Chronic Disease Management

Hypertension

Blood pressure is the pressure exerted by blood pumped by the heart against the walls of the arteries. The maximum pressure on the arteries is exerted by the contraction of the heart and is called systolic pressure. Systolic pressure is denoted by the numerator of the blood pressure reading. As the heart relaxes between heart beats, the pressure in the arteries drop and this pressure is known as diastolic pressure. The denominator of the blood pressure reading represents the diastolic pressure. Blood pressure varies throughout the day as well as depending on the level of your activity. It decreases during sleep and rises with excitation, anxiety and activity.

In adults, blood pressure can be classified into the following categories:

Category	Systolic (mm Hg)		Diastolic (mm Hg)
Normal	> 120	And	> 80
Pre-hypertension	120–139	Or	80–89
High blood pressure
Stage 1	140–159	Or	90–99
Stage 2	≥160	Or	≥100

If most of your blood pressure recordings taken during the day indicate values above 140 mm Hg of systolic blood pressure and/or a diastolic blood pressure of more than 90 mmHg, you may be suffering from high blood pressure, also known as hypertension. High blood pressure can damage different organs of the body such as the brain, heart and kidneys. Medications such as ACE inhibitors, ARBs, diuretics, beta blockers, calcium channel blockers, alpha-blockers, alpha agonists and rennin inhibitors are prescribed to control high blood pressure. If a single drug is ineffective in controlling blood pressure, a combination of two or more drugs may be used.

Simple lifestyle modifications improve the efficacy of the prescribed medications. These lifestyle changes also helpful prevent the progression of pre-hypertension to hypertension or high blood pressure. Some of the common lifestyle modifications include:

Weight loss in obese or overweight individuals
Regular exercise; 30- 60 minutes a day for at least 5 days a week (such as brisk walking)
Eating a healthy diet rich in whole grains, nuts, fruits and vegetables with a restriction on sweets, added sugar, saturated fat, cholesterol or total fats and dairy products
Reduction in salt intake to 2,300 mg/day in normal individuals and 1,500 mg/day in patients with high blood pressure
Abstinence from alcohol
Reduction in consumption of coffee or caffeinated beverages
Yoga or meditation to reduce stress and anxiety
Regular checkups with your doctor, once every 6 -12 months or as recommended
Support from family and friends in the form of encouragement and motivation to improve adherence to these life style changes

Diabetes

Diabetes is a chronic metabolic disorder characterized by hyperglycemia, the presence of high glucose level in the blood. The level of glucose in the blood is regulated by insulin hormone. Impaired production, action or both of insulin increases glucose level in the blood leading to hyperglycemia and uncontrolled hyperglycemia damages various organ systems of the body including cardiovascular system, eyes, kidneys, nerves, and blood vessels. Thus timely detection and management of blood glucose level to normal is crucial to prevent long term serious complications of diabetes.

Diabetes is classified into four types based on the cause or treatment approaches,

Type 1 diabetes
Type 2 diabetes
Gestational diabetes
Secondary diabetes

Type-1 Diabetes

Diabetes in children less than 10 years of age is usually type-1. Type-1 diabetes is caused by the destruction of the insulin producing beta cells of the pancreas by the impaired immune response. Early symptoms include:

Constant hunger
Weight loss
Blurred vision
Increased thirst and urination
Feeling tired

As the diabetes progresses the child may complaint of stomach pain, vomiting and frequent urination.

The management of type-1 diabetes includes giving insulin by either injection or through insulin pump, nutrition management and physical activity.

Type- 2 Diabetes

Type 2 diabetes develops because of lack of sensitivity of the receptors to insulin. Receptors are the transport system that enables insulin to enter the cells and metabolize the carbohydrates stored in the cells. Because of loss of sensitivity to insulin, although sufficient amount of insulin is available, the receptors fail to allow the insulin into the body cells thereby inhibit the breakdown of carbohydrates in the cells and cause hyperglycemia.

Type 2 diabetes was more common in adults however in the current scenario incidence of obesity is increasing in the children so is the incidence of Type-2 diabetes. It is increasingly diagnosed these days in children aged 10 years or older. The symptoms of type-2 diabetes are same as that of type-1 diabetes and in certain cases the child may not show any symptoms at all. Important aspect of diabetes management is lifestyle changes that include diet modification, increased/moderate physical activity and medical treatment. Medical treatment includes medications to lower the glucose known as oral hypoglycemic agents and/or insulin therapy. Regular monitoring of blood glucose is necessary to prevent long term complications of the disease.

Gestational Diabetes

Gestational diabetes is the type of diabetes seen in women only during pregnancy but not had earlier. Pregnant women develop this form of diabetes because of hormonal changes seen during pregnancy. These hormonal changes alter the insulin activity leading to hyperglycemia finally causes diabetes. Gestation diabetes may subside after the delivery of child however the condition may put some women at risk of developing diabetes in future. Treatment options include oral hypoglycemic agents, insulin therapy, and lifestyle modifications.

Secondary Diabetes

Secondary diabetes is the condition caused as secondary effect of certain disease conditions such as pancreatic disease, hormonal disorders, adverse effects of drugs, insulin receptor abnormalities, and some of the genetic disorders. The treatment options include same as other forms of diabetes.