INDICES> Re: The Hypertensive, impotent male with complications of diabetes mellitus. (3)

[DID <did.jms@imul.com>]

Dear Indices Users,


Subject:  THE HYPERTENSIVE, IMPOTENT MALE WITH COMPLICATIONS OF DIABETES
MELLITUS (3)
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An advocate, at his age, without children, i think could afford an
ACE-inhibitor.

Amlodipine is not the choice antihypertensive for a diabetic, prone to
kidney damage, and as you know he has already developed diabetic
neuropathy.  The antihypertensive medicine he was taking faithfully for
about 4 years is not indicated, but, if it was a thiazide diuretic like
bendrofluazide or a beta - blocker, or a centrally acting sympatholytic,
no objection, that this advocate was to be quickly thrown into diabetes.


That is, when i assume that hypertension came before the diabetes he
clearly ignored.  The other problem which affects diabetic males is
impotence, largely due to treatment of hypertension with beta - blockers.


Though autonomic neuropathy may play a role.  Nevertheless, impotence is
a serious problem to married men and, the side - effect of impotence
should never be under estimated.  In fact it can cause non - compliance,
anxiety and increase in blood pressure.

I thought that the rather schooled man did not comply with diabetes
treatment because he was not taught or warned about diabetes, and taught why
he had to receive regular drug treatment, in addition to diet
modification.

As of now, treat diabetic neuropathy with carbamazepine, and high dose B
vitamins.  This will give symptomatic relief.  In Uganda,  we have a product
called neurorubine, it is a brand of vitamin B's in high dose.


If you have that Mepha - Switzerland product in your country.  Use that.
If you do not, use Vitamin B complex in high dose.

Change anti - hypertensive medicine to an ACE-Inhibitor, i would prefer
Lisinopril.

If he is in bed and stressed, treat the diabetes with Insulin.  Please
treat the diabetes as part of priority.  And when he is better, assess
whether he can continue oral hypoglycaemics.  If oral hypoglycaemics do not
control his sugar, put him on insulin injections. In addition to anti
hypertensive medicine.  Upon discharge, educate the man on lifestyle
for hypertensive diabetics.

If management of the symptoms with medicines, fail, surgical manipulation
will be the option, but medication first thing.


I wish all indices users a God blessed, prosperous and happy 2001,

Surely,
George Kibumba, MPS(Uganda).
Drug Information Pharmacist
Drug Information Desk,
Joint Medical Store,
P.O.BOX 4501, KAMPALA, Uganda(E.A)
e-mail: did.jms@imul.com
Tel:    256-41-268482
fax:    256-41-267298



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