Diabetes Type II, Hi CPBP, Lipids

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)
Tools

  1. Statins- now 5 of them- best is Crestor – more potent, less side-effects and raises HDL.
  2. Chol absorption blockers-Welchol, (can help with sugar as well), Zetia.

Triglycerides-Goal <150 fasting
Tools

  1. Best is Tricor, now generic as a fibrate
  2. Niaspan, less flushing than Nicotinic acid OTC

HDL-Goal as high as possible (H=Happy Cholesterol) Preferably >45
Tools

  1. Wt Loss, exercise, give up tobacco
  2. Then Niaspan, Crestor, Tricor & good sugar control.

C Blood Pressure
Goal <130/80

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.

Authored by: Brian Tulloch, M.D.

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