Managing Cystic Fibrosis-related Diabetes (cfrd): An Instruction Guide For Patients & Families


E-Book Content

Managing Cystic FibrosisRelated Diabetes “(CFRD)” An Instruction Guide for Patients and Families 4th Edition Carol Brunzell, R.D., C.D.E., L.D. Dana S. Hardin, M.D. Antoinette Moran, M.D. Terri Schindler, R.D., M.S. Kathleen Schissel, R.D., L.D. Managing Cystic Fibrosis–Related Diabetes (CFRD) n Managing Cystic Fibrosis–Related Diabetes “(CFRD)” An Instruction Guide for Patients and Families 4th Edition CAROL BRUNZELL, R.D., C.D.E., L.D. University of Minnesota Medical Center, Fairview Minneapolis, Minnesota DANA S. HARDIN, M.D. Ohio State University Children’s Hospital of Columbus Columbus, Ohio ANTOINETTE MORAN, M.D. University of Minnesota Medical Center, Fairview Minneapolis, Minnesota TERRI SCHINDLER, R.D., M.S. University Hospitals Case Medical Center Cleveland, Ohio Kathleen Schissel, R.D., L.D. University of Minnesota Medical Center, Fairview Minneapolis, Minnesota Copyright 2008 Cystic Fibrosis Foundation  Address Content-Oriented Correspondence to: Dana S. Hardin, M.D. Division Chief of Pediatric Endocrinology Children’s Hospital of Columbus and The Ohio State University 700 Children’s Drive ED 543 Columbus, Ohio 43205-2696 [email protected] Address All Other Correspondence to: Cystic Fibrosis Foundation 6931 Arlington Road Bethesda, Maryland 20814 (800) FIGHT CF [email protected]  Table of Contents Introduction _________________________________________________________________ 5 Chapter 1 Cystic Fibrosis-Related Diabetes (CFRD)_____________________________ 7 Diabetes Non-CF Diabetes CFRD Causes CFRD Symptoms Chapter 2 How We Diagnose CFRD___________________________________________ 9 Tests Used to Diagnose CFRD Chapter 3 Treating CFRD___________________________________________________ 11 Insulin Insulin Types Insulin Treatment Insulin Syringes and Needles Oral Agents (Diabetes Pills) Chapter 4 Blood Sugar Testing______________________________________________ 19 When to Check Blood Sugar How to Check Blood Sugar Blood Sugar Testing Results Summary Chapter 5 How We Manage CFRD __________________________________________ 23 Tests to Help Manage CFRD Other Tools to Manage CFRD Chapter 6 Low Blood Sugar (Hypoglycemia)_ ________________________________ 25 What Is Hypoglycemia? Low Blood Sugar Symptoms Low Blood Sugar Causes Low Blood Sugar in CF Without Diabetes Low Blood Sugar Treatment Driving & Low Blood Sugar Sick Days & Low Blood Sugar Exercise & Low Blood Sugar  n Table of Contents Chapter 7 Abnormal Glucose Tolerance in CF_ _______________________________ 29 CFRD With Fasting Hyperglycemia CFRD Without Fasting Hyperglycemia Intermittent Diabetes (“Now & Then” Diabetes) Impaired Glucose Tolerance Diabetes When Pregnant Chapter 8 The Diabetes Care Team__________________________________________ 33 Chapter 9 Nutrition and CFRD______________________________________________ 35 A High-Calorie, Healthy Diet Carbohydrates Carbohydrate Units Meals Using Carbohydrate Units Daily Meal Plans Using Carbohydrate Units or Grams Insulin-to-Carbohydrate Ratios (Carbohydrate Counting) Insulin Correction Doses The “CF” Food Guide Pyramid Insulin Coverage of High-Calorie Supplements Special Cases Chapter 10 Nutrition and CFRD When Pregnant _ _____________________________ 47 Gestat