Unit 5 - Diabetes 3 Flashcards
What is a co-morbidity?
Disease or condition that coexists with a primary disease but also stands on its own as a specific disease
- may be physical or mental conditions
What are the possible co-morbidities with diabetes?
- hypertension up to 75% of adults
- dyslipidaemia
- cardiovascular disease
- kidney disease
- cancer
- depression
- non-alcoholic fatty liver disease
- obstructive sleep apnoea
- obesity
What are the two types of complications of diabetes?
- macrovascular damage
- microvascular damage
What is the cause of macrovascular damage?
Damage to larger blood vessels
- coronary arteries
- aorta
- arteries in the brain and limbs
What is the cause of microvascular damage?
Damage to small blood vessels
Give examples of macrovascular complications
- myocardial infarction (MI) and stroke
- coronary heart disease (CHD)
- congestive heart failure
- peripheral vascular disease
- accelerated atherosclerosis
- predisposing to peripheral vascular
- ischaemic heart disease
What percentage of patients with diabetes die from heart disease or stroke?
65%
How much higher is the death rate from heart disease or stroke with diabetes compared to those without the disease?
2 to 4 times higher
How does diabetes contribute to hypertension?
Increasing fluid volume
- diabetes can increase the total amount of fluid in the body
- raises blood pressure
Increasing arterial rigidity
- diabetes can decrease the ability of the blood vessels to stretch
- increasing average blood pressure
Impaired insulin handling
- changes in the way the body produces and deals with insulin
- directly cause increase in blood pressure
At what blood pressure is intervention recommended?
> 135/85 mmHg
- unless the adult with type 1 diabetes has albuminuria or 2 more features of metabolic syndrome
- should be 130/80 mmHg
What is the first line treatment of hypertension in adults with type 1 diabetes?
Renin-angiotensin system blocking drug
- ACEI
- ARB
What is dyslipidemia?
High levels of lipids in the blood
How does type 2 diabetes cause dyslipidemia?
- decreased high density lipoprotein (HDL)
- increased triglycerides
- postprandial lipemia
How does type 1 diabetes cause dyslipidemia?
- hypertriglyceridemia
- normal or increased levels of high density lipoprotein (HDL)
- unless glycaemic control is poor or nephropathy is present
What are the priorities of treating dyslipidemia?
- LDL cholesterol lowering
- statin 1st line - HDL cholesterol rising
- lifestyle - triglyceride lowering
- glycaemic control then fibrates
- fenofibrates
What is ezetimibe?
A drug that lowers plasma cholesterol levels.
- acts by decreasing cholesterol absorption in the small intestine
- recommended as 2nd line therapy for those intolerant of statins
How does ezetimibe work?
Blocks the absorption of dietary cholesterol and reabsorption of cholesterol entering the small intestine in bile
- especially effective when combined with a statin
What is the function of Omacor?
Purified omega-3-fatty acids can lower triglycerides but have little effect on HDL and LDL cholesterol
What values should be obtained in a full fasting blood lipid profile?
Total cholesterol - target less than 4 mmol/L Low density lipoprotein (LDL) - target less than 3 mmol/L Triglycerides - target less than 1.7 mmol/L High density lipoprotein (HDL)
What effect does lowering the concentration of LDL and triglycerides and raising the concentration of HDL have?
Slows the progression of atherosclerosis
What is non-alcoholic fatty liver disease?
Build up of fat in the liver
What percentage of diabetic patients have non-alcoholic fatty liver disease?
70%
What lifestyle interventions may improve non-alcoholic fatty liver disease?
- weight loss
- regular exercise
- smoking cessation
- healthy diet
What does tight control of blood pressure lead to?
Reduced number of cardiac events and stroke
