Atherosclerosis a leading cause of complications among diabetics:AACC:"At the present time, what are the two most common causes of death in type 1
diabetes? Ischemic heart disease (IHD) from coronary artery disease (CAD)
Renal failure. CAD usually results from atherosclerosis. Atherosclerosis is the
process in which intimal thickening leads to blood vessel obstruction of the medium
and large arteries. When cholesterol is deposited in the intima and macrophages and
smooth muscle cells proliferate, an atheromatous plaque is formed. The precursor of
the plaque is the fatty streak. The atheromatous plaque bulges into the lumen of the
artery, decreasing the cross-sectional diameter of the artery. Over time, calcium
can be deposited in the plaques.Other names for the atheromatous plaque include
fibrous, fibrofatty, lipid, and fibrolipid plaque. The endothelium covering the
plaque may be stripped off or may ulcerate. A fibrous cap covering the necrotic core
is present in a fully developed plaque. The fibrous cap consists of smooth muscle
cells, macrophages, foam cells, lymphocytes, collagen, elastin, and proteoglycans.
If this cap is disrupted, platelets can acutely become deposited on the cap, causing
acute blood vessel obstruction and myocardial infarction or stroke." http://www.aacc.org/symposia/ada/img/4.htm
Diabetic Vascular Complications Explained:Penny Stern, MD Proceedings of the National Academy of Sciences:"The complex mechanism by which diabetes wreaks its devastating damage on the blood
vessels of the human body is now closer to being understood, according to a new
report.
The findings may lead to new ways to study and to treat the arterial disease common
in diabetic patients, including poor circulation and heart disease.
Dr. Jose Halperin and colleagues at the Harvard Medical School, the Brigham and
Women's Hospital and the Joslin Diabetes Center, all in Boston, Massachusetts,
examined whether a blood component called complement, can account for the vascular
problems seen in diabetics. Complement is involved in destroying foreign cells and
particles as part of the immune response. The team's results are published in the
May 9th issue of the Proceedings of the National Academy of Sciences." contact the podiatry channel http://www.podiatrychannel.com/PodiatryWorld/vascular.shtml
Coronary atherosclerosis and mortality in type 2 diabetes:medforum:"Diabetes, especially type 2, is associated with a markedly increased risk of
morbidity related to cardiovascular disease in general and coronary atherosclerosis
in particular. Mechanisms by which diabetes leads to this increase in mortality
remain unclear, and evidence linking the prognosis of diabetic patients with the
extent of coronary atherosclerosis has been conflicting [1, 2]. The study by Natali
et al. is an important contribution to our knowledge in this field because it
provides some evidence of a linkage between diabetes, extensive coronary lesions and
prognosis.The concept that diabetes is associated with more severe atherosclerosis
is supported by clinical and angiographic observations: diabetic patients have a
smaller reference diameter, longer lesions, and experience a higher restenosis rate
following angioplasty [3–5]. Also, long-term survival is better in multivessel
patients treated with coronary artery bypass surgery than in those treated with
coronary angioplasty [6]. However, the question remains whether the increased
morbidity and mortality in diabetes is due to anatomical features or to other
mechanisms." http://www.medforum.nl/idm/coronary_atherosclerosis_and____.htm
Diabetics are prone to atherosclerosis and other complications:The internet Pathology Laboratory:"Persons with diabetes mellitus, either type I or type II, have early and accelerated
atherosclerosis. The most serious complications of this are atherosclerotic heart
disease, cerebrovascular disease, and renal disease. The most common cause of death
with diabetes mellitus is myocardial infarction.
Peripheral vascular disease is a particular problem with diabetes mellitus and is
made worse through the development of diabetic neuropathy, leading to propensity for
injury.The eyes can be affected in several ways by diabetes mellitus. Diabetic
retinopathy is one of the leading causes for irreversible blindness in the United
States. This retinopathy can occur with either type I or type II diabetes mellitus,
usually a decade or so after the onset of diabetes. Most persons with type I
diabetes and many of those with type II diabetes develop some background
(non-proliferative ) retinopathy. Proliferative retinopathy is more ominous and is
more likely to occur when diabetes mellitus is poorly controlled.
In severe retinopathy, neovascularization may lead to adhesions (synechiae) between
iris and cornea or iris and lens. Neovascularization of the iris leads to secondary
glaucoma with blindness.
Cataracts are more common in diabetics. This predilection for development of
cataracts is felt to result from hyperglycemia leading to accumulation of sorbitol
that results in osmotic damage to the crystalline lens." http://www-medlib.med.utah.edu/WebPath/TUTORIAL/DIABETES/DIABETES.html
Vascular complications of diabetes:British Medical Journal:"A continuous relation exists between glycaemic control and the incidence and
progression of microvascular complications. Hypertension and smoking also have an
adverse effect on microvascular outcomes. In the diabetes control and complications
trial--a landmark study in type 1 diabetes--the number of clinically important
microvascular endpoints was reduced by 34-76% in patients allocated to intensive
insulin (that is, a 10% mean reduction in glycated haemoglobin ([Hb.sub.A1c])
concentration from 8.0% to 7.2%). However, these patients also had more
hypoglycaemic episodes. Similarly, in the UK prospective diabetes study of patients
with type 2 diabetes, an intensive glucose control policy that lowered glycated
haemoglobin concentrations by an average of 0.9% compared with conventional
treatment (median [Hb.sub.A1c] 7.0% v 7.9%) resulted in a 25% reduction in the
overall microvascular complication rate. It was estimated that for every 1%
reduction in [Hb.sub.A1c] concentration there is a 35% reduction in microvascular
disease." http://www.findarticles.com/cf_dls/m0999/7241_320/61995034/p1/article.jhtml
How hyperglycemia promotes atherosclerosis:Biomed Central:"Both type I and type II diabetes are powerful and independent risk factors for
coronary artery disease (CAD), stroke, and peripheral arterial disease.
Atherosclerosis accounts for virtually 80% of all deaths among diabetic patients.
Prolonged exposure to hyperglycemia is now recognized a major factor in the
pathogenesis of atherosclerosis in diabetes. Hyperglycemia induces a large number of
alterations at the cellular level of vascular tissue that potentially accelerate the
atherosclerotic process. Animal and human studies have elucidated three major
mechanisms that encompass most of the pathological alterations observed in the
diabetic vasculature: 1) Nonenzymatic glycosylation of proteins and lipids which can
interfere with their normal function by disrupting molecular conformation, alter
enzymatic activity, reduce degradative capacity, and interfere with receptor
recognition. In addition, glycosylated proteins interact with a specific receptor
present on all cells relevant to the atherosclerotic process, including
monocyte-derived macrophages, endothelial cells, and smooth muscle cells. The
interaction of glycosylated proteins with their receptor results in the induction of
oxidative stress and proinflammatory responses 2) oxidative stress 3) protein kinase
C (PKC) activation with subsequent alteration in growth factor expression.
Importantly, these mechanisms may be interrelated. For example,
hyperglycemia-induced oxidative stress promotes both the formation of advanced
glycosylation end products and PKC activation." http://www.biomedcentral.com/1475-2840/1/1
Blocking "Rage" Prevents Diabetic Atherosclerosis:David Stern, Ann Marie Schmidt:"P&S researchers report that they have prevented the accelerated atherosclerosis
associated with diabetes in mice by blocking activation of a cell-surface receptor
called RAGE. Atherosclerosis is the major cause of death and disability for patients
with diabetes, and people with diabetes account for more than half of all heart
attacks in the United States.
The research, reported in the September 1998 issue of Nature Medicine, suggests the
discovery may provide the basis for new therapeutic strategies. Currently the only
treatments for atherosclerosis associated with diabetes are control of blood sugar
and conventional treatments for patients without diabetes.
"Our research emphasizes a target that people didn't consider before. RAGE looks
like it is a candidate for future therapy," says Dr. David Stern, professor of
physiology and cellular biophysics and surgery. Dr. Stern and Dr. Ann Marie Schmidt,
assistant professor of surgical science and of medicine, led the P&S research team." http://cpmcnet.columbia.edu/news/journal/archives/jour_v19no1/rage.html
How Diabetes Causes Hypertension:Michael J. Quon, MD, PhD:"The hemodynamic response to insulin involves, in part, the concurrent release of
endothelin and NO, and Dr. Quon believes that the imbalance between the release of
these two substances may predispose to the development of hypertension and
atherosclerosis. The endothelium produces NO in a regulated fashion; it has a
vasodilatory effect stimulated by insulin, an effect opposed by the vasocontriction
provided by endothelin. Vasodilation is impaired in insulin resistance." apicenter@hotmail.com http://stores.yahoo.com/apinet/emmecofdiabc.html
Exercise may ease risk of diabetic heart disease:Kate N. Grossman:"Elevated levels of insulin appear to make people prone to blood clots, a finding
that could explain why diabetics are so susceptible to heart attacks and strokes,
researchers say.
About 75 percent of people with the most common type of diabetes die of heart
attacks or strokes.
Previous studies have found that high blood pressure and low levels of "good"
cholesterol account for about half of the higher-than-normal risk of cardiovascular
disease in diabetics.
This new study -- published in Wednesday's Journal of the American Medical
Association -- tried to determine what role elevated insulin levels play. Based on
their findings, the researchers suggest that exercise, which makes the body more
receptive to the effects of insulin, might improve a person's ability to dissolve
blood clots and possibly lower the risk of cardivascular disease.
"Exercise ought to be really, really encouraged," said Dr. James B. Meigs, an
internist at Massachusetts General Hospital in Boston." http://www.southcoasttoday.com/daily/01-00/01-14-00/c02li076.htm
Diabetic Muscle Infarction triggered by an ischemic event:traders.co.uk:"The April issue of the Annals of the Rheumatic Diseases carries an article
discussing and reporting on two cases of diabetic muscle infarction, a rare
condition that "can be triggered by an ischemic event and cause extensive muscle
necrosis through hypoxia-reperfusion injury and compartment syndrome."
The authors report describe it as "a rare cause of acute severe muscle pain" and
note that it must be distinguished from "focal or systemic myositis, localized
abcess, hematoma, deep venous thrombosis, osteomyelitis, and muscle tumor (sarcoma
or lymphoma)."
Case 1.
The authors describe the case of a 46 yr old Type 2 diabetic woman with nephropathy
and proliferative retinopathy who presented to a hospital with a painful, swollen
left leg after an insulin injection to her left leg. Doppler ultrasound excluded DVT
and a CT scan showed swelling of the left vastus medialis muscle; muscle biopsy
showed chronic inflammation. ESR was elevated, while ANCA, ANA and rheumatoid factor
were negative. The woman was sent for further evaluation after lack of improvement
with 6 wks treatment with steriods and antituberculosis drugs"
http://www.traders.co.uk/insulintrust/jan142002/id4.htm
Protein kinase C and the development of diabetic vascular complications:Pub Med National Libraray of Medicine:"Hyperglycemic control in diabetes is key to preventing the development and
progression of vascular complications such as retinopathy, nephropathy and
neuropathy. Increased activation of the diacylglycerol (DAG)-protein kinase C (PKC)
signal transduction pathway has been identified in vascular tissues from diabetic
animals, and in vascular cells exposed to elevated glucose. Vascular abnormalities
associated with glucose-induced PKC activation leading to increased synthesis of DAG
include altered vascular blood flow, extracellular matrix deposition, basement
membrane thickening, increased permeability and neovascularization. Preferential
activation of the PKCbeta isoform by elevated glucose is reported to occur in a
variety of vascular tissues." http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11903
393&dopt=Abstract
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Nurses' Station:"The idea for the Nurses' Station Catalog was conceived in 1989. After searching the marketplace in response to customer inquiries, it became obvious that there were no catalogs of this type serving the nursing profession. To be sure, there were several catalogs offering nurse's uniforms and a smattering of professional items. But there weren't any catalogs at the time offering a range of gifts, clothing, professional items, name badges, shoes and scrubs for nurses. It took two years of hard work to gather samples and put a together a catalog of the most unique and high-quality items for nurses."
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ER:"Media products under your influence, particularly the NBC/Warner drama "ER," are harming the profession of 2.7 million American nurses by giving the public an inaccurate and inadequate account of what nurses really do to save and improve lives. Research suggests that "ER" strongly and negatively influences the way children view nursing. These products contribute to the nursing shortage, a public health crisis that threatens millions worldwide." http://www.truthaboutnursing.org/letters/er/
House, MD:"The main patient in tonight's episode of Fox's House was a nurse who believed that a cat tended to sit with those who were about to die--including, recently, the nurse herself. That may not sound like a promising vehicle for House to improve its abysmal portrayal of nursing. But the show actually presents the nurse as someone with health knowledge. And her search for meaning in faith, for some reason in tragic events, is a real counterpoint to House's cold rationality. Indeed, despite the obvious potential for mockery in the cat angle, the mighty House treats the nurse with considerable respect--he seems to care what she thinks, or at least to find her views unnerving. Of course, the nurse plays no real clinical role in the episode, and no other nurses do either. So the episode suggests, as usual, that physicians provide all important care in hospital settings, including all meaningful psychosocial and physical care. Still, any suggestion that intelligent life resides in a nurse is a welcome departure for House (and for the episode's writer Peter Blake, who also penned a November 2005 House episode that was notable for its physician glorification and its casual contempt for other health professions). Tonight's episode, "Here Kitty," drew 13.1 million U.S. viewers. more... see the relevant film clips... and please join our letter writing campaign!" http://www.truthaboutnursing.org/letters/house/
Private Practice:"ABC's Private Practice, whose season ends tomorrow, April 30, may be the only broadcast network show with a major nurse character to return next season. In the February 5 episode (Mike Ostrowski's "Acceptance," 13 million U.S. viewers), lone nurse character Dell Parker, who is studying to be a midwife, shows some tentative clinical aptitude and knowledge to go with his boyish eagerness. Under the close supervision of OB/GYN Addison Montgomery, Dell ably performs a vacuum-assisted delivery. Later he haltingly guides the baby's parents toward breastfeeding. Dell also performs an assured solo ultrasound of pregnant psychiatrist Violet Turner, calming her panic attack and eliciting her agreement to his own suggestion that, though he's "not a doctor," he will likely become a "pretty good midwife." The show still condescends to Dell, who is also the office manager/receptionist at the LA clinic where the show is set. In the March 26 episode (Craig Turk's "Do the Right Thing," 10.1 million U.S. viewers)," http://www.truthaboutnursing.org/letters/pp/
"Scrubs" defines nursing:""Scrubs" defines nursing: it's all about shutting up and following physician "orders. " Tonight's episode of NBC's "Scrubs," which purports to teach nurse Carla Espinosa that nursing is all about doing what physicians tell you, is one of the most virulently anti-nurse prime time television episodes the Center has ever seen. more..." http://www.truthaboutnursing.org/news/2009/may/06_scrubs.html
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