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Management of Diabetes in Hypertension
 Nearly 60% of people with Type 2 diabetes have hypertension, and people with
both hypertension and diabetes face a high risk of cardiovascular and kidney
disease. Patients with diabetes should have blood pressure levels less than
130/80 mmHg and low-density lipoprotein cholesterol levels < 100 mg/dL (2.60
mmol/L). If left uncontrolled, diabetes and
hypertension are a
dangerous combination.
Initial treatment goals for diabetes-related hypertension
include:
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 There is a general association in people with diabetes between weight
reduction and a reduction in blood pressure, but there is great variability in
the response. Reduction in blood pressure can occur with a modest amount of
weight loss.
Evidence demonstrates that structured, intensive lifestyle programs
involving participant education, individualized counseling, reduced dietary fat
and energy intake, regular physical activity, and frequent participant contact
are necessary to produce long-term weight loss of as much as 5-7% of
starting
weight fat is probably the most important nutrient to be restricted. Spontaneous
food consumption and total energy intake are increased when the diet is high in
fat and decreased when the diet is low in fat. Exercise by itself has only a
modest effect on weight loss. However, exercise(30-45 minutes for most days ) is
to be encouraged because it improves insulin sensitivity, acutely lowers blood
glucose, and is important in long-term maintenance of weight loss. Weight loss
with behavioral therapy alone also has been modest, and behavioral approaches
may be most useful as an adjunct to other weight loss strategies. However,
optimal strategies for preventing and treating obesity long-term have yet to be
defined.
The available data suggest that weight loss medications may be useful in the
treatment of overweight persons with type 2 diabetes. However, their effect is
modest. Moreover, the available data suggest that these medications only work as
long as they are taken and should be used in conjunction with lifestyle
strategies. These drugs should be used only in people with BMI >27.0 kg/m2.
Although gastric reduction surgery can be an effective weight loss treatment
for severe obesity (including severe obesity in persons with type 2 diabetes),
this surgery should only be considered for patients with a BMI 35 kg/m2. There
are no data comparing medical and surgical approaches to weight loss, and thus
the relative benefits and risks of surgical approaches are uncertain. Therefore,
gastric reduction surgery should be considered unproven in treating diabetes.
Smoking Cessation
Cigarettes provide the delivery system for nicotine, an addictive substance
related to various pharmacological, biochemical, and psychological processes
that interact to support a compulsive pattern of drug use.
The prevention and treatment of smoking should be a high priority for diabetes
care providers. View all of the daily reasons to
quit smoking.
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Include foods containing carbohydrate, particularly from whole grains,
fruits, vegetables, and low-fat milk in the diet of people with diabetes.
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The total amount of carbohydrate in meals and snacks is more important
than the source or the type.
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In persons with type 2 diabetes, on weight maintenance diets, replacing
carbohydrate with monounsaturated fat reduces postprandial glycemia and
triglyceridemia. However, there is concern that increased fat intake in ad
libitum diets may promote weight gain. Therefore, the contributions of
carbohydrate and monounsaturated fat to energy intake should be
individualized based on nutrition assessment, metabolic profiles, and
treatment goals.
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As for the general population, people with diabetes are encouraged to
choose a variety of fiber-containing foods, such as whole grains, fruits,
and vegetables, because they provide vitamins, minerals, fiber, and other
substances important for good health. Early short-term studies using large
amounts of fiber in small numbers of subjects with type 1 diabetes suggested
a positive effect on glycemia. Recent studies have reported mixed effects on
glycemia and lipids.
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In subjects with type 2 diabetes, it appears that ingestion of very
large amounts of fiber are necessary to confer metabolic benefits on
glycemic control, hyperinsulinemia, and plasma lipids. It is not clear
whether the palatability and the gastro-intestinal side effects of fiber in
this amount would be acceptable to most people.
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For persons with diabetes, there is no evidence to suggest that usual
protein intake (15-20% of total daily energy) should be modified if renal
function is normal. As protein is needed to build healthy body tissues,
choose a lean protein, not highly fatty meat or processed foods such as
cheap sausage. Fish is a good choice two or three times a week.
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Instead of cooking in fat, try marinating protein foods in wine, with
herbs and spice. Vegetarians can get their protein from eggs, beans, lentils
and other sources.
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Limit saturated fat and dietary cholesterol intake. Less than 10% of
energy intake should be derived from saturated fats. Some individuals (i.e.
persons with LDL cholesterol 100 mg/dl) may benefit from lowering saturated
fat intake to <7% of energy intake.
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Dietary cholesterol intake should be <300 mg/day. Some individuals (i.e.
persons with LDL cholesterol 100 mg/dl) may benefit from lowering dietary
cholesterol to <200 mg/ day.
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A reduction in sodium intake lowers blood pressure. The goal should be
to reduce sodium intake to 2,400 mg (100 mmol) or sodium chloride (salt) to
6,000 mg/day. The mean effect of a moderate sodium restriction is reported
to be a reduction of 5 mmHg for systolic and 2 mmHg for diastolic blood
pressure in hypertensive subjects and a reduction of 3 mmHg for systolic and
1 mmHg for diastolic blood pressure in normotensive subjects.
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An association between high alcohol intake (3 drinks/day) and elevated
blood pressure has been reported; however, there is no major difference in
blood pressure between people who consume <3 drinks/day and nondrinkers.
While light-to-moderate amounts of alcohol do not raise blood pressure, a
strong association exists between chronic excessive intake of alcohol
(>30-60 g/day) and blood pressure in men and women. Also, To reduce risk of
hypoglycemia, alcohol should be consumed with food.
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A low-fat diet that includes fruits and vegetables (five to nine
servings/day) and low-fat dairy products (two to four servings/day) will be
rich in potassium, magnesium, and calcium and modestly reduce blood
pressure. Diary products are an extremely valuable source of calcium, which
is an important mineral for all women. Dairy products don't adversely affect
blood sugar levels, unless they are also full of added sugar, for example
ice cream or milk chocolate.
'Live' yogurts containing acidophilus and bifidus cultures provide not only
calcium but also beneficial bacteria.
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You should try to have at least two liters (about four pints, or eight
or ten large tumblers) of water a day. This will help to excrete excess
sugar from your body and also help the fiber in your diet to perform its
blood sugar regulatory duties. This amount of water also enables your
kidneys and other organs (including your skin) to stay healthy.
The 'watch points', particularly important for diabetics, are :
saturated/animal fats, sugary, low-fiber foods and alcohol.
Blood glucose monitoring refers to home monitoring of blood glucose levels.
This test uses a portable glucose monitor. Monitoring is done by the individual
or a caregiver on a regular basis. Blood glucose monitoring is used for women
who have
diabetes. This includes individuals with type 1 diabetes, type 2 diabetes,
and pregnant women with gestational diabetes.
 The
test is performed by pricking the finger with a sterile lancet, or pointed
instrument, to get a drop of blood. This drop of blood is placed on the glass
plate of a home glucose monitor. The monitor will give a reading of the blood
glucose level. Some home monitors keep a computerized record of these readings.
According to the National Institutes of Health, or NIH,
Blood glucose level
before meals should be 80 to 130 mg/dL and
Blood glucose level at bedtime should
be 100 to 150 mg/dL.
All tests should be done in clean and healthy environment. Keep complete and
accurate records of your daily routine and your blood glucose levels. These
records will help you with pattern management, which is a way to get more of
your blood glucose values into your target range.
Medication
Diabetes sufferers should monitor their blood pressure carefully. The
chances of heart disease, strokes or kidney disease are increased significantly
for diabetics with hypertension. Dietary controls are often used in the
treatment of both diseases. Prompt intervention is required to control high
blood pressure in these circumstances, often by both medication and by the
elimination of possible contributors to high blood pressure. Women with diabetes
should keep their blood pressure below 130/85.
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Angiotensin Converting Enzyme (ACE) inhibitors:- They have proved
beneficial in the treatment of moderate to severe hypertension. They need to
be used with care in patients with impaired renal function or bilateral
renal artery stenosis. It is best to start with a small dose and then build
up to an effective maintenance dose.
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Calcium Antagonist:- They are particularly useful when hypertension
co-exists with angina.
To sum up, Women with diabetes and high blood pressure should see their
doctors regularly and follow these steps: eat foods to control blood sugar and
salt intake, get 30 to 45 minutes of physical activity most days, quit smoking
and limit alcohol intake, lose weight if needed, and take medications as
prescribed by the physician. You can improve your health dramatically if you
keep your blood sugar and your blood pressure under control.
Dated 01 December 2011
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