I know I should read through past posts and everything, but I'm just wondering if anyone can help with this question. Are there any preventative drugs that diabetics should be on for certain long term complications ? I'm on nothing at the moment, but I wonder if I should be taking something to protect my kidneys and nerves. Thanks you lot. Also would like advice on any vitamins etc that could help.
There are many PWD's taking Ace Inhibitors & or Beta Blockers as a prophylactic in hopes of slowing down are stopping kidney damage and other side effects...but I'm not sure there is any real proof that it helps. I would say if you have high BP it would be a good idea along with a 81mg aspirin, but I would not start the aspirin without asking my doctor. Lowering your salt intake can also help heart and kidneys but if your sodium is too low it can inhibit glucose uptake.
Every PWD needs to be tested for vitamin deficiency, many of us have low D and B vitamins which = low energy.
The best thing you can do is get your A1c as low as possible...but that's still not a 100% guarantee...
I've felt better since getting my Vit D levels up by taking Vit D3 capsules. The accurate test is 25-hydroxyvitamin D. Levels should be above 50 ng/ml (125 nmol/L). Whether it's prevention or not I don't know, but being deficient certainly doesn't help.
As John mentioned, B vitamins are typically low in diabetics & important for nerves. I take B12 daily. B12 injections are the best, if you can get a vial of B12, but sublingual tablets also work. The form you want is methylcobalamin, not cyanocobalamin. Cyanocobalamin is usually the cheap form found in B-complex vitamins.
Some people take Alpha Lipoic Acid (ALA). There is some evidence that it helps neuropathy. But I am not aware of any evidence that it helps "prevent' neuropathy. I don't take ALAL, but I do take a multivitamin, fish oil, vitamin D, coQ10 and extra B12. I suffer from vitD deficiency and take enough to sustain my levels at target. My doctor advised the coQ10 and the B12. In T2s on metformin, B12 can be depleted. Low B12 on it's own can cause neuropathy.
Thanks so much for this, I will ask doc about ACE inhibs. My bl pressure is very low most of the time, bit too low, so I think that's why they decided against aspirin. Big hello to Gerri, gorgeous Gerri I'm going to call ye. Next time I go to doc I'm taking a note pad and pen. Also going to ask for a print out of the bl results. Such a basic request, yet its not being done at our local clinic. I've been reading about Benfotiamine, which is supposed to help diabetics. On fish oils for my joints Brian, I think they help.
I take Lisinopril, as usual a longer story. C. 2004 I was heavier and BP was trending right along with the scale, 150/100 so it seemed reasonable to take it for BP but the docs have always mentioned a benefit for kidneys. My BP is closer to normal these days (115/ 70ish...) but I've just kept taking it as it's really cheap and I figure anything I can do to help kidneys is worth it. No side effects I've noticed.
Taking note of this, as you say anything that helps. If I could just get into exercise, it would do so much for me. I absolutely hate it.
I'm with you on exercise. Only way I'm running is if someone with a loaded gun pointed at my head is chasing me. I do enjoy walking & quite hilly where I live. Also do a lot of gardening & that ends up being a work-out that accomplishes something. I don't think of these as exercise because that would take the fun out of things I like to do.
I also have low BP. At doctor's visits, the nurse takes mine twice & asks if I get dizzy or faint. Nope. Belive my low BP is a cortisol problem from messed up adrenals.
Walking is excellent exercise! It gets your heart rate up and isn't nearly as stressful on your joints, etc as some of the crazy things people do!! If you can get out in nature, even narrow, urban greenspace/ trails/ parks, you will get measurable benefits. One of my friends is a researcher at the University of Illinois and has shown that kids with various autism spectrum disorders will do better on math tests if they play outside first! I'm very much looking forward to walking when I hang up my running shoes. Off for a bike ride today though...
First, the number one killer of diabetics is heart disease. Taking steps to minimize your risk of heart disease is important. This can include exercise, diet, and, for some, statins to get one's lipid profile to a lower risk profile.
See this editorial in the medical journal "Circulation".
http://circ.ahajournals.org/content/100/10/1132.full
The official guidelines from the Heart Association are here :
http://circ.ahajournals.org/content/100/10/1134.full?ijkey=7f87d9ca973137836b2b0ffee14fc4e95b99f506&keytype2=tf_ipsecsha
Here is what they say about type 1 diabetics and CVD:
Implications for Treatment of Patients With Type I DiabetesThe predominant risk factor for CHD in patients with type 1 diabetes is duration of disease. Nonetheless, smoking, hypertension, renal disease (macroalbuminuria and renal insufficiency), and dyslipidemia remain important. Effective treatment of hyperglycemia reduces microvascular complications of type 1 diabetes.106 It also may reduce risk for macrovascular disease.106 Modification of other CVD risk factors almost certainly will reduce risk. This would include not only tobacco avoidance but also maintenance of blood pressures <130/85 mm Hg, screening for microalbuminuria, and reducing triglycerides to at least <200 mg/dL and perhaps lower. The optimal LDL-cholesterol level in patients with diabetes is ≤100 mg/dL; however, use of cholesterol-lowering drugs to achieve this goal in younger patients with type 1 diabetes may not be appropriate. Aspirin also can be administered in patients who have long-standing type 1 diabetes and in whom goals for glycohemoglobin are not achieved.
Second, the national kidney foundation in the United States has these practice guidelines for doctors, based on the best available evidence:
http://www.kidney.org/professionals/kdoqi/guidelines_bp/guide_8.htm
GUIDELINE 8: PHARMACOLOGICAL THERAPY: DIABETIC KIDNEY DISEASEDiabetes mellitus is the most common cause of kidney failure in the United States. Diabetic kidney disease is characterized by the early onset of albuminuria, hypertension, and a high risk of coexistent or subsequent CVD.
8.1 Target blood pressure in diabetic kidney disease should be <130/80 mm Hg (see Guideline 7) (Table 104). 8.2 Patients with diabetic kidney disease, with or without hypertension, should be treated with an ACE inhibitor or an ARB (Table 104).
The link above has links to many studies about effectiveness of ACE inhibitors and ARBs to prevent or slow the progression of kidney disease and grades the evidence, most of which is rated "strong".
Only exercise I do is a bit of dancing in the kitchen when the mood takes me. I do a good bit of gardening but like you Gorgeous Gerri or ( GG ) as you will now be referred to, I don't consider it ex cause that would take the enjoyment out of it. I do a phenomenal amount of housework, that should count a bit. I do like walking and I enjoy ex once its done, but its getting seriously friggin cold here now. Thinking of joining our local health club, at least I would be warm. Used to go to cross country training last year, nearly convinced that's what brought on my arthritis, well I must blame something. I must remember to lock children outside before any maths tests.
Thanks so much HPN, strangely enough I love reading these articles.
One more article....
the link I had above was about use of ACE inhibitors to slow the progression of diabetic kidney disease once you have it (i.e. microalbuminaria and the like).
THe question of whether it prevents the development of kidney disease in patients who have
normal blood pressure and normal kidney function is addressed in this study, which looked at the collective data of other studies. Their "plain language" conclusion is :
Angiotensin converting enzyme inhibitors (ACEi) were found to be effective for the primary prevention of kidney disease in patients with diabetesTwenty to sixty percent of diabetic patients are affected by hypertension and antihypertensive agents are used to treat this condition. These agents are also used to prevent the onset of kidney disease both in normotensive and hypertensive diabetics. Twenty to 40% of patients with diabetic kidney disease progress to end-stage renal disease (ESRD) while the rest may die from associated coronary artery disease or other cardiovascular causes before the onset of ESRD. This study was undertaken to determine the benefits and harms of antihypertensive treatment in patients with diabetes but who do not show signs of kidney disease. Sixteen trials (7603 patients) were identified comparing antihypertensive agents to placebo, no treatment and other antihypertensive agents. ACEi significantly reduced the development of urinary protein (a sign of kidney damage) compared to other agents, but did not reduce all-cause mortality. More trials are needed that report the affect of antihypertensive agents on the prevention of kidney disease in diabetic patients.
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004136.pub2/a...
Thanks again for this, going to print it all out.
My initials really are GG!
Housework & taking care of children definitely qualifies as exercise & exertion. So does dancing in the kitchen:) We tend to think if it doesn't require special shoes, a planned activity, sweating & something to quantify (people love sharing how many miles or repetitions they did), it's not exercise. I think the point is being physically active & not sitting on our butts.
I did a trial membership at a gym. Hated those machines. Boring. Only consistent thing I did was taking classes during lunch with two women I worked with. We actually had fun & kept each other motivated.
Geri, I couldn't agree with you more on exercise. I walk a lot and work regularly. I don't have time to spend at a gym an hour each day doing absolutely nothing.
I'm not a big gym fan and agree the scenery is bleak but I think that you get more benefit out of getting into a "flow" state with your workout by dedicating the time to it. Even the shoes can be a big part of it. Investing time into going to a specialty running store and trying shoes out by walking or running on a treadmill will get you much better results. A lot of people try walking and give up because their shoes aren't up for the task. I'm not a stranger to incidental dancing in the kitchen either but, unless your favorite song is 25 minutes long ("Dark Star", if you're into "spinning...") you're not going to elevate your heart rate enough to strengthen your heart. I think that it's important for everyone, with or without diabetes to do this but I think that as much time as we spend testing our BG, thinking about food strategies, etc. it would be useful for us to get dedicated to some kind of exercise. I think walking is great and am fully anticipating doing that in a few years when I'm not up to running any more.
I also agree with you, Gerri, on exercise. I’ve had Type 1 for 36 years and I have always felt that exercise is what has kept me relatively healthy. Although I work hard at trying to control my BG levels, I’ve had tons of highs and lows through the years especially during all those years before home BG testing. But one constant for me has been exercise and sports. I have increasingly severe arthritis so I don’t run or play tennis anymore. But I still walk several miles every day on hilly terrain and walk 18 holes of golf a few times a week. I also do weight work 2-3 times per week.
Although I do take diabetes and heart disease seriously, I’m not too impressed by most of the medical studies about taking BP and cholesterol meds. Most of those studies are done on people with Type 2 and I feel that the risks for those of us with Type 1 are different. I would love to see more studies on the risks of heart disease for well-controlled Type 1’s.
My most serious health issues in addition to Type 1 are all auto-immune, not the metabolic issues that are common for Type 2’s. But I’m old enough that of course I can’t dismiss heart disease, and I have done all the screening tests recommended by my internist.