Smoking diabetic patients

In addition to medical and surgical management, non-pharmacologic interventions that reduce risk factors for developing osteomyelitis should be communicated to the patient. Examples include smoking cessation, weight-control, exercise, and good nutrition.2 Additionally, a diabetic patient... 

Braunwald (1997) points out that fully half of all patients with CHD do not have any of the conventional risk factors (hypertension, hypercholesterolemia, cigarette smoking, diabetes mellitus, marked obesity and physical inactivity). Further, up to two-thirds of patients with CHD have what may be considered normal serum cholesterol levels (see references in Parodi, 2004). These facts suggest that the role of plasma cholesterol in CHD has been overemphasized and oversimplified. 

Apart from surgical and interventional therapy of occlusive carotid artery disease, the major approach to preventing vascular disease and subsequent stroke is to pay close attention to the control of modifiable risk factors such as hypertension, smoking, diabetes, and hypercholesterolemia. Coumadin, an anticoagulant, is effective for the primary and secondary prevention of stroke in patients with atrial fibrillation. Aspirin, clopidogrel, and the combination of aspirin and cUpyridamole have been proven to be effective for secondary stroke prevention along with the antihypertensive combination of indap-amide and perindopril. 

There is an increased incidence of peripheral vascular diseases in diabetic patients who receive peritoneal dialysis and epoetin (4). In these patients the time to a first vascular incident is shorter, the number of vascular events is increased, and more hospital days associated with vascular disease have been reported compared with patients receiving peritoneal dialysis without epoetin (4). Significant risk factors for the development of peripheral vascular disease are epoetin therapy, epoetin dose, and smoking (4). Peripheral vascular disease may be related to increased blood viscosity or other changes in blood rheology (4). 

Biesenbach G, Grafinger P, Janko O, Zazgornik J Influence of cigarette-smoking on the progression of clinical diabetic nephropathy in type 2 diabetic patients. Clin Nephrol 48 146-150,1997. 

Predisposing factors include older patients, long treatment, smoking, diabetes mellitus... 

For diabetic patients with chronic kidney disease (CKD) stages 1-11 (Creatinine clearance betwem normal and 60 mL/min/1.73 m ), stage-independent actions such as control of cardiovascular risk factors (hypertension, hyperlipidemia, and smoking), avoidance of drug toxicity and diagnostic injury, control of progression, and reduction of proteinuria are essential. 

Helve E, Yki-Jarvinen H, Koivisto VA. Smoking and insulin sensitivity in type I diabetic patients. Metabolism (198 35, 874-7. 

Bott S, Shafagoj YA Sawicki PT, Heise T. Impactof smoking on the metabolic action of subcutaneous regular insulin in type 2 diabetic patients. Horm Metab Res (2005) 37, 445-9. 

Short of revascularization, cessation of smoking is the single most important factor in the management of patients with intermittent claudication (55). In fact, in up to 85% of patients, walking distance can increase as much as 200 to 300% (56,57). Detection and treatment of hypertension and control of risk factors for cardiovascular disease such as smoking, diabetes, and hyperlipidemia offer substantial stroke prevention benefits as well. 

These studies generally support the concept that hypertension accelerates development of peripheral vascular disease in certain populations. The presence of other risk factors such as hypercholesterolemia, smoking, diabetes, and male gender appear to markedly accentuate the effects of hypertension on development of this process. Thus, aggressive reduction in arterial pressure and reduction or elimination of other risk factors is clearly indicated in high-risk patients. 

Figure 14 The SIFT spectrum obtained following the introduction of breath from a diabetic patient with end-stage renal failure who smokes cigarettes (see the text). The concentrations of the major breath gases are given in ppb in parentheses. u= mass, c/s = counts per second.

Educate the patient on lifestyle modifications, including smoking cessation, diet, weight loss, and exercise. For patients with diabetes mellitus, tight glucose control should be emphasized. 

Note Two or more venous plasma concentrations must be met or exceeded for a positive diagnosis of diabetes to be made. The test should be done in the morning after an 8- to 1 4-hour fast and after at least 3 days of unrestricted diet and unlimited physical activity. The patient should remain seated and should not smoke during the test. 

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