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Our mentor, the late Dr. Robert L. Jackson, felt that the treatment of diabetes should be as physiologic as possible, matching the treatment to the actual functioning of the pancreas. He determined that patterns, even those obtained with the archaic use of urine tests, were useful in determining the correct dose of medication to cover the food and activity of the active child (and adult). As machines are now made available to match the body’s functioning release of insulin in real time, and the blood glucose levels after a period of time, knowledge of these values will be useful in directing the algorithms used in the pump, the artificial pancreas, or the injected or oral diabetes medications. A rapid, reactive response is needed when the person is in diabetic ketoacidosis (DKA), in hyperglycemic hyperosmolar nonketotic syndrome (HHNS), or having a severe hypoglycemic reaction. Daily use of diabetes medications to maintain a hemoglobin A1c lower than 6.5% (American Diabetes Association, 7%) does not need to be as dramatic, especially when the decision making is done by the patient or family member. The physiologic or pattern approach to management not only gives a safety factor, but also has proven quite useful in maintaining a high degree of control over long periods of time (evidence by the average, from the worst to the best hemoglobin A1c in our tertiary care diabetes clinic, is 7.4%). As a tertiary care clinic, we get individuals with newly diagnosed diabetes, people who are failing on oral agents, people who have already developed complications, and others that are difficult to control. We therefore have had extensive experience with numerous patients for more than 40 years. We have attempted to put our years of experience in this book and to make this book user friendly for a variety of health professionals. Although the first edition was written as a guide for the working nurse who cared for a patient with diabetes, we recognized, over the years, that the book has become a working
reference for all health professionals, including those professionals specializing in the field, and as a textbook for professionals wanting to know more about the disease and how to manage it by using the pattern approach. I am reminded of an airplane ride in which I became involved in a conversation with a physician seated close by. During the course of the conversation I found that she was using our book as a guide for managing patients with diabetes. When I disclosed that I was one of the authors, tears welled up in her eyes
and she thanked me for the help it had given her and her patient population. When Richard and I discovered that some physicians, in addition to nurses and other health professionals, were using this book, we decided to develop the edition for broader use and for better ease of use. What you will find in the
proceeding pages is the result.
