Management of Diabetes in Children and Adolescents.

Diabetes is a common chronic illness in children and adolescents. This article will discuss the prevalence, diagnostic criteria, types, treatment, and transition of care into adulthood.

Therapeutic Lifestyle Changes for Diabetes Mellitus.

Diabetes mellitus is a common chronic disease affecting approximately 9% of the United States population. Successful management of diabetes demands constant self-management on the part of the patient. The patient has to balance diabetes medications, blood glucose monitoring, food intake, physical activity, and management of diabetes-related acute and chronic complications. The patient is often bombarded with misinformation from friends, relatives, and such sources as the Internet and social media. This article discusses the current recommendations for diabetes self-management education and skills including medical nutrition therapy, physical activity, smoking cessation, and assessment for diabetes distress.

Co-Managing Patients with Type 1 Diabetes and Cancer.

The life expectancy of people with type 1 diabetes is improving and now approaches that of those without diabetes. As this population ages, a growing number will be diagnosed with and treated for cancer. Cancer treatments can drastically affect insulin requirement and glycemic control through multiple mechanisms including high doses of glucocorticoids and targeted therapies that directly interfere with cellular pathways involved in the action of insulin. Patients with cancer frequently also have alterations in gastrointestinal motility or appetite and require supplemental enteral or parenteral nutrition. Few studies have evaluated these patients directly, but data on patients with and without diabetes suggest that glycemic control may play a larger role in cancer outcomes than is often recognized. Collaboration between the treating oncologist and diabetologist allows people with diabetes to receive the most effective therapies for their cancers without undue risk of hypoglycemia or adverse outcomes due to hyperglycemia.

Perioperative care of patients with diabetes.

Proper care of patients with diabetes during the perioperative period is crucial for preventing acute complications such as hyperglycemia, hypoglycemia, diabetic ketoacidosis, hyperosmolar hyperglycemic state, dehydration, and electrolyte imbalances. Many factors influence the optimal care plan, including the usual home diabetes regimen, the level of diabetes control before surgery, the surgery type, the duration of surgery, and the amount of time the patient will be fasting. An optimal plan of care is based on a thorough presurgical assessment and prescribing a regimen that will minimize acute complications. This article discusses recommendations for target blood glucose and diabetes medication adjustment during the perioperative period.

Use of insulin in the noncritically ill-hospitalized patients with hyperglycemia and diabetes.

Hyperglycemia is common and often unrecognized among hospitalized patients, and it increases the risk of poor outcome, increased length of stay, and increased cost. Hyperglycemia can complicate features of underlying disease and some therapies. This article discusses physiology and types of diabetes, glycemic targets in the noncritical care setting, factors that contribute to hyperglycemia and hypoglycemia in the hospitalized patient, insulin types, common insulin regimens used in the hospital setting, and implications for the nurse.

Management of hypertension in patients with diabetes.

Mortality from cardiovascular disease is 2 to 4 times higher in patients with type 2 diabetes compared with patients with similar demographic characteristics but without diabetes. The management of hypertension in patients with diabetes is as important as glucose control in the prevention of long-term diabetes complications. This article discusses the incidence of hypertension in diabetes, the impact of hypertension on the development of long-term complications, diagnosis of hypertension in patients with diabetes, blood pressure goals, the treatment of hypertension in patients with diabetes, and antihypertension medications.