Dislipidemia of Diabetes

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Dislipidemia of Diabetes

Postby dlcnurse » Thu Nov 08, 2007 2:24 am

In another topic, I mentioned the prevalence of metabolic syndrome and diabetes. Mentioned is the connection of cholesterol levels and how it plays a role in the metabolic syndrome.

The pathogenesis of cardiovascular disease of the diabetic is not fully understood. It is likely to be directly influenced by the diabetic state.

The Framington Study found a two-to-threefold increased risk of clinical atherosclerotic disease in those with diabetes compared with non-diabetic persons, including intermittent claudication (peripheral arterial disease), congestive heart failure, and coronary heart disease.

So what is atherosclerosis? Atherosclerosis is hardening of the arteries. Arteries are blood vessels that carry oxygen and nutrients from the heart to the rest of the body.
Atherosclerosis can start as early as childhood. It is a slow progressive disease that starts with damage or injury to the inner layer of an artery.
It can affect arteries anywhere in the body. When it affects the limbs, it can result in peripheral arterial disease, in the heart results in the form of coronary arterial disease or commonly abbreviated as CAD, angina or known as chest pain, or a heart attack. In the brain, it results in strokes or transient ischemic attacks, commonly known as TIA's.

Cardiovascular events are four times more common in individuals with diabetes, and occur at a younger age, and have a higher case mortality rate.

Studies have shown that at least 60% of adults with diabetes have high blood pressure, and nearly all have one or more lipid abnormalities.

So, you are asking, what does this have to do with diabetes, the metabolic syndrome and dislipidemia?

The characteristic pattern of lipoproteins in Type 2 diabetes includes an increase in triglycerides, a decrease in HDL (high density lipoproteins), and more small dense LDL (low density lipoproteins) particles that are more intrinisically atherogenic than the larger normal particles of LDL.
And because of their small density, a greater number of LDL particles are contained within the plasma of the blood.

So what exactly is Triglycerides?
Triglycerides are a type of fat found in the blood. When you eat, your body converts any calories it doesn't need to use right away into triglycerides. These are stored in fat cells. Later, hormones release triglycerides for energy between meals.
HDL is the "good" cholesterol. It helps to remove deposits from the inside of the blood vessels and stops the blood vessel from getting blocked.
LDL is the "bad" cholesterol, it can narrow or block the arteries by a build up in the arterial wall.
With diabetes, hyperglycemia results in higher concentrations of cellular glucose levels in endothelial cells unable to reduce glucose intake. It causes glycosylation of proteins, which leads to cross-linking of collagen and other extracellular matrix proteins in the arterial wall that leads to the increased risk for atherosclorosis.

Okay, now I will try to put it in English---
glycosylation means the addition of sugar molecules that bond to a protein or lipid molecule. These molecules go through a series of slow reactions through the body, and the end products from this process are eliminated from the body slowly. The half life of these products are 240 days. This is how Diabetics are monitored by doing a Hgb A1c. Because of the long lived cells, this simple blood test can determine what the amount of glucose that has built up in the cells over a 2-3 month period.

The problem comes in because of the slow elimination of these sugar molecules that have bound to proteins or lipids, it develops into plaque formation that leads to atherosclerosis.
The blood vessels are directly damaged by this process. Because of the elevated triglycerides, it destroys the protective mechanisms of HDL and so causes a decrease in the "good" cholestrol. Which in turn allows for more build up of the "bad" cholesterol, blocking or narrowing the arteries with plaque.

And because of this buildup, it also causes a stiffening of the collagen in the blood vessel walls leading to hypertension, or elevated blood pressure. Because of the elevation in blood pressure, it tends to stimulate VLDL (also a form of cholesterol)production. This VLDL contains the highest amount of triglycerides. It is a cycle that repeats itself and continues to build up plaque on the arterial walls.
The prevalence of hypertension is 1.5 to 3 times higher in diabetics. Studies show that 71% of persons with diabetes have high blood pressure. The goal is to keep blood pressure below 130 for the top number and below 80 on the bottom number.
You can decrease your risks by lowering triglyceride levels, and decrease blood pressure which are directly linked to the metabolic syndrome
Use less oil, butter, margarine, and other fats'
Choose low fat dairy products
Eat small servings of meat, fish, and poultry.
Choose whole grains in breads and cereals
Exercise at least 30 minutes each day
Decrease sodium intake (salt)
Use a meal plan to control blood sugars.
Avoid eating foods high on the glycemic index. Foods high on the glycemic index are good after exercise to restore but daily intake with cause a up and down effect on the blood sugar. Steady states are best to control the cycle of proliferation of the glycolation process.
Medications for high blood pressure as indicated by your physician if lifestyle changes does not lower it.

Consult a dietician to help you develop a meal plan if you aren't sure how to do it. Decreasing your risk for cardiovascular complications of diabetes can add years on to your life.
Diabetes is a life long illness that does not go away so being proactive in your life and maintaining blood glucose levels is a must to avoid some of the complications that comes with long term diabetes.
dlcnurse
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