 |
| Manage arterial risk aggressively in people with Type 1
diabetes if any other risk factor is abnormal including family history of arterial disease |
|
|
| Review arterial risk factors : |
|
 |
blood lipid profile |
blood pressure |
albumin excretion rate |
|
|
smoking |
family history |
arterial / heart symptoms |
|
 |
at diagnosis |
|
|
at 18 years of age |
|
|
three-yearly for lipids if all risk factors consistently
normal |
|
|
yearly |
|
|
more frequently if abnormal or treated |
Educate people : |
|
|
about the risks of heart disease from the time of diagnosis |
|
|
about not smoking and smoking cessation programmes ( see box
) |
|
|
about healthy eating ( see Healthy
eating ) |
Prescribe : |
|
|
a programme of regular physical exercise |
|
|
healthy eating |
|
|
lipid lowering therapy if profile is abnormal ( see box ) and
another risk factor present |
|
|
ACE inhibitors if indicated by kidney damage ( see Kidney damage ) |
|
|
anti-hypertensives if blood pressure remains >135/85 mmHg
( but see Kidney damage if raised albumin excretion rate ) |
|
|
low-dose aspirin for those with known arterial problems |
|
|
selective ß-adrenergic blockers if known ischaemic heart
disease |
|
|
hormone replacement therapy post-menopausally ( if agreed ) |
Diagnose : |
|
|
silent myocardial ischaemia in higher risk patients |
Manage : |
|
 |
smoking aggressively ( see box ) |
|
|
ischaemic heart disease and other arterial disease otherwise
as for the non-diabetic person |
