Goals for living with Diabetes Type 2, Hi BP and Lipids
A – Sugars – Best goals are fasting sugar 75-120, HbA1c of 7%
Tools to get there:
- Diet & Exercise – can be very effective if taken seriously
- Insulin Sensitisers
- Metformin – best first-line therapy, a few folk get diarrhea, (less with the XR form)
- Actos – may cause ankle swelling, possible issue with Bladder cancer, but preserves Insulin producing cells.
- Insulin secretors – eg Glipizide 10mgs, or similar. Can cause low sugars if taken without food. One of Gps 1&2 can work well together.
- GLP1 analogues – These are stimulators of insulin which cut the appetite eg Victoza
- Insulin – Basal type eg Levemir- last 24 hrs and often can get good control with one shotShort-acting – eg Novolog – last 3-4 hrs, can be used to cover the carbs in a meal
B Lipids – Goal Total Chol < 200, LDL < 100, HDL- as high as possible (preferably >45)
- Statins- now 5 of them- best is Crestor – more potent, less side-effects and raises HDL.
- Chol absorption blockers-Welchol, (can help with sugar as well), Zetia.
Triglycerides-Goal <150 fasting
- Best is Tricor, now generic as a fibrate
- Niaspan, less flushing than Nicotinic acid OTC
HDL-Goal as high as possible (H=Happy Cholesterol) Preferably >45
- Wt Loss, exercise, give up tobacco
- Then Niaspan, Crestor, Tricor & good sugar control.
C Blood Pressure
Tools Lo salt, wt loss, plus
Meds- up to 15 options, best is “prils” like Fosinopril, but 8% get a cough, so
ARB’s like Avapro are useful here,
Both can be potentiated by a small dose of a “zide” diuretic hence “Avalide” etc.