia, 140

Macrovascular complications in diabetes: glycemic control for prevention of, 6, 113

insulin infusion in acute myocardial in-1 farction, DIGAMI study, 157, 170 insulin treatment not cause, based on results of ITKPDS in type 2 diabetes, 5, 116 prevention of: ACE inhibitors, MICRO-HOPE

study, 17 aspirin use for primary and secondary prevention of, 19 cholesterol guidelines. 2, 16-17 glycemic control in UKPDS study. 113

lipid guidelines, 16-17 smoking, 19

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