Biomedical subjects
Publications and source records attributed to L B Haas.
The most common types of diabetes observed in a primary care practice are type 1, type 2, and gestational diabetes. Type 1 diabetes is an autoimmune disease characterized by total destruction of the pancreatic beta cells, whereas insulin resistance, impaired insulin secretion, and inappropriate hepatic glucose secretion characterize type 2 diabetes. Gestational diabetes is similar to type 2 diabetes, but is first diagnosed during pregnancy.
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Explore the source record for details and available documents.
This article addresses the long-term or chronic complications of diabetes mellitus, including macroangiopathy, microangiopathy, and neuropathy, with a special emphasis on the insensate foot frequently seen in patients with diabetes. This article presents nursing strategies for assessment and suggestions for effective nursing interventions related to these complications. It also identifies some strategies for preventing further complications.
As the number of patients with diabetes treated by peritoneal dialysis continues to grow, nurses will increasingly be challenged to assist these patients to prevent, manage and adapt to the chronic complications of diabetes, including microangiopathy, macroangiopathies and neuropathies. This article presents nursing assessments and interventions related to these chronic complications to hopefully enhance the quality of life for these patients.
Drug therapy with oral hypoglycemic agents and insulin are components of diabetes management regimens that also include diet, exercise/activity, monitoring, and education. Major concerns for practitioners using drug therapy are selection of the appropriate therapy for a particular patient, and drug interactions and side effects. Drug therapy is based on knowledge of the medications' pharmacokinetics; glucose goals, as determined by practitioners and patients; common sense; and strong participatory relationships between practitioners and patients and, if indicated, families. When using insulin, practitioners need to consider the differences between insulin therapy for insulin-dependent and non-insulin-dependent diabetes; how to initiate, adjust, and supplement insulin; situations that require variations in insulin therapy; and injection mechanics.
The acute and chronic complications of diabetes account for the morbidity and mortality associated with this disease. Acute complications include diabetic ketoacidosis, hyperosmolar hyperglycemic nonketotic coma, and hypoglycemia. Chronic hyperglycemia is central to the pathophysiology of chronic complications such as cardiovascular and peripheral vascular disease, retinopathy, nephropathy, and neuropathy. Pathophysiology and assessment of, and interventions for these complications are discussed.
The prevalence and incidence of diabetes are higher in several ethnic minority populations in the US, including Hispanic, Asian, African, and Native Americans. Nurse practitioners will encounter increasing numbers of patients from these population groups in the future. Of major concern is the high prevalence of additional risk factors, such as smoking, obesity, hypertension, hyperlipidemia, and low socioeconomic status, which contribute to the increased rate of complications of this disease in these groups. Emphasis must be placed on screening and risk reduction, and diabetes management in these groups must be culturally sensitive and relevant.
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21 hypertriglyceridemic hemodialysis patients were treated with 1--2 g/week of clofibrate. The dosage reduction from the usual clofibrate dose of 14 g/week avoided toxicity and corrected the abnormalities in serum triglyceride and high density lipoprotein cholesterol levels to or toward normal.
In 11 hypertriglyceridemic patients on hemodialysis, clofibrate (1 to 1.50 g per week) reduced plasma triglyceride (-40 +/- 20%, P less than 0.001), very-low-density-lipoprotein triglyceride (-44 +/- 20%, P less than 0.001) and very-low-density lipoprotein cholesterol (-39 +/- 25%, P less than 0.01), and it increased high-density-lipoprotein cholesterol (82 +/- 106%, P less than 0.005). Low pretreatment lipoprotein-lipase activity in adipose-tissue specimens and postheparin plasma increased to normal with clofibrate, whereas low hepatic triglyceride lipase activity did not change. The reduced very-low-density-lipoprotein triglyceride correlated with the increased lipoprotein-lipase activity in adipose tissue (rs = 0.792, P less than 0.02, n = 8) and postheparin plasma (rs = 0.851, P less than 0.02, n = 8), whereas increased high-density-lipoprotein cholesterol correlated with changes in this activity in adipose tissue (rs = 0.696, P less than 0.06) and post-heparin plasma (rs = 0.679, P less than 0.10). There was no correlation between changes in hepatic triglyceride lipase activity and plasma lipids during treatment. Reduced lipoprotein-lipase activity may cause hypertriglyceridemia and decreased high-density-lipoprotein cholesterol in patients on hemodialysis; clofibrate may correct these abnormalities by increasing lipoprotein-lipase activity to normal.
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The acute effect of feeding high concentration carbohydrate meals containing equicaloric amounts of dextrose or sucrose on the activity of adipose tissue lipoprotein lipase and the concentration of plasma triglyceride was assessed in 11 hemodialysis patients. Dextrose feeding resulted in higher postprandial glucose levels and a greater insulin response than sucrose. The relationship between the postprandial change in the activity of adipose tissue lipoprotein lipase and the insulin response to feeding almost reached statistical significant (rs = 0.40, P = 0.08, n = 20), and the increase in the activity of the enzyme after dextrose feeding was greater than after sucrose (P less than 0.01). There was a significant decrease in plasma triglyceride levels after dextrose feeding (P less than 0.01), but no change was observed after the ingestion of sucrose. These results indicate that the inability of the administered sucrose to raise the plasma insulin concentration to the same level as isocaloric amounts of dextrose probably accounts for the smaller increase in the activity of adipose tissue lipoprotein lipase after sucrose. The failure of plasma triglyceride levels to fall after sucrose feeding suggests that the extent to which the activity of adipose tissue lipoprotein lipase increases postprandially may be important in the regulation of triglyceride metabolism in hemodialysis patients.
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A daily dose of 1.5 to 2.0 gm of clofibrate lowers serum triglyceride (TG) levels in patients with normal renal function but causes muscle toxicity and elevated creatine phosphokinase (CPK) levels in patients with long-term renal failure. Plasma clofibrate disappearance is prolonged as much as seven times normal in severely uremic patients. A marked reduction in the standard 14 gm/wk clofibrate dose to a total dose of 1.0 to 1.5 gm/wk effectively lowered serum TG levels (--28%, p less than 0.02) in hypertriglyceridemic hemodialysis patients without toxicity. The serum clofibrate level at this dose was comparable to that in hypertriglyceridemic nonuremic patients receiving 14 gm/wk of clofibrate. The dose of clofibrate administered to hemodialysis patients can be adjusted to avoid toxicity and provide the desired therapeutic effect by monitoring serum CPK and TG levels.
Fasting levels of serum triglyceride, cholesterol, high-density lipoprotein (HDL), apoprotein A-I, HDL cholesterol, and HDL triglyceride were measured in 94 uremic males receiving maintenance hemodialysis and 6 uremic males receiving chronic peritoneal dialysis. These patients had higher serum triglyceride levels (p less than 0.001) and lower cholesterol levels (p less than 0.001) than normal controls. The dialysis patients treated with androgen or propranolol and those who were hypothyroid or diabetic had significantly higher triglyceride levels than the other dialysis subjects. The dialysis patients who had no additional secondary causes of hypertriglyceridemia had abnormalities in HDL; in comparison to normals and triglyceride-matched controls, these patients had elevated HDL triglyceride levels and low HDL cholesterol levels, despite similar HDL apoprotein A-I levels. The HDL cholesterol levels appeared to be lower in those patients than could be accounted for by their degree of hypertriglyceridemia.
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