Disease States

Chronic disease in where there is high levels of sugar in the blood. 

Causes:  Not enough insulin; resistance to insulin, or both

Symptoms:  blurry vision, excess thirst, fatigue, frequent urination, hunger, weight loss

• Tests: 
• -urine analysis (may suspect if blood sugar level >200mg/dL)
• -fasting blood glucose level
• -hemoglobin A1c
• -oral glucose tolerance test

• ACE-I:  first line of therapy due to renal protective & cardiovascular protective qualities
•       **Do not use for bilateral renal artery stenosis!**

Beta blockers, ARBs - okay as first line

Beta-blockers:  may mask signs of hypoglycemia (B1 preferred)

• Microproteinuria = ACE-I/ARB
• Gross proteinuria = ACE-I/ARB
•        Don't use both together!

Goal BP = 130/80

Most kidney diseases attack the nephrons and leaves them unable to remove of waste.

• CrCL < 60 mL/min
• SrCr > 1.5    
• AND/OR gross proteinuria

Want goal BP = 130/80

• ACE-I/ARB
•        *do not use if:   SrCr >/= 2.5 (males) or 2.0 (females)
•          or    K>5.0

Loop diuretics may be needed later in the disease (CrCL < 30 generally)

Metabolic syndrome is a name for a group of risk factors that occur together and increase the risk for coronary artery disease, stroke, and type 2 diabetes

• If "prediabetic" or at high risk for T2DM
• -ACE-I/ARB may decrease incidence
• -HCTZ or Beta-blocker may increase incidence

ACE-I has better data for preventing progression to diabetes

Heart failure is when the heart can no longer pump enough blood to the rest of the body

• RX USE:
• -ACE-I/ARB (if ace is not tolerated)
• & Beta-1 blocker  (or alpha/beta blocker-use B1)

• Aldosterone antagonists if stage III or IV or if EF<40%
• -or- hydralazine/isosorbide dinitrate (data for AA)

• Can add loop diuretic if fluid overload occurs
•        -peripheral edema
•        -positional shortness of breath

If diuretic resistance - can add thiazide to combat

Do NOT use:  nonDHP, clonidine, alpha-blockers

MI occurs when blood flow to part of your heart is blocked for long enough time that part of the heart muscle is damaged or dies

• Causes:
• -blood clot
• -atherosclerosis

• Start:
• Beta1-blocker & ACE-I (ARB if not tolerated)

*patient must be hemodynamically stable before adding B-blocker

Aldosterone antagonists, thiazides may be added.

Non-DHP may be used if B-blocker is contraindicated unless pregnacy