Lifestyle Failure To Avoid Med Use

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  • Pharmacotherapy: out of the scope of this presentation
    Algorithm for treatment of hypertension available at JNC-7
  • According to the Diabetes Prevention Program, pre-diabetics can prevent Type 2 DM from developing and even showed that diet and exercise work better at preventing diabetes than did medication. As Rosa mentioned before, the initial steps in preventing and controlling diabetes is to make changes to one’s lifestyle, mainly by modifying one’s diet and increasing physical activity. This is the first step because in many cases diet and exercise can be so beneficial to one’s health that prescription medications may not even be needed and can perhaps be entirely avoided. The Diabetes Prevention Program also mentions that even a small reduction in weight of about 5-10% can decrease diabetes.
    Unfortunately to some this can seem like they’ve been sentenced to a life of tasteless, boring food or to an endless monotony of dreadful exercises. Fortunately this is not necessarily the case.
    Organizations such as the American Diabetes Association, nutrition specialists, and motivational coaching experts have designed strategies for helping diabetics meet and maintain their goals.
  • Starting with diet, it is important that diabetics are familiar with foods that not only keep their blood glucose at normal levels but also those that meet and even exceed their nutritional requirements.
    Since carbohydrates are the main external source of glucose, diabetics need to be educated on the types and quantity of this fuel that they include in their diets. For example, potatoes, white bread, and any food with refined flour and sugar such as pastries and or pasta are worse than say a sweet potato, wild rice with nuts, or even whole grain pasta with some olive oil and garlic instead of red sauce that tends to have sugar.
  • Some ways to manage carbohydrate intake are:
    the plate method where the plate contains more non-starchy vegetables and less of everything else. Or the Carb counting method where as the title suggests you limit yourself to a certain amount of carbs each day and therefore count the carbs that are in each meal to help keep track.
    There’s also the glycemic index that shows you the types of foods that tend to raise your blood glucose higher and faster than other foods and those that take longer to cause your glucose to rise, which is better.
  • For many people, holidays can be an opportunity for weight gain and foregoing regular exercise.
    In order to stay on track, plan menus according to your dietary needs. For example if turkey and mashed potatoes and cranberry are to be had, go for the white meat, add a bit of fat to your mashed potatoes, and try to make your own cranberry sauce without the added sugar that’s normally found in store bought cans.
    For desserts try adding more spices like cinnamon (which helps lower glucose by the way), nutmeg, or vanilla instead of sugar.
    Also, if you just can’t resist having a certain food as is with all the sugar and fat, try and settle for a smaller portion.
  • It’s crucial that people know the reasons of why and how physical activity can prevent and manage diabetes. For starters, exercise is not all about joining a gym and hiring a personal trainer, although it certainly does help.
    Some very important reasons for exercise are:
    It can improve insulin utilization so more glucose is burned and not stored.
    It can improve your circulation and hence make your heart stronger without having to overwork it. It also lowers blood pressure and heart rate.
    It increases your good cholesterol and decreases your bad cholesterol.
    It can decrease or eliminate the amount of medicine taken for diabetes, high blood pressure, or high cholesterol.
    It can help you lose and maintain weight which would in turn decrease the risk for bone pain, heart disease, cancer, and stroke.
    It makes you feel more energetic so you don’t feel sluggish

    Exercise doesn’t have to be hard and can actually be incorporated into daily activities such as gardening, shopping, house cleaning, and working.
    For example, when shopping, park as far away from the store as possible and if at night as safe as possible. Take elevators, hand wash dishes, save money and clean the house yourself instead of hiring a housekeeper, or even adopt a pet you have to constantly walk.
    Find your motivation: you may have young kids that require you to be active. You may have activities you enjoy doing like traveling or going to the movies but cant carry out because you might be overweight.
  • Lifestyle Failure To Avoid Med Use

    1. 1. Presented by: Lynda Pardo, Jorge Garcia, Rosa Garcia Pharm.D. Candidates 2010
    2. 2. OUTLINE  Introduction to Lifestyle Modifications  Overview of Hypertension Disease  Overview of Diabetes Mellitus  Lifestyle Modifications for Hypertension  Lifestyle Modifications for Diabetes Mellitus
    3. 3. DID YOU KNOW…?  ~133 million people in the U.S have at least one chronic condition  U.S spends ~ $1.5 trillion on chronic conditions annually  U.S is the number one drug market worldwide
    4. 4. INTRODUCTION  Chronic conditions affect the national economy and our patient's health  Lifestyle modifications prevent most of these conditions  Lifestyle modifications may be use in the management of chronic conditions
    5. 5. LIMITATIONS  Difficulties achieving a new lifestyle  Difficulties maintaining new lifestyle for long terms
    6. 6. BENEFITS  Low cost  Safety profile  Benefits seen rapidly  Enhance medication efficacy  Decrease incidence of complications  Decrease the need for Pharmacotherapy
    7. 7. LIFESTYLE MODIFICATIONS  Prevention and management  Dyslipidemia  Gastroesophageal reflux disease (GERD)  Obesity  Hypertension (HTN)  Diabetes Mellitus (DM)
    8. 8. HYPERTENSION
    9. 9. HYPERTENSION (HTN)  Defined as consistently elevated blood pressure (BP)  Multifactorial etiology  Primary or Essential Hypertension (Unknown)  Secondary Hypertension
    10. 10. CLASSIFICATION CLASSIFICATION SBP mmHg DBP mmHg Normal < 120 and - < 80 Pre-hypertension 120 – 139 or - 80 -89 Hypertension Stage 1 140 – 159 or - 90 - 99 Hypertension Stage 2 ≥ 160 or - ≥ 100 SBP = Systolic Blood Pressure DBP = Diastolic Blood Pressure
    11. 11. EPIDEMIOLOGY  Most common primary diagnosis in America  ~ 50 million Americans have high BP that needs some type of treatment  Lifetime risk of developing hypertension between 55 – 65 years old is > 90 %  Continuous relationship between BP and risk of cardiovascular events
    12. 12. PATHOPHYSIOLOGY  A variety of systems and mechanisms involved:  Renin Angiotensin Aldosterone System (RAAS)  Nervous System Regulation  Peripheral and Vascular mechanisms  Oxidative Stress
    13. 13. CLINICAL PRESENTATION  Most patients present with no symptoms  Severe symptoms occur as a result of organ damage  Heart  Brain  Retinopathy  Peripheral arterial disease  Chronic Kidney Disease (CKD)
    14. 14. GOALS OF THERAPY  BP <140/90 mmHg for most patients  BP <130/80 mmHg for patients with diabetes or chronic kidney disease
    15. 15. TREATMENT  Pharmacotherapy  Non-pharmacotherapy
    16. 16. DIABETES MELLITUS
    17. 17. DIABETES MELLITUS (DM)  Chronic condition  Defined as elevated blood glucose (sugar) levels  Inadequate insulin secretion or insulin action
    18. 18. CLASSIFICATION  Type 1 Diabetes Mellitus  Type 2 Diabetes Mellitus  Gestational Diabetes Mellitus
    19. 19. EPIDEMIOLOGY  ~ 20.8 million Americans have DM  Type 2 Diabetes accounts for 90 – 95%  Elderly 65 - 74 years old have greater incidence  Hyperglycemia (high blood glucose levels) is a strong risk factor for cardiovascular disease
    20. 20. PATHOPHYSIOLOGY  Metabolic disorder resulting from deficiencies at multiple organ sites  Insulin resistance in muscle and adipose tissue  Decreased insulin secretion by pancreas  Excessive hepatic glucose production  Inadequate glucagon secretion
    21. 21. CLINICAL PRESENTATION  Polyuria (excessive urine)  Polydipsia (excessive thirst)  Unexplained weight loss  Fatigue  Blurred vision  Dehydration
    22. 22. COMPLICATIONS  Microvascular Complications  Nephropathy  Peripheral neuropathy  Retinopathy  Impotence  Macrovascular Complications  Cardiovascular disease  Stroke  Peripheral vascular disease
    23. 23. GOALS OF THERAPY According to the American Diabetes Association  70 – 130 mg/dL fasting and preprandial  <180 mg/dL postprandial  Glycosylated hemoglobin (A1C) < 7%  As close as possible to < 6% (normal) without significant hypoglycemia
    24. 24. TREATMENT  Pharmacotherapy  Insulin  Non-pharmacotherapy
    25. 25. HYPETENSION: Lifestyle Modifications
    26. 26. HTN: Lifestyle Modifications
    27. 27. What We’re Up Against  Larger portions at fast food restaurants  Little to no availability of healthy food in schools and jobs  High cost of healthy food  High amounts of sodium in processed foods  Efficient physical education programs lacking in schools
    28. 28. HTN: Lifestyle Modifications  Reduction of BP can be achieved by losing as little as 10 pounds (4.5 kg)  1,600 mg sodium DASH diet = single antihypertensive drug  Multiple lifestyle modifications ideal
    29. 29. HTN: Lifestyle Modifications  Quit smoking!  Community programs: Preventing Hypertension  Employing culturally sensitive educational messages  Lifestyle support services  Cardiovascular risk-factor screening and referral programs
    30. 30. DASH Diet: Daily Calories
    31. 31. DASH Diet: Sodium Intake
    32. 32. DASH Diet  Tips to reduce sodium intake  Buy low or reduced sodium foods whenever possible  Limit cured foods (bacon or ham)  Cook rice or pasta without salt (avoid instant mixes)  Rinse canned goods such as tuna and beans to remove some salt  Use spices instead of salt
    33. 33. DASH Diet  Tips on getting started  Baby steps  Initiate or add one more fruit or vegetable to every meal  Meat should NOT be the focus of the meal, just another part of it  Snack on fruits or other products which are low in fat, sodium, and calories
    34. 34. DIABETES: Lifestyle Modifications
    35. 35. DM: Lifestyle Modifications  Diet  Exercise
    36. 36. DM: Lifestyle Modifications  Diet  Become educated on the types of foods that help lower or maintain blood glucose at healthy levels
    37. 37. DM: Lifestyle Modifications  Manage carbohydrate intake by:  Plate Method  Carbohydrate Counting  Glycemic Index
    38. 38. DM: Lifestyle Modifications  How to manage the holidays  If cooking, plan menu ahead of time  Include festive, but healthy foods  Watch your portions!
    39. 39. DM: Lifestyle Modifications  Exercise  Know the reasons!  Strive to incorporate exercise into everyday activities  Find what motivates you  For more strenuous physical activities, always consult your physician beforehand
    40. 40. REFERENCES 1. http://www.diabetes.org/about-diabetes.jsp 2. http://www.diabetes.org/food-nutrition-lifestyle/lifestyle- prevention.jsp 3. http://www.fightchronicdisease.org/news/pfcd/pr10022007.cfm 4. Chicago Tribune ONLINE Web Site. Available at: http://newsblogs.chicagotribune.com/triage/2008/06/death-rates- plu.html. Accessed September 22, 2009. 5. Partnership to Fight Chronic Disease ONLINE Web Site. Available at: http://www.fightchronicdisease.org/news/pfcd/pr10022007.cfm. Accessed September 22, 2009. 6. CNN Money ONLINE Web Site. Available at: http://money.cnn.com/2008/04/15/news/companies/IMS/index.htm ?postversion=2008041511. Accessed September 22, 2009.
    41. 41. REFERENCES 7. American Association of Clinical Endocrinologist Medical Guidelines for Clinical Practice for Management of Diabetes Mellitus. Endocrine Practice 2007; 13:3-12. 8. Nathan D, Buse J, Davidson Mayer et al. Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the initiation and Adjustment of Therapy. Diabetes Care 2006; 29 (8): 1963 – 1969. 9. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care 2008; 31 (suppl 1) s12 – s44. 10. DiPiro JT, Talbert RL, Hayes PE, et al. Pharmacotherapy: A Pathophysiologic Approach. 6th ed. New York, NY: McGraw Hill; 2005.

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