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Suggest Treatment For High BP In An Insulin Dependent Diabetic
Question: I am obese, an insulin dependent diabetic female with high blood pressure controlled with medication. I check my sugar levels twice a day and my blood pressure periodically. I have been watching my diet, especially carbs, very closely the past 8 to 9 months. My goal is to get off insulin, and with that in mind, my doctor cut the amount of insulin I take almost in half and added metformin twice daily. It has worked well since January, with very good numbers on a daily basis. But, lately, the past week or two, my numbers are higher. I've not made any drastic changes in my diet, and have increased my activity levels, albeit not drastically, but I am not sedentary any more. And now, my blood pressure is somewhat higher than usual. Again not a drastic difference, but enough to get my attention. Any idea what might be going on? I have lost approximately 15 pounds during this lifestyle change. My email is YYYY@YYYY Thank you for your time. XXXX
Brief Answer:
Diabetes & Hypertension.
Detailed Answer:
Hi,
Thanks for your question.
After going through your question, I can understand your concern.
Diabetes is a progressive disease.
It has two important aspects
1) Insulin resistance that is there is increase in demand of insulin by body for glucose metabolism.
2) Pancreatic dysfunction that is pancreas cannot fulfill demand of extra insulin by body.
As duration of diabetes advances the insulin resistance may or may not change significantly (exercise, weight reduction, dietary changes plays significant role in decreasing insulin resistance and has minimal direct impact on insulin secretion) but Pancreatic dysfunction progresses significantly and there is progressive decrease in insulin secretion by pancreas.
That's why there is progressive rise in blood glucose levels with use of same medicines on which blood glucose levels were well controlled previously.
To control this rising blood glucose levels there is a need for increasing dose of current medicines or addition of new medicines.
Also other factors like change in dietary and exercise pattern, acute illness may also responsible for deranged blood glucose control.
For increase in blood pressure following factors may be responsible -
1) Advancing age.
2) Changes in blood vessels due to diabetes, cholesterol and blood pressure it's self.
3) Changes in heart function due to diabetes, blood pressure and cholesterol problem.
4) Nephropathy due to changes in Kidney by diabetes, blood pressure and cholesterol problem.
You should consult your treating doctor and discuss this issue which requires further evaluation and appropriate changes in medicines.
Hope I have answered your question.
Regards, Dr Abhay Mali.
Diabetologist.
Diabetes & Hypertension.
Detailed Answer:
Hi,
Thanks for your question.
After going through your question, I can understand your concern.
Diabetes is a progressive disease.
It has two important aspects
1) Insulin resistance that is there is increase in demand of insulin by body for glucose metabolism.
2) Pancreatic dysfunction that is pancreas cannot fulfill demand of extra insulin by body.
As duration of diabetes advances the insulin resistance may or may not change significantly (exercise, weight reduction, dietary changes plays significant role in decreasing insulin resistance and has minimal direct impact on insulin secretion) but Pancreatic dysfunction progresses significantly and there is progressive decrease in insulin secretion by pancreas.
That's why there is progressive rise in blood glucose levels with use of same medicines on which blood glucose levels were well controlled previously.
To control this rising blood glucose levels there is a need for increasing dose of current medicines or addition of new medicines.
Also other factors like change in dietary and exercise pattern, acute illness may also responsible for deranged blood glucose control.
For increase in blood pressure following factors may be responsible -
1) Advancing age.
2) Changes in blood vessels due to diabetes, cholesterol and blood pressure it's self.
3) Changes in heart function due to diabetes, blood pressure and cholesterol problem.
4) Nephropathy due to changes in Kidney by diabetes, blood pressure and cholesterol problem.
You should consult your treating doctor and discuss this issue which requires further evaluation and appropriate changes in medicines.
Hope I have answered your question.
Regards, Dr Abhay Mali.
Diabetologist.
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
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