R.F. is a 48-year-old white man with type 1 diabetes since age 24. He was initially seen at the Utah Diabetes Center in Salt Lake City on 15 September 2006. The patient had been treated with NPH insulin, 2 units at bedtime; ultralente insulin, 3 units twice a day; and lispro insulin, 2-3 units at each meal. The patient corrected elevated blood glucose levels with 1 unit of lispro for blood glucose readings > 200 mg/dl and about 2 units of lispro for blood glucose readings > 300 mg/dl. His hemoglobin A1c (A1C) was 9.2%, and he described losing control of his diabetes progressively through the years.

The patient often developed nocturnal hypoglycemia, most likely as a result of the combination of NPH and ultralente insulins taken at bedtime, and his blood glucose levels often dropped by 50-80 mg/dl through the night. The fear of nocturnal hypoglycemia and the patient’s inability to control postprandial blood glucose levels were very frustrating to him. He had no evidence of microvascular complications. His blood pressure and lipids have always been within the normal range.

R.F.’s basal insulin regimen was changed to detemir insulin twice daily, and he was also given an insulin-to-carbohydrate ratio to determine lispro doses at mealtimes and a correction scale to aggressively correct hyperglycemia. He also received intensive diabetes education. By 7 April 2007, his A1C was 7.8%, and he had gained much more confidence as his blood glucose levels remained stable through the nights.

The patient then decided to purchase a continuous glucose monitor (CGM) system (Medtronic MiniMed Guardian REAL-Time Continuous Glucose Monitoring System). The patient was instructed on the use of the sensor system by the diabetes education team at the Utah Diabetes Center. He continued to monitor his blood glucose levels four to six times per day. He found that he was able to aggressively dose insulin at meals based on anticipated carbohydrate intake and to correct even mild hyperglycemia throughout the day. His A1C had improved to 5.5% when measured on 11 October 2007. More …..

Evidence review: hypertension as a risk factor for complications of diabetes

Diabetes increases the risk of coronary events twofold in men and fourfold in women. Part of this increase is due to the frequency of associated cardiovascular risk factors such as hypertension, dyslipidemia, and clotting abnormalities. More …

Evidence for target levels of blood pressure in patients with diabetes

The UKPDS and the Hypertension Optimal Treatment (HOT) trial both demonstrated improved outcomes, especially in preventing stroke, in patients assigned to lower blood pressure targets. Optimal outcomes in the HOT study were achieved in the group with a target diastolic blood pressure of 80 mmHg (achieved 82.6 mmHg). More …

Evidence for non-drug management of hypertension

Dietary management with moderate sodium restriction has been effective in reducing blood pressure in individuals with essential hypertension. Several controlled studies have looked at the relationship between weight loss and blood pressure reduction. Weight reduction can reduce blood pressure independent of sodium intake and also can improve blood glucose and lipid levels. The loss of one kilogram in body weight has resulted in decreases in mean arterial blood pressure of 1 mmHg. The role of very low calorie diets and pharmacologic agents that induce weight loss in the management of hypertension in diabetic patients has not been adequately studied. Some appetite suppressants may induce increases in blood pressure levels, More …

American Diabetes Association

Evidence for drug therapy of hypertension

There are a number of trials demonstrating the superiority of drug therapy versus placebo in reducing outcomes including cardiovascular events and microvascular complications of retinopathy and progression of nephropathy. These studies used different drug classes, including angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), diuretics, and ß-blockers, as the initial step in therapy. All of these agents were superior to placebo; however, it must be noted that many patients required three or more drugs to achieve the specified target levels of blood pressure control. More …

American Diabetes association

Summary

There is a strong epidemiological connection between hypertension in diabetes and adverse outcomes of diabetes. Clinical trials demonstrate the efficacy of drug therapy versus placebo in reducing these outcomes and in setting an aggressive blood pressure–lowering target of <130/80 mmHg. It is very clear that many people will require three or more drugs to achieve the recommended target. Achievement of the target blood pressure goal with a regimen that does not produce burdensome side effects and is at reasonable cost to the patient is probably more important than the specific drug strategy. More …

American Diabetes Association

Treatment

A-Level evidence:

• Patients with diabetes should be treated to a diastolic blood pressure <80 mmHg.
• Patients with a systolic blood pressure of 130–139 mmHg or a diastolic blood pressure of 80–89 mmHg should be given lifestyle/behavioral therapy alone for a maximum of 3 months and then, if targets are not achieved, should also be treated pharmacologically.
• Patients with hypertension (systolic blood pressure 140 mmHg or diastolic blood pressure 90 mmHg) should receive drug therapy in addition to lifestyle/behavioral therapy.

Initial drug therapy may be with any drug class currently indicated for the treatment of hypertension. However, some drug classes More …

American Diabetes Association

During exercise, low blood sugar is sometimes a concern. If you’re planning a long workout, check your blood sugar every 30 minutes during exercise — especially if you’re trying a new activity or increasing the intensity or duration of your workout.

If your blood sugar is 70 mg/dL or lower or you feel shaky, nervous or confused, stop exercising and eat or drink something to raise your blood sugar level.  More …

After exercise, check your blood sugar right away and then several times during the next few hours. Exercise draws on reserve sugar stored in your muscles and liver. As your body rebuilds these stores, it takes sugar from your blood.  More …

By Mayo Clinic Staff
Feb. 23, 2007 © 1998-2008 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these materials may be reprinted for noncommercial personal use only. “Mayo,” “Mayo Clinic,” “MayoClinic.com,” “EmbodyHealth,” “Reliable tools for healthier lives,” “Enhance your life,” and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research.

Exercise is an important part of any diabetes treatment plan. To avoid potential problems, check your blood sugar  before, during and after exercise.
Diabetes and exercise go hand in hand, at least when it comes to managing diabetes. Exercise can help you improve your blood sugar control, as well as boost your overall fitness and reduce your risk of heart disease and nerve damage.
But diabetes exercise pose special challenges, too. More …

Publish by: Alfento P Sinurat S.Si,Apt
                   Pharmacist