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Risk Factors: Sedentary lifestyle, obesity, over-consumption of food,…

- - - - Elevated inflammatory markers causes dysregulation of the autonomic nervous system
        
        ANS regulates the SA node, end diastolic volume, end systolic volume, and systemic vascular resistance
        
        causes arterial stiffness, left ventricular hypertrophy, and loss of cardiac function
      - increased triglycerides causes increased myocardial triglyceride content
        
        Increased myocardial triglyceride is associated with lipotoxicity and altered calcium hemostasis in
        myocardium
        
        effects diastolic function of the heart
      - Damaged blood vessels causes endothelial dysfunction, MI and cardiomyopathy (CMP) which leads to insulin resistance
        
        Pancreatic beta cells increase production of insulin to overcome insulin resistance and transport glucose into the cells
        
        Relative Insulin Deficiency
        Insulin resistance continues to increase and inflammatory adipokines continue to be released leading to a deficit in insulin
        
        Absolute Insulin Deficit
        Beta cells become fully unfunctional and no longer produce insulin. At this point, the body is enterally insulin deficient
        
        Diabetes Mellitus Type II
        
        excess levels of sugar in the blood is excreted as waste into the urine. Excess glucose causes more water to be excreted in the urine
        
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        high blood glucose and HTN causes atherosclerosis/weakens the integrity of large vessels of the brain
        
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        high blood glucose damages the nerves in the periphery
        
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        Since diabetes has a correlation with low levels of sex hormones Benign Prostatic Hypertrophy may develop in males
        
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        High blood sugar levels can damage the blood vessels and harden arterial walls
        
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        Meds: insulin (Rapid-acting inhaled, regular/short, intermediate, long-acting); use of sliding scale and carb count
        
        Provides insulin that the body is unable to make in order to intake glucose into cells and lower content in the bloodstream that my be damaging.
        
        Labs: HgA1c, Blood glucose, C-peptide test
        
        Lifestyle changes: exercise, healthy diet, 10k steps a day, adequate hydration, reducation of alcohol/sugars
        
        HgA1C is a test that indicates the average blood glucose level over the past two to three months. This will be elevated in diabetic patients. High blood glucose can damage blood vessels
        
        C-peptide test measures the amount of C-peptide in the blood or urine and is an accurate way to find out how much insulin your body is making. A high level could indicate insulin resistance, insulinoma, or kidney disease. A low C-peptide could indicate type 1 or type 2 diabetes
        
        Prediabetes = 5.7-6.4
        
        Diabetes = 6.5 +
        
        Cues: Angina, pain radiating to shoulder or jaw, epigastric pain, sweating, N/V, anxiety, fatigue, swelling in ankles, arrhythmias, tachycardia, dizziness, bloating, jugular vein distension, shortness of breath
        
        Labs:
        Dx: EKG, Chest x-ray, echocardiogram, Cardiac catheterization, MRI, CT
        
        MI Tx: aspirin, nitroglycerin, oxygen, morphine, thrombolytics, beta-blockers
        Cardiomyopathy Tx: Hydrochlorothiazide, Lasix, ace-inhibitors, beta-blockers, anticoagulant, pacemaker, Ablation procedure, transplant, coronary artery bypass
        
        Aspirin: to prevent blood from clotting
        Nitroglycerin: causes vasodilation and increase blood flow to myocardium
        morphine: treat any pain associated with MI
        thrombolytics: break up or dissolve in blood clots
        Beta-blockers: decreases O2 demand and force on heart; also helps aid in angina
        
        Hydrochlorothiazide: help kidneys get rid of uneeded H2O and salt; prevent fluid overload
        Lasix: same use as hydrochlorothiazide (another diuretic)
        ACE-inhibitors: vasodilates to decrease blood pressure and improve blood flow to cardiac muscle
        Beta-blockers: helps decrease high heart rate
        anticoagulant: prevent blood clots from forming
        Pacemaker: helps treat any arrhythmias
        Ablation: help diminish Atrial fibrillation via surgery
        Coronary Artery Bypass: helps improve blood flow to heart
        
        Troponin: chronic hyperglycemia decreases the GFR which then decreases troponin elimination causing the concentrations to build up
        
        Creatine Kinase/CK-MB: The small increase in creatine kinase in diabetes is related to the energy shortage due to metabolic pathways leading to energy production being supressed
        
        Myoglobin: a chronic increase in myoglobin observed in diabetic patients related to increased muscle oxygen consumption and muscle damage
        
        CBC: in diabetic patients, white blood cell count, neutrophil and lymphocyte counts are increased and correlated with cardio-metabolic risk factors
        
        Comprehensive metabolic panel: this panel will show high glucose levels which is indicative of diabetes
        
        HDL/LDL: due to the fact that diabetes damages the lining of the arteries, it's more likely that cholesterol will stick to them causing them to narrow/become blocked. This causes lower levels of HDL (good cholesterol) and higher levels of LDL (bad cholesterol)
        
        BNP: levels are high in diabetic pts because of poor glycemic control which can lead to overdiagnosis of CHF
        
        Iron levels: diabetes can contribute to anemia due to the reduced absorption of iron. There is a direct link between anemia caused by iron deficiency and higher amounts of glucose in the blood so the patient may need to take iron supplements to take care of this.
      - Cues: increase blood pressure, headaches, Intermittent pain (claudication), coldness of the affected body part, numbness/tingling, shortness of breath, chest pain
        
        Labs: C-reactive protien, ESR, HDl, LDL, triglycerides, HgA1C
        Dx: angiogram
        
        C- reactive is a protein found in blood plasma that rises in response to inflammation due to interleukin-6 secretion by macrophages and T cells. C-reactive would be ordered to indicate if there is inflammation in blood vessels causes a decrease in blood to the periphery
        ESR is erythrocyte sedimentation rate (that rate at which red blood cells in descend in a tube over a period of one hour). The speed is a sign of how much inflammation is occuring in the body. Faster ESR rates mean higher levels of inflammation
        
        HDL, LDL, Triglycerides, and HgA1C are all labs that would be elevated in diabetes. Elevations in theses labs can cause damage to the blood vessels decreasing blood flow to the periphery. Increases in LDL and Triglycerides can indicate atherosclerosis (plaque buildup) which decreases blood flow to the periphery.
        Elevated LDL = <100 mg/dl
        Elevated Triglycerides = <150 mg/dl
        HgA1C is a test that indicates the average blood glucose level over the past two to three months. This will be elevated in diabetic patients. High blood glucose can damage blood vessels
        Prediabetes = 5.7-6.4
        Diabetes = 6.5 +