Managing and Reducing Cardiovascular Risk in Type 2 Diabetes Mellitus Essay Example for Free

Managing and Reducing Cardiovascular luck in Type 2 Diabetes Mellitus look forDiabetes mellitus is a metabolic dis regulate in which the bodys capacity to make use of glucose, change and protein is disturbed due to insulin lack or insulin resistance. It is a hormone secreted from pancreas that helps glucose from food to enter the bodys cells where it is transformed into power required by muscles and tissues to function. Diabetes is caused either because the pancreas does not secrete adequate insulin, or because cells do not answer to the insulin that is produced. Due to this reason, an mortal with diabetes does not realize up glucose appropriately and glucose continues circulating in the wrinkle (hyperglycaemia) harming tissues oer time. This damage leads to acute health tortuositys. The classic symptoms of diabetes mellitus are, Polyuria ,Polydipsia ,Polyphagia ,lethargy and load loss. There are many causes for high rent glucose trains in the body and so a number of fictional characters of diabetes exist. Diabetes mellitus occur through stunned the world. Based on the teaching conducted by IDF, the number of diabetics on earth stands at 365 million nearly 8. 5% of the global universe of discourse.It is much widespread in the more developed countries. The greatest raise in incidence is, however, expected to decease in Africa and Asia, where majority of the diabetes patients lead most give carely be constitute by 2030. Diabetes mellitus is categorised into quaternity broad groups Type 1, Type 2, Gestational diabetes other specific types. Scientists in US have found a Type 3 diabetes, it is still continuing further study. Type 1 diabetes is absolute insulin deficiency usu aloney affects children and young adults. Type 2 Diabetes is an insidious modernized disease that is often diagnosed late when leg are present.Dunning (2004) described it as a long status complication with neuropathy, cardiovascular disease and retinopathy. It is a universal metabolic disorder affecting more than 2 million the great unwashed in the fall in Kingdom and up to 750,000 more are expected to have it without knowing they do. Studies conducted show that 80% of population affected by diabetes live in developing and underdeveloped countries and the majority of stack with diabetes is between 40 to 59 years of age. It is also estimated that 183 million people (50%) with diabetes are undiagnosed. It is observe that Diabetes caused 4. million deaths in 2011 and caused astute extend in medical expenditure.I am a staff nurse working in the cardiac ward and we often receive patients with cardiac businesss as a long term complication of type 2 diabetes. Cardiovascular disease is a major cause of hospital admission and fatality rate in people with diabetes. Most of them are not diagnosed until they are admitted. During the course of this study the medical biography and care and handling provided to a patient named Mr M Davies who was adm itted in my ward is chosen to learn virtually managing and reducing cardiovascular disease among patients with type 2 diabetes.In 1998 UKPDS pointed out the importance of reducing lipoids channel imperativeness and relationship Glucose to reduce the happen of cardiovascular disease. Hypertension leads to thicker, less elastic blood watercraft walls and increase the strain on the content. Studies indicated that there is a linear correlation between the diastolic blood pressure and the eventual outcome of type 2 diabetes. Standl Schnell (2000) pointed out that as a result of ischemia-induced remodelling cunning changes occur in the heart and the effects of hyperglycaemia on the endothelium of large blood vessels that causes heart to failure.Mr M Davies (Mr.MD) is a 61-year-old pensioner with a 4 years history of type 2 diabetes. He was diagnosed in 2008 and he had symptoms of hyperglycaemia for 2 years before diagnosis. His fasting blood glucose records indicated values of 67 mmol/L, which were explained to him as symptomatic of borderline diabetes. During the preliminary diagnosis, he was well-advised to reduce weight (at least(prenominal) 10 lb. ), but no further action was taken. Other medical problems include fleshiness and high blood pressure. He was admitted in the ward with recurrent bosom pain. (Appendix 1) This assignment is about managing and reducing cardiovascular gamble in type 2 diabetes mellitus.Heart disease is well acknowledged as a chronic problem of diabetes, and is the major reason of morbidity and mortality in patients from middle-age onwards. Type 2 diabetes is associated at the onset with essay ciphers for heart disease such as hypertension and obesity, raising the question of whether diabetes is the independent risk factor for heart disease. In 2001 Morrish et al pointed out that the majority of cardiovascular deaths are specifically due to heart disease and this is support by Fisher, Miles, (2008) commenting that heart disease is the major cause of morbidity and mortality at young as well as older ages.Butler (1997) said that increase life apprehension has led to an increase in the number of people over 65 years of in both the developed and developing worlds. Marso (2003) pointed out that due to the clear association between age and the development diabetes, this increase in the number of older individuals in the population will inevitably contribute to the increased prevalence of diabetes. Watkins (2008) mentioned that Type 2 diabetes is a disease of relative prosperity, prosperity leads to overweight and physical indolence.Insulin resistance, increasing with obesity, associated with progressive failure of insulin secretion in relation to ageing underlies the development of diabetes. It is anticipated that by 2025 the number of people with type 2 diabetes will be around 380 million and people with impaired glucose tolerance will be around 418 million. Diabetes is the foremost global cause of pr emature mortality that is broadly underestimated, because exclusively a few among the diabetic patients die from reasons uniquely associate to the condition.Nearly one half of type 2 diabetes patients die prematurely of a cardiovascular reason and approximately 10% die of renal failure. Diabetes is a condition that required to be bear awayd every twenty-four hour period. The moldment of Diabetes tolerate refer to dealing with short term measures like high and low blood scratch line to regulating it over the long term for slip by attaining to grips with knowing the condition. All patients with Type 2 diabetes require active dietetical management throughout their disease. Watkins (2008) pointed out that weight loss in the obese is extremely valuable but is separate from dietary manipulations to control blood glucose.Treatment typically includes diet control, exercising, monitoring blood colewort at home, and in some cases, oral medication and/or taking insulin. Based on the type diabetes medicines are separate into different groups and each category of diabetes pills functions differently. Commonly used medicines to control diabetes are Sulfonylureas, Thiazolidinediones, Biguanides, Alpha-glucosidase inhibitors, Meglitinides and, Dipeptidyl peptidase IV. Sulfonylureas reduce blood sugar by stimulating the pancreas to produce more insulin. Sulfonylureas medicines like Glimeperide, Gliclazide,.Biguanides improve insulins capacity to transfer sugar into cells oddly into the muscle cells. They also stop the liver from releasing stored sugar. Biguanides are not advised to be used in people who have heart failure or kidney damage. Biguanides medicines such as Metformin. Thiazolidinediones like Pioglitazone and Rosiglitazone enhances effectiveness of insulin in muscle and in fat tissue. Alpha-glucosidase inhibitors, such as Precose (acarbose) and Glyset (miglitol) celebrate enzymes that help concentrate starches, reducing the rise in blood sugar.These me dicines may cause diarrhea or gas. They can mitigate hemoglobin A1c by 0. 5%-1%. Meglitinides, like Prandin (repaglinide) and Starlix (nateglinide) reduces blood sugar level by stimulating the pancreas to secreate more insulin. Dipeptidyl peptidase IV (DPP-IV) inhibitors, such as Januvia (sitagliptin), Onglyza (saxagliptin), and Tradjenta (linagliptin) lowers blood sugar level in patients with type 2 diabetes by accelerating insulin secretion from the pancreas and lowering sugar production. The case history of Mr.MD indicated that he was advised to manage blood sugar level by diet control and regular exercise. It was also advised to take metformin 1000mg twice a day when diet and exercise are not enough to manage blood sugar level. The history showed that Mr. MD was non-compliance with any of these. On admission his random blood sugar was 20 mmol/L. As he was unable to tolerate oral inlet due to nausea and chest pain, GKI was commenced for a day to control his blood sugar. On seco nd day his blood sugar level was controlled and he started eating and drinking normally.Mr MD was referred to diabetic specialist nurse and dietician . Diabetic specialist nurse advised to stop GKI and advised to start OHA. Mr. MD commenced on metformin 1000mg three multiplication a day (Learning outcome 1). Metformin has long been accepted as a appropriate first-line survival of oral medicine for Type 2 diabetes as it is the only oral hypoglycaemic agent related with no weight gain or even weight reduction. They decrease hepatic gluconeogenesis, boost skirting(prenominal) glucose uptake and also lower the absorption of carbohydrate from the gut lumen.Because metformin functions on insulin sensitivity and with only endogenous glucose stimulated insulin secretion, it virtually never causes hypoglycaemia on its own and patients using it with diet and exercise do not need routinely to self-monitor blood glucose. The UK Prospective Diabetes Study (UKPDS, 2002) demonstrated a primal survival advantage for Type 2 patients started on metformin as first-line therapy, with less cardiovascular mortality, although it should be noted that they only used the drug in obese patients. Obesity is a worldwide problem.Barnett (2009) pointed out that obesity and overweight are independent risk factors for cardiovascular morbidity and mortality. Various studies reveal that obesity is a major cardiovascular disease risk factor across worlds populations. Risk of morbidity and mortality begins to increase at body mass index (BMI) 25 kg/m 2 and the risk raises sharply at BMI 30 kg/m 2. Each kilogram of weight put on from the age of 18 years was linked with 3. 1% higher risk of cardiovascular disease. In 1998 Gunnell find that over weight in adolescence is a forecaster of these dangers in adulthood .These decision were supported by Must in 1992,who explained that this increased risk extends to overweight children and adolescents, who may be at risk of premature cardiovascular mor bidity and death. The mechanism by which obesity causes increased cardiovascular morbidity and mortality is attributed to associated co-morbidities and risk factors such as hypertension, dyslipidaemia, type 2 diabetes and insulin resistance. The co-occurrence of some or all of these risk factors along with obesity is termed the cardiometabolic syndrome.On examination it was noticed that Mr.MD has a high BMI (30. 9). westmost (2007). Suggested that addressing obesity is an essential aspect of managing diabetes, because type2 diabetes and many other health problems coexist. However it is important to consider the individuals specific nutritional needs rather than just providing them with a weight loss plan, diabetic diet, a standard meal plan or information about healthy eating. Mr. MD was referred to the dietician. nutritionist gave dietary advice and educated about importance of weight management by diet and regular exercise.He was advised to avoid take-away foods, reduce alcohol outgo and taking isotropyd food to prevent hypo and hyper glycaemia (Learning outcome 1).. Hypertension-Prevention care is very important in the management of metabolic diseases. In 1985 Modan et al pointed out that there is a strong relationship between high blood pressure and insulin resistance. This findings is supported by Reaven, (1999) . He said that the prevalence of insulin resistance in hypertension has been estimated at 50%. Scheen, (2004) proposed several(prenominal) possible mechanisms for this.Coutinho et al. (1999) said that impaired fasting blood glucose is related with high cardiovascular risk particularly if accompanied by hypertension. Henry et al. , (2002) said that in people with diabetes, cardiovascular disease risk is increased two to fourfold compared with those with normal glucose tolerance. This was supported by the study conducted by Heffner et al. , (1998) who said that diabetic people without past history of myocardial infarction may have as high a r isk of myocardial infarction as non-diabetic patients with a history of previous myocardial infarction.Non- pharmacologic interventions are cheap than pharmacological interventions and have no known dangerous effects. A range of lifestyle changes reduce blood pressure and the occurrence of hypertension. Non-pharmacological interventions such as weight loss in the overweight, exercise programmes, limiting alcohol intake and a diet with increased fruit and vegetables and limited saturated fat content, minimising dietary sodium consumption and increased dietary potassium intake.From the medical history of Mr MD it is noticed that he was taking Ramipril 5 mg/day and bisoprolol2. mg/daily. It is established that where non-pharmacological interventions are not enough to achieve the objectives then pharmacologic interventions are required. Several drug treatments are of proven value in minimising cardiovascular risk in people with diabetes and hypertension. Low-dose aspirin is suggested i n diabetes whether or not there is evidence of large vessel disease. Williams et al. , (2004) noticed that the British Hypertension Society recommends 75 mg of aspirin for all with hypertension and diabetes, unless contraindicated.Antihypertensive therapy diminishes the risk of macrovascular complications by around 20%. Reducing blood pressure reduces progression of retinopathy, albuminuria and progression to nephropathy. Staessen et al. , (1997) observed that clinical trials with ACE inhibitors, beta-blockers, diuretics, angiotensin receptor blockers and calcium channel blockers have demonstrated benefit of treatment of hypertension in type 2 diabetes (Learning outcome 1).. On admission blood pressure level of Mr MD was very high. He was recommended treatment with antihypertensive drugs.Consultant prescribed Losartan 100 mg/day and increased ACE inhibitor (ramipril 10 mg/day) and beta-blocker (bisoprolol 5 mg/dayl). Studies show that treatment with ramipril in assenting to standar d therapy minimised combined myocardial infarction, calamity and cardiovascular death by about 25% and stroke by 33% compared with placebo plus conventional methods. This was supported by Sowers and Haffner, (2002) saying that almost all patients with hypertension and diabetes require combinations of blood pressure reducing drugs to attain the recommended blood pressure targets.During the treatment Mr. MD was advised non-pharmacological methods of blood pressure management and importance of diet control and referred to cardiac rehabilitation for regular exercise. Management of high cholesterol plays an important role in the management of diabetes. Lipid abnormalities are common in type 2 diabetes and can be broadly categorized into two groups those that are common to the planetary population, for example elevated amount of money and LDL cholesterol and additional diabetes-related abnormalities, for example elevated triglycerides and reduced alpha-lipoprotein cholesterol.Current US and European guidelines emphasize reducing LDL-C level to less than 100 mg/dL (2. 59 mmol/L). To reduce the cholesterol Mr. MD was undergone intensive lipid-lowering treatment with atorvastatin 80 mg/day. dietetical therapy was also a part of the treatment which was found effective to lower Lipids. Interventions to stabilize lipids in order to decrease the risk of CVD are warranted in people with type 2 diabetes. Both Fibrates and Statins improve lipid profiles in people with diabetes. Many studies have established the safety and effectiveness of the fibrates (gemfibrozil, bezofibrate, fenofibrate) in diabetes.Fibrates stimulate the peroxisome proliferator-activated receptor-a, changing the expression of a number of enzymes that regulate lipid metabolism, including lipoprotein lipase. Statins inhibit hepatic 3-hydroxy-3-methylglutaryl coenzyme A reductase, which is rate limiting in cholesterol production. Another major strategy in the management diabetes is lifestyle intervent ions. Lifestyle interventions can progress lipid levels. Studies conducted on weight loss and lipids in type 2 diabetes have varied greatly as to the study diet, design and duration.A Meta-analysis of 89 studies and 1800 subjects with type 2 diabetes reported that a weight loss of 5% or greater reduced triglyceride levels by 1040% and total cholesterol by 515%. These effects were greatest with very low-calorie diets, and the effects were seen in studies up to 6 months. A variety of diets can alter the lipid profile in people with type 2 diabetes. The organisation of diabetes care is very important in the long term management of diabetes care. Diabetes is the meaning(a) disease confronting the United Kingdoms (UK) health care system.As a result, understanding how best to manage diabetes facilities is an important area if the health system is going to deal with the growth in both the demand for and appeal of diabetes treatment. Care should be planed at reducing symptoms and minimiz ing the danger of long-term problems. It is pointed out that a proper balance of glucose and other cardiovascular risk factors such as smoking, hypertension, inactive lifestyle, dyslipidaemia and obesity is very crucial (UKPDS, 2002) in the organisation care of diabetes.