About the Book

This book is a unique combination of rigorous pathophysiology with very practical approaches to diabetes prevention and control.
Contribution from 76 experts.
Offers a comprehensive practical approach for the management of diabetes.
All previous chapters have been revised and updated.
6 new chapters have been added.
Includes practical examples and diagrammatic illustrations.
Most recent Multiple Choice Questions (MCQs), with recent concepts have been added at the end.
Highly useful for specialists, physicians, general practitioners and counsellors.

About the Author

Nihal Thomas MBBS MD MNAMS DNB (Endo) FRACP (Endo) FRCP (Edin) FRCP (Glasg) Nitin Kapoor MBBS MD (Med) DM (Endo) ABBM (USA) Post-Doctoral Fellowship (Endo) Jachin Velavan MBBS DNB (Fam Med) MRCGP (Int) Senthil Vasan K MBBS PhD

Table of Contents:
Contents 1. Physiology 1 Solomon Sathish Kumar • Pancreas 1 • Diabetes Mellitus 11 2. Introduction and Overview of Glycemic Disorders 16 Part A: Epidemiology and Pathogenesis 16 Nihal Thomas, Senthil Vasan K • Epidemiology and Evolution 16 • Pathogenesis 19 Part B: Classification and Approach 26 Nihal Thomas, Senthil Vasan K • Classification 26 • History Taking in Diabetes 27 • Diagnosis of Diabetes Mellitus 29 • Concept of Prediabetes 29 • Concept of “The Metabolic Syndrome” 30 • Screening for Diabetes 33 • Summary of Recommendations for Adults with Diabetes 34 • Glycosylated Hemoglobin 35 3. Practical Medical Nutritional Therapy 39 Leepica Kapoor, G Sai Mala • Goals of Nutrition Therapy 39 • Maintenance of Body Weight 39 • Macronutrients 40 • Carbohydrate 41 • Protein 43 • Fat 44 • Micronutrients 47 • Non-Nutritive Sweeteners 47 • Alcohol and Diabetes 47 • Fenugreek 48 • Food Exchanges 48 • Meal Planning 48 • Carbohydrate Counting 54 4. Exercise 56 Jubbin Jagan Jacob, Samuel Vinod Kumar • Physiological Changes Occurring During Exercise 56 • Clinical Implications of the Effects of Exercise in Diabetes 57 A Practical Guide to Diabetes Mellitus xxvi • Benefits of Exercise in Patients with Diabetes 57 • Potential Adverse Effect of Exercise in Patients with Diabetes 58 • Exercise Prescription 59 • Types of Physical Activity 63 • Practical Considerations 66 5. Counseling 72 Ruchita Mehra Srivastava • Steps in Counseling 73 • Conclusion 84 • Case Studies 84 • Acknowledgment 87 6. Oral Antidiabetic Agents 90 Senthil Vasan K, Nitin Kapoor, Nihal Thomas • Role of Oral Antidiabetic Agent Therapy in Type 2 Diabetes Mellitus 91 • Biguanides 91 • Sulfonylureas 93 • Meglitinide 96 • Alpha-Glucosidase Inhibitors 97 • Thiazolidinediones 98 • Incretin Effect 100 • Hydroxychloroquine in Diabetes 103 • Sodium-Glucose Cotransporter 2 Inhibitors 103 • Bromocriptine 105 • Guidelines for Initiating Oral Antidiabetic Agents 105 7. Parenteral Therapeutic Agents 113 Senthil Vasan K, Nitin Kapoor, Nihal Thomas • Pathophysiology and the Basis for Insulin Replacement Regimens 113 • History 114 • Sources of Insulin 115 • Classification of Insulin 115 • Indications for Insulin Therapy 116 • Therapeutic Regimens 117 • Oral Medications Plus Insulin 119 • Insulin Analogs 120 • Types of Insulin Analogs 121 • Glucagon Like Peptide-1 Analogs 126 • Amylin Analogs 129 8. Insulin Therapy—Practical Aspects 133 Mercy Jesudoss, Ruth Ruby Murray • Insulin Syringes 134 • Factors that Affect Rate of Absorption of Insulin 139 Contents xxvii • Complications of Insulin Therapy 140 • Barriers to Insulin Therapy 143 • Sick Day Management 144 • Alternative Methods of Insulin Delivery 145 • Determining Effectiveness of Self-Injection Education 147 • Dose Adjustment for Normal Eating 155 9. Blood Glucose Monitoring 159 Mercy Jesudoss, Ruth Ruby Murray • Self-Monitoring of Blood Glucose 159 • Continuous Glucose Monitoring System 166 10. Peripheral Neuropathy 171 Mahesh DM, Thomas V Paul, Nihal Thomas • Definition 171 • Risk Factors 172 • Classification 172 • Pathogenesis 173 • Clinical Presentation 174 • Management 181 11. Feet, Foot Care and Neuroarthropathy 190 Part A: Foot Care and Neuroarthropathy 190 Dukhabandhu Naik, Bharathi S, Sunitha R, Edwin Stephen, Jubbin Jacob, Nihal Thomas • Ulceration 190 • Neuroarthropathy 198 • Peripheral Artery Occlusive Disease 207 Part B: Wound Care in Patients with Diabetes 213 Hari Krishna Nair • Wound Assessment 213 • Wound Cleansing 214 • Debridement 215 12. Therapeutic Footwear 220 Judy Ann John, Bobeena Rachel Chandy, Rajan P, Premkumar R • Foot Injury Mechanism due to Sensory Neuropathy 220 • Foot Injury Mechanism due to Motor and Sensory Neuropathy 221 • Foot Examination for Selecting Appropriate Foot Orthotics 222 • Selection of Footwear 226 13. Hypertension 245 Sudeep K, Jubbin Jagan Jacob • Definitions 245 • Hypertension and Age 245 • Hypertension and the Vascular System 246 • Pathophysiology 246 A Practical Guide to Diabetes Mellitus xxviii • Secondary Hypertension 247 • Management of Hypertension 248 • Antihypertensive Drugs 254 • Principles in Management of Hypertension 256 14. Nephropathy 259 Santosh Varghese, Suceena Alexander • Definitions 260 • Risk Factors 260 • Classification 260 • Survival in Patients with Diabetic Nephropathy 262 • Pathogenesis of Nephropathy 262 • Pathology 263 • Differentiating from other Causes of Kidney Diseases 264 • Management 265 • What should be done when the Gfr has begun to Decline? 268 • Avoidance of Further Injury 270 • Supportive Treatment for the Chronic Kidney Disease Patient 270 • Investigations 273 • Renal Replacement Therapy 273 • Normoalbuminuric Chronic Kidney Disease in Diabetes 274 • Newer/Experimental Therapy for Diabetic Nephropathy 275 15. Macrovascular Complications in Diabetes 279 Part A: Cardiovascular Complications and Dyslipidemia 279 Subhrangshu Dey, Viji Samuel • Epidemiology 279 • Diabetes Mellitus and Cardiovascular Disease 279 • Diabetic Dyslipidemia 286 Part B: Stroke and Diabetes 290 Sanjith Aaron 16. Ocular Disease and Retinopathy 296 Saban Horo, Elizabeth Tharion, Padma Paul • Corneal Changes 296 • Lens and Cataract 296 • Diabetes and Glaucoma 297 • Orbital Involvement 297 • Neuro-Ophthalmic Manifestations of Diabetes 298 • Diabetic Retinopathy 299 • Classification and Features of Diabetic Retinopathy 300 • Pathology and Implications of The Features of Diabetic Retinopathy 303 • Management of Diabetic Retinopathy 304 Contents xxix • Ophthalmoscopy 308 • Recording of Fundus Findings 311 17. Autonomic Neuropathy 314 Kanakamani Jeyaraman • Epidemiology of Dan 314 • Pathogenesis 315 • Clinical Manifestations of Dan 316 • Current Guidelines for the Diagnosis of Dan 330 • Management Implications of Dan 332 18. Infections in Diabetes 334 George M Varghese, Ravikar Ralph, Abraham OC • Specific Infections 336 19. Hyperglycemic Emergencies 354 Jubbin Jagan Jacob • Precipitating Factors 355 • Pathophysiology of Dka and Hhs 355 • Clinical Recognition, Establishing a Diagnosis and Assessment of Comorbidities 357 • Diagnostic Evaluation and Laboratory Studies 358 • Clinical Management of Dka and Recognition of Complications 360 • Complications 364 • Special Situations 365 • Use of Inpatient Standard Management Protocols in Diabetic Ketoacidosis 367 • Clinical Management of Hyperosmolar Hyperglycemic State 367 • Prognosis 367 20. Hypoglycemia 370 Nitin Kapoor, Jubbin Jagan Jacob, Nihal Thomas • Clinical Classification of Hypoglycemia 370 • Pathophysiology of Counter-Regulation 371 • Causes 371 • Clinical Recognition of Hypoglycemia 372 • Clinical Management of Hypoglycemia 374 • Long-Term Management 374 • Recurrent Hypoglycemia 375 • Consequences 375 21. Pregnancy and Diabetes 379 Mahesh DM, Philip Finny, Kanakamani Jeyaraman, Senthil Vasan K, Mathew John • Terminology 379 • Gestational Diabetes Mellitus 381 • Pregestational Diabetes 387 A Practical Guide to Diabetes Mellitus xxx • Management 390 • Future Risks in Mother 394 22. Diabetes in Childhood and Adolescence 397 Asha HS, Mathew John, Anna Simon, Veena V Nair • Epidemiology 397 • Diagnosis 397 • Classification 398 • Clinical Features 401 • Approach to Diagnosis 402 • Management 404 • Chronic Complications 410 • Acute Complications 412 • Sick Day Management 413 • Type 2 Diabetes in Children 414 23. Diabetes in the Elderly 419 Rahul Baxi, Nihal Thomas • Diabetes in the Older Adult: How is it Different? 419 • Management of Diabetes in the Elderly 420 24. Secondary Diabetes and other Specific Types 427 Kishore Kumar Behera, Dukhabandhu Naik, Nitin Kapoor, Nihal Thomas • Classification of Secondary Diabetes 427 • Chronic Complications in Secondary Diabetes 438 • Other Specific Types of Diabetes 440 25. Perioperative Care 445 Georgene Singh • Metabolism at Rest 445 • Metabolic Challenge of Surgery 446 • Preoperative Management of Diabetic Patients 446 • Level of Glycemic Control 446 • Classification of the Type of Surgery 451 • Management of Diabetes Depends On 451 • Choice of Anesthesia 451 • Premedication 452 • Intraoperative Anesthetic Management of Diabetic Patients 453 • Point of Care Glucose Measurements 455 • Major Surgery Regimen 455 • Management of Diabetic Patients Under Different Modes of Anesthesia 455 • Problems to be Anticipated in a Diabetic Patient under Anesthesia 456 • Emergency Surgery in the Diabetic Patient 458 • Special Clinical Scenarios 459 • Postoperative Management of Diabetic Patients 459 Contents xxxi 26. Obesity with Diabetes 463 Nitin Kapoor, Inian Samarasam, Nihal Thomas • Definition of Obesity 463 • Epidemiology of Obesity and its Impact on Diabetes 464 • Etiopathogenesis of Obesity 464 • Evaluation of Obesity 466 • Management 468 27. Laboratory and Analytical Methods 477 Geethanjali Arulappan, Charles Stephen • Laboratory Errors 477 • Preanalytical, Analytical and Postanalytical Errors 478 • Role of Laboratory in Diabetes Management 481 • Available Assays 483 • Other Tests of Relevance 487 28. Recent Advances 492 Mahesh DM, Ron Thomas Varghese, Nihal Thomas • Drugs Which Potentiate Insulin Secretion 492 • Insulin Receptor Activators 494 • Newer Peroxisome Proliferator-Activated Receptor Agonists 495 • New Hepatic Targets for Glycemic Control in Diabetes 496 • Advances in Insulin Therapy 498 • Immunotherapy for Type 1 Diabetes 501 • Stem Cell Therapy 502 29. In-hospital Management of Diabetes 508 Rahul Baxi, Nihal Thomas • Effects of Hyperglycemia in Hospitalized Patients and Benefits of Glycemic Control 508 • Which Patient Should we Admit? 509 • Aims and Targets 510 • The Diabetes Inpatient Team 510 • The Paradox: Barriers to Glycemic Control in Hospital 511 • Common Errors in Management 511 • Glucose Control 513 • Diabetes Management in the Critically Ill Patients 515 30. Integrating Systems 519 Part A: Team approach to Management of Diabetes 519 Flory Christina, Nihal Thomas, Abraham Joseph, Mercy Jesudoss, Senthil Vasan K, Ross Kristal • Disease Prevention 519 • Prevention and its Importance 520 • Integrated Diabetes Clinics 521 • Functionaries of an Integrated Diabetes Clinic and their Role 522 A Practical Guide to Diabetes Mellitus xxxii • Improving Foot Care for People with Diabetes Mellitus: An Integrated Care Approach 526 • Diabetes Support Groups 526 Part B: Telehealth—Bridging Distances in Diabetes 531 Vinod Shah, Hasna Rajesh, Nihal Thomas • Telehealth Classroom Setup 532 • Desktop Conference: Web-Based Learning Method 534 • Requirements for Quality Transmission 536 • Administrative Challenges and Issues 536 Final Evaluation 539 Answers to Self-Assessment 559 Appendices 1. Dietary Recommendations 573 2. A Quick Guide for Choosing Footwear, MCR Add-ons and Braces 579 3. Evidence in Medicine 580 4. Diabetes Case Record 581 5. Patient Handouts and Educational Material 585 Index 591