2019-05-01_Diabetes_Self-Management

DIABETES

[DEFINITIONS]

ACE INHIBITORS

A class of medicine usually used to treat

high blood pressure. Angiotensin-converting

enzyme (ACE) inhibitors also appear to protect

people with diabetes from diabetic nephropa-

thy (kidney disease).

People with diabetes are especially

prone to hypertension (defined as a

blood pressure level of 140/90 mm Hg

or greater). Hypertension increases the

risk not only of heart disease and stroke but

also of peripheral vascular disease, dia-

betic retinopathy (eye disease), diabetic

nephropathy and possibly diabetic neu-

ropathy (nerve disease). The American

Diabetes Association (ADA) currently

recommends a target blood pressure

level of under 130/80 mm Hg in people

with diabetes.

The ADA recommends measures

for lowering blood pressure, including

weight loss, sodium restriction and exercise.

When these measures aren’t enough,

medications may be needed. There

are several different classes of blood

pressure drugs, including angiotensin-

receptor blockers (ARBs), diuretics, beta

blockers and ACE inhibitors.

Overall, drug therapy has been

shown to substantially decrease the

risk of cardiovascular disease, diabetic

retinopathy and diabetic nephropathy. ACE

inhibitors may have a special advantage

in terms of slowing the progression of

diabetic nephropathy. Research shows that

ACE inhibitors can slow the progres-

sion of kidney disease more effectively

than other antihypertensive drugs and

that they may be able to protect the

kidneys even in people with diabetes

whose blood pressure levels are in the

normal range.

DIABETIC BLADDER

Bladder problems caused by diabetic auto-

nomic neuropathy (nerve disease). The blad-

der stores urine produced by the kidneys.

Ordinarily, once urine is collected in the

bladder, the pressure on the inner wall of

the bladder signals the urge to urinate.

Urine flows out of the bladder through a

narrow channel called the urethra, and this

flow is controlled by a ring of muscles known

as the urinary sphincter. 

Various nerves are responsible for signaling

the brain that we need to urinate, signaling the

bladder to contract to force the urine out and

controlling the tone of the urinary sphincter

to allow us to urinate—and then stop urinat-

ing when we’re done. Diabetic autonomic

neuropathy can damage any of these nerves,

causing individuals to urinate less often, have

difficulty completely emptying the bladder,

have a weak stream of urine, have difficulty

starting to urinate or have dripping after-

ward. In some cases, diabetic bladder can

lead to urinary tract infections (UTIs).

Some drugs may help. Bethanechol

increases the tone of the muscle that con-

tracts to begin bladder emptying. Terazo-

sin and doxazosin can relax the urinary

sphincter to allow it to open and let urine

pass through. 

LIPID PROFILE

Results of a blood test that measures levels of

lipids, or fats, including cholesterol and tri-

glycerides, which affect a person’s risk of

heart disease. Cholesterol is both produced

by the body and absorbed from some

of the foods you eat. Cholesterol and

triglycerides are transported in the blood

by combinations of lipids and proteins

called lipoproteins, which are made up

of protein and cholesterol. HDL (high-

density lipoprotein) cholesterol, the

so-called “good” or “healthy” cho-

lesterol, can help to clear cholesterol

deposits in blood vessels left by another

blood component called low-density lipo-

proteins, or LDLs.

The American Diabetes Association

(ADA) recommends keeping HDL cho-

lesterol levels at or above 40 mg/dl in

men and 50 mg/dl or above in women.

The ADA also recommends keeping tri-

glyceride levels under 150 mg/dl.

You can raise your HDL cholesterol

level, lower your triglyceride level, and

lower your risk of heart disease by keep-

ing your blood glucose level as close to

the normal range as possible, exercising

regularly, stopping smoking, losing weight

if you are overweight, maintaining a diet

low in saturated fat and cholesterol, and

consuming more soluble fiber. †

Robert Dinsmoor is a medical writer and

editor, is a contributing editor of Diabetes

Self-Management.

NEWS &

NOTES

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12 May/June 2019