Dear pnranjith
the medical problem your presented in this case, that is exacerbations of renal function is a very common complication in patients with
hypertension and
diabetes. In deed it is estimated that the majority of patients with both
diabetes and
hypertension will eventually present with
acute renal failure and if
diabetes/blood pressure are left uncontrolled,
acute renal failure can progress to end stage renal disease.
- assessing your dad's case, i noticed that he is on
insulin therapy for the management of his
diabetes, suggessting that he is a type 1 diabetic patient. based on the
blood glucose level of 75, which is within the normal recommended range, the dose of the
insulin seems to be appropriate. usually frequent monitoring of
blood glucose before and after meals help us in deciding on an
insulin schedule and the type of
insulin (short acting, intermediate, and long acting, depending on each patient's case).
- the second key point is blood pressure. you noted that your father's blood pressure is 160/100. this is a high reading, and with the different medications your dad is recieving , amlodipine and
diuretics, it is possible that your dad needs to be on additional medication, or the whole therapy needs to be assessed.
the target goal for blood pressure is patients with
diabetes is 135/80 and your dad bp is 160/100 suggessting that your dad is not at his target goal.
this is important because as i mentioned in my introduction, it is important to control both blood pressure and
blood sugar to prevent further kidney damage.
ACE inhibitors are very effective class of drugs to treat
hypertension and it is usually first line therapy for patients with
diabetes. this class has been shown to provide a nephroprotective effect, that is a renal protective effect. I wonder if your dad has tried these agents before, such as lisinopril, ramipril, accupril, etc. or even ARBs (angiotensin receptor blockers like irbesartan, candasartan, etc).
one more thing i want to point out to you, since you requested detailed answers :)
diuretics are great agents and first lines for the management of
hypertension, but they can increase
blood sugar via an unknown mechanism. Now this is not a reason to perclude their use in
hypertension and
diabetes, but it is something that one need to be aware off.
overall, hydration is always very important, but i highly recommend tight glucose and blood pressure control for your dad to prevent further exacerbations of his renal function. worsenning of renal function is a consequence of
diabetes and
hypertension; we can not eliminate it , but we can for sure help preventing it from getting worse.
thank you very much and remain blessed
Riham Zein, Pharm.D., Ph.D.
Clinical Pharmacy Specialist
