Curing Diabetes

Diabetes is a risk factor for coronary artery disease (CAD). Thus, an adult who has recently been diagnosed with diabetes should have a fasting lipid profile to detect any lipid abnormalities. Obesity and lipid abnormalities-both risk factors for CAD-are common in patients with Type 2 diabetes, no matter how well they control their blood glucose levels. Plus, diabetes may eliminate the protective effect premenopausal women usually have against CAD.Before the test, the patient must fast overnight. You’ll obtain blood by venipuncture, and the sample will be used to measure total cholesterol, high­density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride levels.

Lipid profiles of patients with Type 2 diabetes commonly show increased total cholesterol, LDL cholesterol, and triglyceride levels and decreased HDL cholesterol levels. A high LDL cholesterollevel increases the risk of CAD, whereas a high HDL cholesterol level decreases the risk. High triglyceride and total cholesterol levels also increase the risk of CAD.

If the test detects a lipid abnormality, teach your patient about the need for lifestyle changes, such as a low-fat diet and an exercise program. Her physician may prescribe an antilipemic drug, such as simvastatin or fluvastatin. Patients taking such drugs should have a fasting lipid profile at least once a year.

Effective therapy should lower LDL choles­terollevels in patients with diabetes to less than 130 mgjdl and raise HDL cholesterol levels to more than 35 mgjdl in men and more than 45 mg/dl in women (normal HDL cholesterol levels are more than 45 mgjdl in men and more than 55 mg/dl in women). If your patient has already been diagnosed with CAD, her LDL cholesterol levels should be lowered to 100 mgjdl, and her triglyceride levels should be lowered to 190 mgjdl.

Nursing Considerations

Instruct your patient to fast for 12 hours before the test. She should avoid vigorous exercise the day before the test and shouldn’t alter her diet before the fast begins. Also, instruct her to avoid alcohol for 24 hours before the test because it may falsely elevate triglyceride levels. If possible, your patient’s physician will withhold drugs that may alter cholesterol or triglyceride levels.

Before drawing blood for a fasting lipid profile, determine if your patient has a fever or has had surgery or trauma recently. These conditions may interfere with the test results. If you note such a condition, reschedule the test.

Filed under: Diabetes Tests