Atherosclerosis and Dyslipidemia:Diabetic-Lifestyle:"The importance of treating dyslipidemia in type 2 diabetics is linked to an associated two to fourfold excess risk of coronary heart disease. There are also findings that the increased cardiovascular risk factors exist before the onset of type 2 diabetes. The most common pattern of dyslipidemia in type 2 diabetes is elevated triglycerides and decreased HDL levels. Diabetics may also have elevated levels of LDL and VLDL; however, type 2 diabetic patients typically have more smaller, denser LDL particles, which possibly increases atherogenicity, even if the absolute concentration of LDL is not significantly increased. There are few studies of lipids and lipoproteins as predictors of CHD in type 2 diabetics with somewhat contradictory results, but in observational studies HDL may be the best predictor of CHD in type 2 diabetes followed by triglycerides and total cholesterol. Furthermore, the results from clinical trials and observational studies in diabetic subjects are somewhat inconsistent in that LDL lowering has been beneficial in clinical trials but not a significant predictor in observational studies." publishers@diabetic-lifestyle.com http://www.diabetic-lifestyle.com/articles/apr99_whats_1.htm
Diabetes and Hyperlipidemia:National Pharmacy Cholesterol Council:"Initial treatment for hyperlipidemias in diabetes involves lifestyle changes and optimizing glucose control. Weight reduction is recommended in overweight patients and is associated with improvements in insulin sensitivity, glucose control, and lipid levels. A NCEP Step-One diet is suggested initially with less than 30% of calories from fat, less than 10% of total calories from saturated fat, and a cholesterol intake of less than 300 mg/dl.(11) If the desired outcomes are not achieved, the NCEP Step-Two diet can be implemented with a further reduction in saturated fat to less than 7% of total calories and less than 200 mg of cholesterol daily. Generally, complex carbohydrates are substituted for the fat calories. There is some controversy surrounding this issue, though, since a high carbohydrate diet can cause an elevation in triglycerides and lower HDL cholesterol. As an alternative, monounsaturated fats can be used to replace some of the carbohydrate.(12) Exercise is also important to facilitate weight loss and improve lipid levels with the plan individualized for the patient. Optimizing blood glucose control will help to improve the lipid profile but may not normalize it completely." National Pharmacy Cholesterol Council
Health Tech Solutions
4455 Duncan, Suite 101
St. Louis, MO 63110-1088 http://www.npccnet.org/NPCC/fatfacts/fat3n5.html
What are the Complications of Diabetes?:diabetes-tests.com:"Diabetes increases the risk for atherosclerotic vascular disease. This risk is greatest in people who have other known risk factors, such as dyslipidemia, hypertension, smoking, and obesity. Furthermore, in type 2 diabetes there is an additional increased risk for obesity and lipid abnormalities independent of the level of glycemic control. A common abnormal lipid pattern in such patients is an elevation of VLDL, a reduction in HDL, and an LDL fraction that contains a greater proportion of small, dense LDL particles. Recent studies have shown Lp(a) to be a significant independent risk factor for assessing CHD." http://www.diabetes-tests.com/Complications.html
Dyslipidemia in type 1 diabetes:medforum:"This study was undertaken with the purpose of identifying an important risk factor for atherosclerotic complications in people with type 1 diabetes mellitus, namely dyslipidemia. Dyslipidemia has been widely discussed in type 2 diabetes but very little information has been published in type 1. The study also attempted to elucidate epidemiological data on the prevalence of dyslipidemia as well as its phenotypical distribution in type 1 diabetes. Since previous studies have primarily emphasized only the total cholesterol and total triglyceride concentrations with regard to dyslipidemia, this study aimed to assess the effects of improving glycemic control on the prevalence of dyslipidemia and on LDL and HDL cholesterol concentrations in type 1 diabetic patients compared with a non-diabetic control group." http://www.medforum.nl/idm/dyslipidemiaintype1diabetes.htm
Management of dyslipidemia in adults with diabetes:National Guideline Clearinghouse:"Modification of Lipoproteins by Nutritional Therapy and Physical Activity
Diabetic patients who are overweight should be given a prescription for medical nutrition therapy (MNT) and for increased physical activity. The proportion of saturated fat in the meal plan should be reduced. The American Diabetes Association (ADA) suggests either an increase in carbohydrate or monounsaturated fat to compensate for the reduction in saturated fat. Some (but not all) studies suggest that a high-monounsaturated-fat diet may have better metabolic effects than a high-carbohydrate diet, although other experts have suggested that such a dietary modification may make weight loss more difficult in obese diabetic patients." info@guideline.gov http://www.guideline.gov/VIEWS/summary.asp?guideline=2358&summary_type=brief_summary&view=brief_summary&sSearch_string=
Cardiac Implications Diabetic Dyslipidemia:Diabetes Care:"Three large-scale studies with fibric acid drugs have included diabetic patients: The Helsinki Heart Study, the Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial (VA HIT), and the Diabetes Atherosclerosis Intervention Study (DAIS). The Helsinki Heart Study This study measured the effect of treatment with gemfibrozil versus placebo in men with an average total cholesterol level of about 290 mg/dL and a triglyceride level of approximately 175 mg/dl. The study included 135 patients with type 2 diabetes. The Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial (VA HIT) Investigators compared gemfibrozil versus placebo in 2531 men with CHD whose primary lipid abnormality was a low HDLlevel.Diabetes Atherosclerosis Intervention Study (DAIS) This was a 3-year, multinational, angiographic, double-blind, placebo-controlled study, in which subjects received 200 mg micronized fenofibrate or placebo. The primary objective was to determine if long-term correction of dyslipoproteinemia with fenofibrate decreased progression, or caused regression, of preexisting coronary atherosclerosis." http://www.diabetes-tests.com/Cardiac_Implications.html
Defeating dyslipidemia in the diabetic patient:Power Pak:"Elevation of triglyceride levels and reduction in HDL levels are common in type 2 diabetic patients. While LDL levels are not usually elevated in type 2 diabetes, the LDL component in these patients is typically made up of smaller and denser particles than those seen in nondiabetic populations, and this specific difference tends to facilitate plaque formation. This highlights the importance of detecting and treating any dyslipidemia in the diabetic patient, since he bears not only a heightened risk of developing dyslipidemia but also a heightened risk of macrovascular complications in response to the resulting atherosclerosis and consequently a higher mortality rate once coronary heart disease develops." http://www.powerpak.com/PowerGraphs/1999/aug/Defeating.cfm
The Role of Lipid Lowering Agents In The Diabetic Patient:St Paul's Hopital:"The American Diabetes Association has recently recommended new guidelines for the treatment of diabetic dyslipidemia. A brief summary follows: The first priority for therapy is lowering of LDL cholesterol. The primary therapy for LDL lowering is HMG-CoA reductase inhibitors. The first treatment for elevated triglycerides is improved glycemic control. The LDL goal (and initiation level for pharmacological therapy) for diabetic subjects with CHD is a 100 mg/dl. For diabetic subjects without preexisting CHD, the LDL goal (and initiation level) is 130 mg/dl. However, in a footnote to the table (because of controversy among the committee), it was suggested that diabetic subjects without prevalent CHD but with other CHD risk factors (smoking, hypertension, family history of CHD, low HDL, microalbuminuria, and/or proteinuria) might be treated to an LDL goal of less than 100 mg/dl. Most diabetic subjects are expected to have at least one other CHD risk factor." St Paul's Hopital
B180-1081 Burrard St.
Vancouver, BC V6Z 1Y6.
Phone: 604-631-5591 http://www.healthyheart.org/Education/Conferences/980620/AbHaffner.htm
ADVANCES IN THE STUDY OF LIPIDS AND DIABETES:diabetes forum:"The characteristic diabetic dyslipidemia is that of low HDL cholesterol, hypertriglyceridemia, and highly atherogenic small and dense LDL particles. The etiology of accelerated atherosclerosis in individuals with diabetes is clearly multifactor, but dyslipidemia has been shown to play an important role in this process.There is now abundant clinical evidence that the typical dyslipidemia associated with insulin-resistant states and diabetes is highly atherogenic, and plays a major role in the pathogenesis of the most important clinical problem to affect individuals with these conditions. Although lipid-lowering therapy and treatment of the underlying insulin resistance are promising areas of research, solid clinical trial evidence proving the safely and efficacy of these methods is currently lacking. Until such evidence becomes available it is recommended that patients with insulin resistance and diabetes be treated very aggressively for risk-factor modification." Mr. K.Janaki Raman.
Chief Diabetologist
23-B Ramakrishna Road,
Salem 636 007, TamilNadu. India feedback@diabetesforum.net http://www.diabetesforum.net/eng_treat_lipids-diabetes.htm
There is more than one type of dyslipidemia in diabetes:healthyheart.org:"There are 5 classes of lipoproteins: chylomicrons, very low density lipoproteins (VLDL), intermediate density lipoproteins (IDL), low density lipoproteins (LDL) and high density lipoproteins (HDL). Any of these lipoproteins can be affected, singly or in combination, in dyslipidemias in diabetes.The type of diabetes and the quality of glucose control determine which lipoprotein class is abnormal. The changes int he lipoprotein profile are shown in Table 2." http://www.healthyheart.org/Education/dyslip/dyslip04.html
Slide program for management of dyslipidemia in diabetic patients:Cariological Society of India:"This slide program is intended for physicians and pharmacists interested in the incidence, causes, and management of dyslipidemia in patients with diabetes
The purpose of this slide program is to review the additional risk of cardiovascular disease faced by patients with type 2 diabetes, discuss the causes of this increased risk, especially dyslipidemia, and describe how physicians can manage cardiovascular risk factors with diet, exercise, and pharmacotherapy, based on data from clinical trials.CHD is the leading cause of death among patients with type 2 diabetes. Patients with type 2 diabetes frequently have dyslipidemia, which may contribute significantly to accelerated coronary atherosclerosis.
Because risk factors for heart disease are believed to be additive (even multiplicative), mild degrees of dyslipidemia may increase CHD risk. Therefore, controlling dyslipidemia should be given equal emphasis as controlling hyperglycemia when developing strategies for managing type 2 diabetes." http://csitn.org/june_diabetic.htm
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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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