Table Of ContentD
Q
What is the best treatment for diabetes? If I have diabetes, will I end up
I THE
needing dialysis? Why should I test my blood glucose if I feel fi ne? If
A
DIABETES
I’m not overweight, why do I have diabetes?
B
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“Th e Diabetes Answer Book is a terrifi c resource for people with
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A diabetes and their families, whether they are newly diagnosed or have
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lived with diabetes for many years.”—Martha M. Funnell, MS, RN, CDE,
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ANSWERBOOK
Michigan Diabetes Research and Training Center
S TTMM
At least 20.8 million people—7 percent of the population—have
diabetes, and this number is growing. Th e amount of information on
the subject can be overwhelming, confusing, and often confl icting.
The Diabetes Answer Book is a reassuring, authoritative reference for
you and your family, providing sound advice, immediate answers, and
Practical Answers to
A essential information.
N
300
What are the symptoms Why does stress affect my blood More Than Top Questions
S (cid:2) (cid:2)
of hypoglycemia? glucose so much?
W
If I am pregnant and have What can I do to lower my risk of
(cid:2) (cid:2)
E diabetes, what can I do to make getting kidney damage?
R
sure my baby stays healthy? (cid:2)(cid:2)(cid:2) HHow many ttypes off
What is the best diet for
B (cid:2)
If I lose weight, will my diabetes someone with diabetes? diabetes are there?
(cid:2)
O
go away?
O (cid:2) What can I do to
K Written in an easy-to-read question-and-answer format, The Diabetes Answer Book
prevent it?
TM helps you fully understand diabetes and learn how to successfully manage it day to day.
David K. McCulloch, MD, is a Clinical Professor (cid:2) Does diabetes ever
of Medicine at the University of Washington in go away on its own?
Seattle. He has worked in the fi eld of clinical diabetes
innovation for almost thirty years (cid:2) How can I make
and has over eighty publications on
sense of my blood
a wide variety of diabetes-related
topics. Since 1994, he has been the glucose results?
senior diabetes specialist at Group
Health Cooperative, a healthcare
McCulloch
organization in Washington state www.sourcebooks.com
with over half a million enrolled members.
DAVID K. McCULLOCH, MD
Susan Ashley, PhD
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DIABETES
BOOK
TM
Practical Answers to
More Than Top Questions
D K. M C , MD
AVID C ULLOCH
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Copyright © 2008 by David K. McCulloch
Cover and internal design © 2008 by Sourcebooks, Inc.
Cover photo © iStockPhoto.com/evgenyb
Sourcebooks and the colophon are registered trademarks of Sourcebooks, Inc.
All rights reserved. No part of this book may be reproduced in any form or by any
electronic or mechanical means including information storage and retrieval
systems—except in the case of brief quotations embodied in critical articles or
reviews—without permission in writing from its publisher, Sourcebooks, Inc.
This book is not intended as a substitute for medical advice from a qualified
physician. The intent of this book is to provide accurate general information in
regard to the subject matter covered. If medical advice or other expert help is
needed, the services of an appropriate medical professional should be sought.
All brand names and product names used in this book are trademarks, registered
trademarks, or trade names of their respective holders. Sourcebooks, Inc., is not
associated with any product or vendor in this book.
Published by Sourcebooks, Inc.
P.O. Box 4410, Naperville, Illinois 60567–4410
(630) 961–3900
Fax: (630) 961–2168
www.sourcebooks.com
Library of Congress Cataloging-in-Publication Data
McCulloch, David K.
The diabetes answer book : practical answers to more than 300 top questions /
David K. McCulloch.
p. cm. ISBN-13: 978-1-4022-2062-3
Includes index.
1. Diabetes—Popular works. I. Title.
RC660.4.M375 2008
616.4'62—dc22
2008027159
Printed and bound in the United States of America.
DR 10 9 8 7 6 5 4 3 2 1
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Dedication
To all those who cope bravely with diabetes.
They teach me humility and understanding every day.
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Contents
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix
Some Questions Before We Start . . . . . . . . . . . . . . . . . . . . . . . . .xi
Part One: The Big Picture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Chapter 1: Causes of Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . .3
Chapter 2: Types of Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . .23
Chapter 3: Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35
Chapter 4: Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45
Chapter 5: Cure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53
Part Two: Staying Healthy Longer . . . . . . . . . . . . . . . . . . . . . . .65
Chapter 6: Reducing Cardiovascular Risk . . . . . . . . . . . . . . . . . .67
Chapter 7: Blood Glucose Control . . . . . . . . . . . . . . . . . . . . . . .81
Chapter 8: Hypoglycemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91
Chapter 9: Preventing Eye Damage . . . . . . . . . . . . . . . . . . . . .107
Chapter 10: Preventing Kidney Damage . . . . . . . . . . . . . . . . . .115
Chapter 11: Nerve Damage: Feet and Legs . . . . . . . . . . . . . . . .121
Chapter 12: Nerve Damage: Less Common Forms . . . . . . . . . .135
Part Three: Living with Diabetes . . . . . . . . . . . . . . . . . . . . . . .147
Chapter 13: Monitoring Blood Glucose . . . . . . . . . . . . . . . . . .149
Chapter 14: Interpreting Glucose Results . . . . . . . . . . . . . . . . .159
Chapter 15: Eating Right . . . . . . . . . . . . . . . . . . . . . . . . . . . . .171
Chapter 16: Losing Weight . . . . . . . . . . . . . . . . . . . . . . . . . . . .179
Chapter 17: Carbohydrate Counting . . . . . . . . . . . . . . . . . . . .189
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The Diabetes Answer Book
Chapter 18: Healthy Exercise . . . . . . . . . . . . . . . . . . . . . . . . . .199
Chapter 19: Stress and Diabetes . . . . . . . . . . . . . . . . . . . . . . . .209
Chapter 20: Drugs for Type 2 Diabetes . . . . . . . . . . . . . . . . . .215
Chapter 21: Insulin Resistance Drugs . . . . . . . . . . . . . . . . . . . .219
Chapter 22: Insulin Production Drugs . . . . . . . . . . . . . . . . . . .225
Chapter 23: Other Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . .229
Chapter 24: Going on Insulin . . . . . . . . . . . . . . . . . . . . . . . . . .235
Chapter 25: Insulin Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . .239
Chapter 26: Insulin Management . . . . . . . . . . . . . . . . . . . . . . .257
Chapter 27: Advanced Insulin Management . . . . . . . . . . . . . . .271
Chapter 28: Traveling and Diabetes . . . . . . . . . . . . . . . . . . . . .277
Chapter 29: Alternative Therapies . . . . . . . . . . . . . . . . . . . . . .283
Part Four: Staying Positive . . . . . . . . . . . . . . . . . . . . . . . . . . . .293
Chapter 30: Making a Good Plan . . . . . . . . . . . . . . . . . . . . . . .295
Chapter 31: Getting Support . . . . . . . . . . . . . . . . . . . . . . . . . .305
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .312
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .325
About the Author . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .334
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Acknowledgments
I am grateful to my agent, Jacky Sach, for giving me this opportunity.
As a medical student and young doctor in the 1970s, I was
inspired and encouraged by two great mentors: Professor Ian W.
Campbell in Edinburgh and Professor Robert B. Tattersall in
Nottingham. They showed me how to make the complexity of
diabetes accessible to people of all ages and in all walks of life. I have
tried to follow their example of compassion and humanity in my
clinical practice over the past thirty years.
In compiling this book, I am grateful to my colleagues and patients
who supplied many of the questions and critiqued my answers to
ensure that they were written in plain language: Dan and Rita
Bockman, Lynn Briggs, Char Benedict, Mary Pat Bergin-Sperry,
Meredith Cotton, Debbie Ciani, Monica Droker, Felipe Frocht,
Annamarie Flott, Carol Freeman, Gage Foster, Kay Herndon, Patricia
Heaven, Deborah Huang, Debra Hensler, Tenece Jones, Joan Kocher,
Susan Kolberg, Dan Kent, Steve and Linda McDonald, Kelly McGraw,
Janet Nolte, Mamatha Palanati, Vladimir Polyakov, Martha Price, Sue
Ruedebusch, Sandy Randles, Nichole Richardson, Kathryn Ramos, Tim
Scholes, Alan Searle, Rizwana Siddiqui, Lynda Sager, Betsy Schmidt,
Wende Wood, Susan Weinstein, Lynn White, and Susan Whorton.
Finally to my editors at Sourcebooks, Sara Appino and Shana
Drehs, for their careful attention to making this book as readable and
useful as possible.
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Introduction
To say that the management of diabetes has changed in the past thirty
years is a major understatement. It has been transformed. When I
became interested in diabetes as a medical student in Edinburgh in the
1970s, there were only two types of pill to help lower the blood
glucose. The insulin we used contained impurities that could cause
ugly scars where it was injected. Patients used large glass and metal
syringes that had to be taken apart and boiled once a week to keep
them clean. The needles were large and had to be sharpened on a
Carborundum stone when they got blunt. The only way to have any
idea what your blood glucose level was involved urinating into a test
tube, adding a Clinitest tablet, and seeing what color it turned when it
had finished boiling and frothing. While this exciting spectacle may
have appealed to our inner alchemist, the information that it gave was
about as useless as hanging seaweed out of the window and inspecting
the color of that a few minutes later. People with diabetes lived in
constant fear of passing out from low blood glucose levels (hypo-
glycemia) or of developing awful complications of their disease. The
day-to-day burden on their lives was enormous.
The past three decades have seen many advances. There are now
many different types of pill to help lower blood glucose and to
protect the kidneys, heart, and blood vessels from the ravages of
diabetes. We now use highly purified analogs of human insulin that
can be delivered using disposable pens and tiny needles. You can carry
little meters in your pocket that can give you an accurate blood
glucose reading in a matter of seconds from just a drop of blood.
Other tests allow us to know how well diabetes is being managed
