HELP please! HTN/DM

[krltdy]

I need to answer this question:

Why is HTN one of the 1st signs of type 2 DM?

Here's what I came up with, but I still don't see how it could be one of the first signs because HTN usually has no s/s, and with this theory, the person probably already knew they had DM .

1. Consistent and continued high blood glucose levels, which leads to:

2. Narrowing of renal artery, which leads to:

3. deprivation of blood to the kidney

4. Kidney then produces more renin and angiotensin, thereby

5. Causing constriction and resistance in peripheral arteries thoughout the body, which equals:

6. HTN

Thanks for any input!

[TheSquire, DNP, APRN, NP]

I never sat through a proper physio class (my school counted the buttload of molecular & cellular biology classes I sat through), but I don't remember reading/hearing anywhere that increased blood sugar would cause narrowing of the renal artery. However, arteries are involved, so you're on the right track for one of them. Additionally, you should consider volume.

Remember, a sign is something that we as providers can detect. HTN is detected easily - three sequential SBP readings over 140 or DBP over 90 per JNC-7.

[CuriousMe]

I've never heard of HTN being a sign of Type II DM. We learned the S/S of DM (I or II) being polydipsia, polyuria, polyphagia. (we had to take cell bio and patho :) )

The only sign I know of for DM is blood sugars--two fasting blood glucose levels over 126mg/dL if my memory serves.

I have been taught that there is a correlation between HTN and Type II DM....especially if you throw hyperlipidemia in as well, which is called Metabolic Syndrome.

But I didn't look at my notes, I could be wrong.

[TheSquire, DNP, APRN, NP]

I've never heard of HTN being a sign of Type II DM. We learned the S/S of DM (I or II) being polydipsia, polyuria, polyphagia. (we had to take cell bio and patho :) )

The only sign I know of for DM is blood sugars--two fasting blood glucose levels over 126mg/dL if my memory serves.

I have been taught that there is a correlation between HTN and Type II DM....especially if you throw hyperlipidemia in as well, which is called Metabolic Syndrome.

But I didn't look at my notes, I could be wrong.

That sounds like what I remember; however, I'll buy that HTN is an early symptom of DM II due to fluid balance issues, though my pathophys textbook sadly does not include a mechanism.

[CuriousMe]

That sounds like what I remember; however, I'll buy that HTN is an early symptom of DM II due to fluid balance issues, though my pathophys textbook sadly does not include a mechanism.

Hmmm, I'll have to look that up.

At a guess I'd say it would be tough to say which condition was primary and which was secondary since they both stem from similar lifestyle choices.

Edit:

Hmmm....I said that wrong. What I meant was whether the HTN was secondary or a comorbidity.

Didn't mean to suggest that the DM was secondary to the HTN.

[ghillbert, MSN, NP]

Look at how diabetes affects the vascular system, and how hyperglycemia leads to activation of RAA system.

Diabetic nephropathy usually affects Type I DM.

This is very common patho and is outlined in detail in most pathophys books and many journal articles.

[krltdy]

Thanks everyone for your help! I'll let you know what I come up with :)

[Saysfaa]

The kidney path isn't the main reason for the HTN due to DM. The electrolytes in the blood stream pulls water directly from the cells causing the HTN, therefore the HTN happens AS the glucose rises.

I am still in phsyiology, so this might not be what a nursing class wants, but because the HTN rises with the glucose levels, there aren't any earlier s/s. HTN might not be what takes a pt into the dr, but bp is taken so routinely that it would be one of the first s/s caught as well as one of the first s/s of the DM.

[TheSquire, DNP, APRN, NP]

The kidney path isn't the main reason for the HTN due to DM. The electrolytes in the blood stream pulls water directly from the cells causing the HTN, therefore the HTN happens AS the glucose rises.

I am still in phsyiology, so this might not be what a nursing class wants, but because the HTN rises with the glucose levels, there aren't any earlier s/s. HTN might not be what takes a pt into the dr, but bp is taken so routinely that it would be one of the first s/s caught as well as one of the first s/s of the DM.

It's a homework question, you're not supposed to just give the answer to her.

[Saysfaa]

Oops. Hm, no hand-to-head bang icon.

[krltdy]

Actually, it was NOT a homework question. I just couldn't wrap my head around why htn would be one of the first signs of dm. I spoke with my instructor, and she agreed with me, but added that I left out the aldosterone. Thanks everyone for your input.