Insulin: A Case Study

Insulin as per Oxford word reference (2000) is a pancreatic hormone which directs glucose levels in the blood, an absence of which causes diabetes. Insulin is a hormone created in the islets of Langerhans of the pancreas that directs the digestion of sugars, fats, and starches in the body. Insulin empowers the cells of the body to take up glucose, the basic sugar that cells consume for vitality. On the off chance that the pancreas does not deliver adequate insulin or if the cells wind up plainly impervious to the impacts of insulin, the body can't utilize glucose viably, and the sickness diabetes mellitus comes about. This is a genuine disease that can prompt kidney disappointment, visual deficiency, and passing if left untreated (Vimalavathini

The algorithm begins with an indication that is used for adults over the age of 18 and noted that lifestyle interventions should be continued throughout management. Goal blood pressures are separated by age and presence of chronic disease. The goal for patients over 60 is SBP < 150 mmHg and DBP < 90 mmHg. The goal for patients under 60 is < 140 mmHg and DBP < 90 mmHg. Different goal values are presented for patients with chronic conditions. Treatment with medication is categorized by: general population nonblack, general population black, chronic conditions black, and chronic condition all races. Based on the algorithm black patients should only be prescribed thiazide type diuretics and/or calcium channel blockers. While non-black patients can take all of the medications listed in JNC 8 (thiazide type diuretics, ACEI, ARB, and/or CCB). If patient does not reach goal blood pressure then three strategies are listed, along with lifestyle adherence. The algorithm also explains not to use ACEI and ARB together. The final option for patients not at goal blood pressure includes additional medications and/or referral to physician with an expertise in hypertension

During our interview G.F. stated that his blood pressure was “170/40”. I feel that it is important for G.F. to become more educated on blood pressure screenings due to his lack of knowledge on his baseline BP and his family history of cardiovascular disease. “Among patients with HTN, having an elevated SBP carries the highest risk for cardiovascular events” (Rodriguez, Swett, Agarwal, 2014, 1252-61).

Insulin is a hormone that is produced in the pancreas to regulate the amount of glucose in the blood. The pancreas of an individual suffering from diabetes either does not produce insulin or only produces very little insulin. Before 1922 diabetes was a feared disease with no cure.

The mechanism of action of the two types of drugs are very similar, but evidence has shown that the ARB is less effective at decreasing the mortality and morbidity rates (Burchum and Rosenthal, 2016).

Diabetes is a disease caused by malfunctions in glucose metabolism. It is the malfunctioning of beta cells of the pancreas, which causes an over or under production of insulin, or the cells become insulin- resistant. The pancreas is the organ in the body located partially behind the stomach composed of millions of cells called pancreatic islets, or islets of Langerhans. These islets contain two major hormone- producing cells which are the alpha cells and the beta cells. The alpha cells synthesize glucagon and the beta cells synthesize insulin. These cells secrete glucagon and insulin, especially during the period of fasting and fed states. Glucagon and insulin are both involved in regulating blood glucose levels. Insulin is the main factor

Mancia G, Omboni S, Parati G. Assessment of anti-hypertensive treatment by ABP. J Hypertens 1997, 15 (Suppl.2): 543-50.

Guidelines from the American Heart Association (AHA)/American Diabetes Association (ADA) [7] and the European Society of Cardiology [8] present different recommendations for individuals with diabetes depending on an individual 's risk profile. To identify patients who will benefit most from

target blood pressure before starting VSPi. To this end, shorter acting antihypertensive medications with closer follow up may be more suitable to avoid any delays in starting VSPi. As long as an adequate plan has been established between the patient and physician, the dose titration to achieve target BP can be achieved while the patient is on VSPi. It may not be necessary to delay initiation of VSPi if the blood pressure is not at target, as long as it is not elevated to levels that are more likely associated with acute complications. [Maitland 2010] If the patient is already on antihypertensive medications, the importance of adherence and regular follow up should be explained, and the patient should be initiated on a single antihypertensive medication, titrated to maximum tolerated dose in order to achieve the target blood pressure before adding a second medication if required. [Maitland 2010]

Insulin is an anabolic and anticatabolic hormone made by beta cell in the pancreas. It plays major roles in diabetes mellitus treatment. Insulin treatment is usually offered as subcutaneous injections with syringes, insulin pens or an insulin pump. New technique for the delivery of insulin continue to be discovered, including oral, transdermal, and inhalation delivery.1

According to the American Diabetes Association ML’s first line of treatment for hypertension would be an angiotension converting enzyme inhibitor or angiotension receptor blocker (Isaacs & Vincent, 2016). However, because ML is of African descent the recommendation would be to start with a calcium channel blocker or thiazide diuretic (Isaacs & Vincent, 2016). Ultimately, multiple medications may be needed to reach therapeutic goals

ACE inhibitors block the conversion of angiotensin I to angiotensin II and the effects of angiotensin II are therefore prevented. This competitive inhibition of ACE to prevent the formation of angiotensin II occurs in the kidney, blood vessels, heart, brain and adrenal gland This leads to an increase in the amount of sodium and urine excreted, reduced resistance in kidney blood vessels, an increase in venous capacity and decreases in cardiac output, stroke work and volume.

Once an individual develops Hypertension, it can be divided into two different stages. Stage 1 of hypertension can be defined as a systolic reading of 140-159 and a diastolic reading of 90-99. Beth Orenstein states, “Management includes the same lifestyle measurements as with prehypertension and the use of one of a number drugs that are known to not only reduce blood pressure but also reduce the risk of heart disease and stroke”. Stage 2 of hypertension

Insulin treatment is always required for type 1 diabetes. Insulin is the alternative way to replace the function of pancreatic beta cell. Usually type 1 diabetes needed insulin all the time especially at meal time. When the pancreas doesn’t produce enough insulin, then the type 2 diabetes will need insulin treatment. Insulin is also needed for gestational diabetes or diabetes during pregnancy to help for the well-being of the developing fetus. There are many types of insulin:

Type 1 insulin is a result of deficiency of insulin present in the body. Whereas, Type II insulin is caused due to the resistance to Type 1 insulin. Therefore, there have been various types of insulin dosages characterized in the industry. They focus on the duration and how quickly they are capable of acting. They include, rapid, intermediate, short and long acting insulins. This will affect the type of dosages required to sustain good blood glucose levels. (Steiner, 2009)