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Free Clinics of the Great Lakes Region 2007 Conference

Free Clinics of the Great Lakes Region 2007 Conference. Chronic Disease Management Hypertension & Diabetes: Invisible Danger. Andrea Lee Witt RN CDE. Mercy Medical Center-Clinton Education Specialist Mercy Medical Diabetes Center Gateway Free Clinic wittal@mercyhealth.com.

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Free Clinics of the Great Lakes Region 2007 Conference

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  1. Free Clinics of the Great Lakes Region2007 Conference Chronic Disease Management Hypertension & Diabetes: Invisible Danger

  2. Andrea Lee Witt RN CDE • Mercy Medical Center-Clinton • Education Specialist • Mercy Medical Diabetes Center • Gateway Free Clinic • wittal@mercyhealth.com

  3. Participants who complete this session should be able to: • 1. list the diagnostic & treatment targets for blood pressure and blood sugar • 2.describe the cell damage that occurs from elevations. • 3. list possible approaches people can take to improve BP and BG other than medication. • 4. list standard medication use for hypertension in diabetes. • 5. discuss approaches to better BGs/BPs for people with limited resources.

  4. ADA Clinical Practice Recommendations: • A1C of <7% • blood pressure <130/80 mmHg

  5. AHA Clinical Standards • Blood Glucose • <100 • Blood Pressure • <120/80 mmHg

  6. American Heart Association • Lower than 120/80 mm Hg is the most desirable reading • 120–139/80–89 is considered pre-hypertension. • Systolic of 140 or higher or diastolic of 90 or higher is considered hypertension

  7. ADA Clinical Standards • <130 systolic • <80 diastolic • BP measured each visit any BP >130/80 verified on a separate visit • BP>130/80 begins treatment

  8. Diabetes Causes Trouble • Increased glycosolation • Abnormal lipid metabolism • Increased inflammation • Hypercoagulation • Renal damage

  9. Hypertension Causes Trouble • Increased vessel permeability • Damage to vessel walls • Increased insulin resistance • Inflammation • Renal damage

  10. Diabetes cannot be ignored • Aggressive treatment of the blood sugar control is equal in importance to hypertension control • Evaluate BGs each visit • Always seek to achieve A1c<7% • Evaluate every 3 months

  11. Clinical Significance • Hypertension is common, affecting the majority of people with diabetes. • Hypertension is a major risk factor for heart disease,and vascular complications that may cause vision and kidney damage. • Hypertension can be caused by kidney disease. • Studies show thatBPs >115/75 mmHg are associated with more cardiovascular events and death in people withdiabetes

  12. Clinical significance • In 90 to 95 %: hypertension the cause is unknown. You can have it for years without knowing it. That's why it's called the “silent killer”  • African Americans are at higher risk for this serious disease • Salt/sodium sensitivity may be high in some people.

  13. Treatment Recommendations • 130–139 mmHgor a diastolic blood pressureof 80–89 mmHg should begiven lifestyle and behavioraltherapy alone for a maximum of3 months • If targetsare not achieved,medication therapy is added.

  14. Hey Wait a Minute…. • ….what was that about lifestyle and behavioraltherapy?????

  15. AHA tips • Body Mass Index (BMI) • <25 Kg/m² • Waist Circumference • <35 inches • Exercise • Minimum of 30 minutes most days, if not all days of the week

  16. Free Clinic realities • Do you find that free clinic patients : • are depressed • do not “do” exercise • eat salty food because it is cheap • do not believe that diet and exercise can work • ??

  17. Lifestyle: Food • DASH Diet • Caveman foods • Less salt and salty foods like: • Pop • Cold cuts/hotdogs/breakfast meats • Cheese/ pizza • Frozen entrees • Canned veggies/soups

  18. DASH DIET Servings for 1600 - 3100 Calorie diets Servings on a 2000 Calorie diet Grains and grain products(include at least 3 whole grain foods each day) 6 - 12 7 - 8 Fruits 4 - 6 4 - 5 Vegetables 4 - 6 4 - 5 Low fat or non fat dairy foods 2 - 4 2 - 3 Lean meats, fish, poultry 1.5 - 2.5 2 or less Nuts, seeds, and legumes 3 - 6 / wk 4 - 5 / wk Fats and sweets 2 - 4 limited

  19. Lifestyle: Activity • Moving a little at a time • Moving something • Moving >30 mins a day • 3-5 times a week • no more than 1 day off

  20. Lifestyle: Stress ReductionHoo weeee • Encourage good choices that de-stress • Encourage positive motion • Encourage hobbies • Encourage good friends • Be not the stressor today

  21. Treatment Recommendations • ACEinhibitor or an ARB.If one class is not tolerated, the othershould be substituted. • If needed to achieve blood pressure targets,a thiazide diureticshould be added.

  22. Treatment Recommendations • If ACE inhibitors,ARBs, or diuretics are used, watch kidneyfunction and potassium levels. • In patients with Type 1 diabetes, withhypertension and anydegree of albuminuria,ACE inhibitors havebeen shown to delaythe progression of kidney disease. • In those with Type 2 diabetes, hypertension,macroalbuminuria,and renal insufficiency, ARBs have been shownto delay the progressionof kidney disease.

  23. Free Clinic Thinkers: • Cheap can be effective. • Once a day is easier to remember to take. • Some drugs can be split-and some can’t. • Med/Food interactions should be posted. • When drug companies compete-we win!

  24. Your Mission • Be a good example • Accept my thanks for the work you do. Thank you!

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