Managing and Reducing Cardiovascular Risk in Type 2 Diabetes Mellitus Essay

Diabetes mellitus is a metabolic disorder in which the body’s capacity to make use of glucose, fat and protein is disturbed due to insulin deficiency or insulin resistance. It is a hormone secreted from pancreas that helps glucose from food to enter the body’s cells where it is transformed into energy required by muscles and tissues to function. Diabetes is caused either because the pancreas does not secrete adequate insulin, or because cells do not react to the insulin that is produced. Due to this reason, an individual with diabetes does not take up glucose appropriately and glucose continues circulating in the blood (hyperglycaemia) harming tissues over time. This damage leads to acute health complications. The classic symptoms of diabetes mellitus are, Polyuria ,Polydipsia ,Polyphagia ,lethargy and weight loss. There are many causes for high blood glucose levels in the body and so a number of types of diabetes exist. Diabetes mellitus occur throughout the world. Based on the study conducted by IDF, the number of diabetics on earth stands at 365 million nearly 8. 5% of the global population. It is more widespread in the more developed countries. The greatest raise in incidence is, however, expected to happen in Africa and Asia, where majority of the diabetes patients will most likely be found by 2030. Diabetes mellitus is categorised into four broad groups: Type 1, Type 2, Gestational diabetes & â€Å"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 usually affects children and young adults. Type 2 Diabetes is an insidious progressive disease that is often diagnosed late when complication are present. Dunning (2004) described it as a long term complication with neuropathy, cardiovascular disease and retinopathy. It is a universal metabolic disorder affecting more than 2 million people in the United 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 people 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 noticed that Diabetes caused 4. million deaths in 2011 and caused sharp increase in medical expenditure. I am a staff nurse working in the cardiac ward and we often receive patients with cardiac problems as a long term complication of type 2 diabetes. Cardiovascular disease is a major cause of hospital admission and mortality in people with diabetes. Most of them are not diagnosed until they are admitted. During the course of this study the medical history and care and treatment provided to a patient named Mr M Davies who was admitted in my ward is chosen to learn about managing and reducing cardiovascular disease among patients with type 2 diabetes. In 1998 UKPDS pointed out the importance of reducing lipids blood pressure and blood Glucose to reduce the risk of cardiovascular disease. Hypertension leads to thicker, less elastic blood vessel walls and increase the strain on the heart. 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 subtle 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 6–7 mmol/L, which were explained to him as symptomatic of â€Å"borderline diabetes. † During the preliminary diagnosis, he was advised to reduce weight (â€Å"at least 10 lb. †), but no further action was taken. Other medical problems include obesity and hypertension. He was admitted in the ward with recurrent chest pain. (Appendix 1) This assignment is about managing and reducing cardiovascular risk 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 risk factors 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 supported 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 increased life expectancy 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 premature mortality that is broadly underestimated, because only a few among the diabetic patients die from reasons uniquely related 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 managed every day. The management of Diabetes can refer to dealing with short term measures like high and low blood sugar to regulating it over the long term for instance by attaining to grips with knowing the condition. All patients with Type 2 diabetes require active dietary 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, exercise, monitoring blood sugar at home, and in some cases, oral medication and/or taking insulin. Based on the type diabetes medicines are classified 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 insulin’s capacity to transfer sugar into cells particularly 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) prevent enzymes that help digest starches, reducing the rise in blood sugar. These medicines may cause diarrhea or gas. They can decrease 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 intake due to nausea and chest pain, GKI was commenced for a day to control his blood sugar. On second 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 times a day (Learning outcome 1). Metformin has long been accepted as a appropriate first-line choice 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 peripheral 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 significant 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 world’s 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 observed that over weight in adolescence is a forecaster of these dangers in adulthood . These finding 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 morbidity 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). West (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 individual’s 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. Dietician 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 consumption and taking balanced food to prevent hypo and hyper glycaemia (Learning outcome 1).. Hypertension-Prevention & Management 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 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 risk of myocardial infarction as non-diabetic patients with a history of previous myocardial infarction. Non-pharmacological 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 Pharmacological 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 in 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 addition to standard therapy minimised combined myocardial infarction, stroke 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 general population, for example elevated total and LDL cholesterol; and additional diabetes-related abnormalities, for example elevated triglycerides and reduced HDL 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. Dietary 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 restrictive in cholesterol production. Another major strategy in the management diabetes is lifestyle interventions. 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 10 ±40% and total cholesterol by 5 ±15%. 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 significant disease confronting the United Kingdom’s (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 cost of diabetes treatment. Care should be planed at reducing symptoms and minimizing 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.

Business law Essay Example | Topics and Well Written Essays - 750 words - 2

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The phenomena of Colony Collapse Disorder in honeybee Essay

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Violent Video Games and Increase of Aggressiveness Research Proposal

Violent Video Games and Increase of Aggressiveness - Research Proposal Example These games are violent in nature, some with parental warnings regarding violence, blood, and gore. Examples of such video games include titles like Killer Instinct, Mortal Kombat, and Sega's Primal Rage. All of these games intertwine a character-driven storyline with adventures and quests, including personal combat which requires the player to fight with and kill, various adversaries in an extremely violent way. While earlier versions of such games, such as Quake or Doom, were more plot-driven and less gratuitously violent, many of the more recent industry offerings (known as "first-person shooter" games) have escalated the combat element in favor of increasingly difficult opponents, more sophisticated weaponry, and an unhealthy focus on domination. As Bok points out, "players are rewarded for slashing, gouging, or shooting their opponents...[and are able] to see with the eyes of the killer holding the gun." (1999, p. 37) In fact, other researchers have determined that in the most p opular games, harming other characters is the primary activity and that killing occurs at a high rate. (Cicchirillo and Chory-Assad, 2005, p. 436).

Journalism of the Founders Essay Example | Topics and Well Written Essays - 1000 words

Journalism of the Founders - Essay Example According to the paper  truthful reporting leaves no scope for adding opinions, lest it be called yellow journalism. But, the journalists and editors too are part of the society. They have a responsibility to highlight the wrongs, illegal activities and excesses being committed against the society, by some powerful people. Going through the articles it is more than apparent that American Revolution was indeed influenced by the writings at that time. In fact, it won’t be an exaggeration to say that the writings developed the urge in revolutionaries for freeing themselves from unjustified occupation. Thomas Jefferson aptly acknowledged the contribution of Tom Paine for his critical role in ‘propelling the American colonists towards independence from Great Britain’. Journalists too are human beings and they too have political leanings.This study highlights that  history testifies that, there have been numerous attempts to make use of the newspapers and media on p ure political considerations, but the impact have never been so high as to bring about a monumental change. This shows that the journalistic writings alone are not considered the final statement of truth. In fact, carrying through such imaginary and untenable arguments has become much more difficult in today’s times. Publications like the ‘Journal of Occurrences’ and Thomas Paine’s ‘Common Sense’ and ‘Crisis’ provided a window of hope to the people oppressed by the colonial powers. Such publications were used as discussion forums by the people.... Such publications were used as discussion forums by the people. Comparing such publications with the present times led by the IT era, blogging seems to be the forum for people to come out with their opinions/ anger a particular set of people and circumstances. The major difference being the speed for information exchange and the number of people whose views can be accommodated on the pages. Earlier, the information used to take days/ weeks and months to travel from one place to another, but the internet has made possible the information exchange at a speed of light. Though the media landscape has undergone a sea-change since the times of the American Revolution, yet the basic concept remains similar. In today's media rich environment, journalism, the profession, has acquired newer dimensions. Be it the coverage of war on Iraq and Afghanistan or the hidden camera sting operations, more value addition has taken place in the traditional form of journalism. Adverse circumstances appear to be the basic breeding ground for journalistic excellence. Duri ng the occupation of American land, the French and British soldiers exhibited outrageous behavior and resorted to brutalities against women, which led to simmering discontent, further fueled by the writings from the likes of Tom Paine, Sam Adams etc. This had definite contribution towards shaping the revolution. Journalistic writings have the ability to read pulse of the people, and after gathering the realistic feedback, the writings help in generating a debate amongst larger section of masses. Not only the printed publications, but any media with a mass appeal like poets, writers, journalists, singers, drama

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Fredricksons various models in the story of Stephen Cruz by Studs Essay

Fredricksons various models in the story of Stephen Cruz by Studs Terkel - Essay Example For Stephen Cruz, who was taught and brought up by his father to work hard in whatever he does and avoid taking things that he does not deserve, is seen in the story being told to fall in the line and learn the way of doing business as the dominant and powerful group does. The Civil Acts of 1964 is used in this story to signify the way policies and legislations are used to assimilate minority groups. Fredrickson’s one way assimilation methods is apparently used in this story as the minorities are being accepted and employed to and by the dominant group, but they still play a subordinate role and are not allowed to fully enjoy the freedoms nor fulfill their American dream (Fredrickson, 335). As Stephen Cruz rises up through the corporate ladder slowly with his sheer hard work, he continues to discover that maybe the American dream he is working on is not meant for him. This is because he discovers that the dream and the relations between the minority-weak and dominant-powerful, are to the advantage of the later. This relation is described by Fredrickson as group separatism. Although the method of doing so might not be as direct as it may be perceived to be, through taking advantages of various legislations and policies to their (dominant group), can be seen as a way to separate the dominant and the minority. The dominant and powerful in America continue to get stronger and wealthy and the expense of the minority. This separates the two groups even further and no equally is presented.