How many of us estimate about Postprandial lipemia in DM::: In diabetes this lipaemia is an treatable risk factor for subsequent cardiovascular disease .
Men &
women suffering from DM die of Coronary Heart diseases and or athermanous Renal
diseases (CKD). We the gynaecologits should not view that DM as just an another
non communicable disease characterized by elevated blood glucose
only , but time has come when our Face
Bok members and friends in this page should also realize and believe that if we allow
formation of atheroma it may be treated as
an act of negligence Atheroma & Diabetic dyslipidaemia which
is forerunner of serious vascular
disease with poor prognosis. What is more important is Lipid abnormalities which play an important part in raising the risk of
cardiovascular diseases in diabetic subjects . Among
the metabolic abnormalities
that commonly accompany diabetes are disturbances in the A) production and clearance of plasma lipoprotein , B) increased triglycerides and
postprandial lipemia.
This pattern is most frequently
seen in type 2 diabetes
and may be treatable risk factor for subsequent cardiovascular disease . In addition the National cholesterol Education
Program Expert Panel on Detection
Evaluation and Treatment of High
Blood cholesterol in Adults
proposes that persons with diabetes
and without coronary heart disease are to be treated
to the level of CHD risk equivalents
. Consequently patients with type
2 diabetes should be
treated aggressively to
reduce the risk of CHD .
What are the
adjunctive therapies that are safe
efficacious and cost effective in obese diabetics ?? -. People often ask
diabetologists can U change the drug?? Now we have to consider what
pharmacological medications are currently available to treat
patients with type 2 diabetes with an aim to reduce associated possible heart
diseases?? Many diabetic patients do
not achieve the current recommended
goal of HbA1 < 7% especially
those who are obese . They feel depressed as in spite of stringent
diet , exercise & drugs
many an Obese patients are likely to be the most insulin resistant and are the
most difficult to control with currently available standard therapies . Thus there is
a need to identify and
evaluate adjunctive therapies that are
safe efficacious and cost effective.
Conventional and alternative therapies for type 2 diabetes
. In
addition to the conventional therapy supplementation with additional key nutrients and vitamin has been shown to improve blood sugar levels and prevent or ameliorate many major
complications in diabetes . Some
of the minerals and vitamins that can be
useful as adjunctive treatments
in diabetes include the following Evidenced data indicate that antioxidant vitamins
such as vitamins C and E flavonoids
vitamin D conjugated
linoleic acid omega
3 fatty acids , minerals such
as chromium and magnesium alpha lipioic acid
phytoestrogens and dietary fibers have been
shown to target the pathogenesis
of diabetes mellitus
metabolic syndrome and
their complications and favorably
modulate a number of biochemical and clinical endpoints.
The drugs which have claimed in last two decades as an
adjunct drug in established DM to minimize atheroma and delay coronary attack
and or CKD(chr Kidney diseases).
1)Alfacalcidol
1.
N
Acetyl cysteine
2.
Chromium
3.
Biotin
Vitamin D and type 2
diabetes link
The relationship
between type 1 diabetes
mellitus and vitamin D deficiency has been extensively reported . Animal and human models have shown
the vitamin D treatment has been
shown to improve and even prevent type 1 diabetes
mellitus . However recent studies throw focus
on the association between vitamin D
and type 2 diabetes . Published
data report that vitamin D
deficiency alters insulin synthesis and secretion in both humans and animal models Vitamin D deficiency may predispose to glucose intolerance
. altered insulin secretion and
type 2 diabetes mellitus.
Researchers suggest a
role for vitamin D in the pathogenesis
of type 2 diabetes mellitus as vitamin d
replenishment improves glycaemia
and insulin secretion in
patients with Type 2 diabetes
with established hypo vitaminosis
D .
Vitamin D may be obtained
directly from the diet or by
means of the sunlight induced
photochemical conversion of 7
dehydrocholesterol to pre vitamin D . Pre vitamin d is thermodynamically unstable
and undergoes thermally
induced conversion to vitamin D To become biologically active Vitamin D must be hydroxylated twice in the body . The first
hydroxylation process takes
place in the liver and forms 25 hydroxy
vitamin D 25 D. The second hydroxylation
step occurs predominantly in the kidney which produces
the final active metabolite of
vitamin D -1,25d . This formed 1,25
d is released into the
circulation where is binds to vitamin d binding protein
until it reaches its target
tissue by means of the vitamin D receptors
. The entire process
described .
The pancreas possesses
VDR and 1-a hydroxylase and thus
has the vitamin D machinery for
circulating 25 D to be converted to 1,25D to work as a
paracrine or autocrine hormone.
The mechanism of action of vitamin D in
type 2 diabetes is though to be mediated not only
through regulation of plasma
calcium levels which
regulate insulin synthesis and secretion but also
through a direct
action on pancreatic B
cell function.
Thus substantial evidence
supports a relationship between
vitamin D status and insulin
sensitivity however the
underlying mechanisms require further
exploration.
The action of vitamin D
in type 2 diabetes is thought
to be mediated not only
through regulation of plasma
calcium levels which regulate
insulin synthesis and secretion but also
through a direct action on pancreatic B cell
function.
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