Functional Insulin Treatment

1 Introduction.- 2 Overview of the Phases of Rehabilitation in Persons with Type I (Insulin-Dependent) Diabetes.- 2.1 Intermezzo 1: A Strategy for Failure - or How Not to Educate Patients.- 3 Basic Diabetes Education (Phase I of Rehabilitation).- 3.1 Insulin Action in Healthy Persons; Insulin Deficiency.- 3.2 Diet.- 3.3 Self-monitoring.- 3.4 Strategies for Insulin Treatment.- 3.5 Insulin.- 4 FIT Training (Phase II of Rehabilitation).- 4.1 Initial Algorithms, "K" and the Blood Glucose Target Value.- 4.2 Intermezzo 2: A Strategy for Failure - or How to Demotivate Even the Most Convinced Enthusiast.- 4.3 Introducing FIT in Practice.- 4.4 Pedagogical Aspects of Insulin Substitution: Transactional Analysis and "Insulin Games".- 4.5 Is "Yielding to Temptation" All Bad?.- 4.6 Testing Algorithms for Correcting Blood Glucose (and Determining the Kidney Threshold for Glucose). Why?.- 4.7 Why fast?.- 5 Criteria for Functional Insulin Treatment.- 5.1 Basal Substitution.- 5.2 Prandial Insulin Substitution - Problems in Dosing Regular Insulin.- 5.3 Self-monitoring and Glycemic Control - Why Keep Records?.- 6 Hypoglycemia.- 6.1 Definition of Hypoglycemia.- 6.2 Increased Probability of Severe Hypoglycemia.- 6.3 Causes of Hypoglycemia.- 6.4 Prevention of Hypoglycemia.- 6.5 Treatment of Hypoglycemia.- 7 Hyperglycemia.- 8 Rules for Algorithm Modification.- 8.1 Global Changes in Insulin Requirement.- 8.2 Modification of Individual Algorithms.- 9 Physical Activity.- 9.1 Short, Sporadic Periods of Physical Activity.- 9.2 Prolonged Periods of Physical Activity.- 10 Pregnancy in Type I (Insulin-Dependent) Diabetes.- 10.1 Patient Education Concerning Diabetes and Pregnancy.- 10.2 Consequences for Treatment.- 10.3 Interdisciplinary Care for Pregnant Diabetic Women.- 10.4Special Aspects of Secondary Adjustment of Insulin Dosage During Pregnancy and Childbirth.- 11 Functional Insulin Treatment for Type II Diabetes.- 11.1 Characteristics of Treatment of Type II Diabetes.- 11.2 Covering Basal Insulin Requirements in Insulin-Treated Type II Diabetic Patients.- 11.3 Special Aspects of the FIT Training Program for Type II Diabetic Patients.- 11.4 How Can Weight Loss Be Reached with Type II Diabetes During Functional Insulin Treatment.- 12 Coping with Special Situations.- 13 Frequent Patient-Related Problems.- 13.1 Grief-Work in Persons with Diabetes.- 13.2 Inadequate Information.- 13.3 Failure to Adjust to the Realities of Diabetes.- 14 Frequent Physician-Related Problems.- 14.1 Communication Problems.- 14.2 Inability to Understand What Life Is Like for the Patient.- 14.3 Inadequate Information.- 15 The "Contras".- 15.1 Contraindications for Functional Insulin Treatment.- 15.2 "Difficult" Patients.- 15.3 Intermezzo 3: A Strategy for Failure or How to Mess Things Up in the Outpatient Phase.- 16 Checklist for Continuing Care of FIT Patients (Phase III of Rehabilitation).- 16.1 The Patient's Knowledge.- 16.2 Applying Knowledge; Practicability of Therapeutic Measures.- 16.3 Motivation.- 16.4 Acceptance of Diabetes.- 16.5 Metabolic Status.- 16.6 Late Complications.- 16.7 Comorbidity.- 16.8 Social Environment.- 16.9 The Patient's Contact with the Diabetes Treatment Center, Physician or Diabetes Counselor.- 16.10 Humor.- 17 Review of Results and Experience.- 17.1 Patients.- 17.2 Follow-up.- 17.3 Results.- 17.4 Experience with FIT in Special Situations.- 18 Open Questions, Unsolved Problems and Limits of FIT.- 19 Epilogue.- References.- Appendix 1: Didactic Aspects of the FIT-Training Program.- Appendix 2: FIT - Initial Information forPatients.- Appendix 3: Nomogram for Generating the Initial Algorithms for FIT/Coauthors: H. Egger and H. Thoma.- Appendix 4: Selection of Available Human Insulins.- Appendix 5: Examples of Carbohydrate Units.