Diabetes,Hypertension & Rheumatoid Arthritis

by Dr. Vaijayanti Lagu - Joshi

These are frequently found chronic illnesses that have many features in common.

Diabetes -

It results from either insulin deficiency and / or insulin resistance. Accordingly, there are 2 main subgroups of diabetes:-

Type I - Insulin dependent
Type II - Non - Insulin dependent
The clinical features as well as management differ in these groups.

How to diagnose diabetes?

Some of the clinical features -

Laboratory Criteria.

Fasting plasma glucose > 126 mg / dl
  • (2hr) Post prandial glucose > 200 mg / dl
  • Random blood glucose > 200 mg / dl on 2 random occasions.

  • Multisystem complications of diabetes are -

    Control of diabetes

    It involves non - pharmacological as well as pharmacological measures. Non pharmacological measures play important role.

    Diet :-

    Exercise: -

    Stress Management

    Yoga, meditation and other relaxation techniques better for stress management .

    Drugs -

    i) For glycemic control.

    1)Oral hypoglycemic agents - Increase insulin secretion and improve sensitivity of insulin receptors.

    2)Insulin - Dose, time, type and strength should be confirmed by experts.
    Doses of drugs not to be changed without expert's opinion.

    ii) For associated problems like hypertension and dysplipidemia -

    Antihypertensives and lipid lowering agents.

    Monitoring of diabetes

    1)Regular blood glucose profile- Fasting and Postoprandial measurements are to be done 2 monthly in well controlled diabetes, or as & when required.

    2)Other periodic investigation are needed to rule out complications

    Hypertension -

    It is a condition in which there is elevation of blood pressure in peripheral arteries. Readings are mentioned as systolic pressure that indicates contractility of heart and diastolic pressure indicates tone / resistance of peripheral vessels. The blood pressure of an individual varies with time . Factors like age, posture, sympathetic nervous system activity, etc. affect the blood pressure from time to time.

    Average blood pressure for adults ( 18 years or older) 120/80 mm Hg is taken as normal blood pressure, 2 or more diastolic BP reading > 90mm Hg on at least 2 subsequent visits is taken as diastolic hypertension.

    At one end hypertension can remain asymptomatic, however, it can give rise to fatal sequelae like acute left ventricular failure or renal shut down. Hence it needs to be detected early & treated aggressively.

    Risk factors for hypertension -

    Target organ damage can manifest as

    Nonpharmacological Measures:-

    To be continued lifetime along with definitive treatment.

    Drugs -

    Many anti hypertensives are available for the treatment in the market, but choice of drug depends on many factors like age, renal status associated conditions like diabetes etc. Hence, proper selection of proper drug is most important.