Insulin Enalapril

Sliding scale insulin Allopurinol 1 00 mg orally daily Ranitidine 150 mg orally every 12 hours Atenolol 50 mg orally daily Enalapril 2.5 mg orally daily... 

Julie Singer is a 55-year-old white woman who was admitted to the emergency department in acute distress. A previous physical examination showed hypertension and diabetes mellitus type 2. The patient s present medications include enalapril 40 mg, nifedipine 60 mg, and 100 U insulin. A physical examination revealed prominent ankle edema, a palpable spleen, and hepatomegaly. Chest radiography revealed diffuse cardiac enlargement and left ventricular hypertrophy. Based upon the history and clinical hndings, what is your diagnosis and what treatment do you recommend ... 

Mechanism uncertain. ACE inhibitors possibly t insulin sensitivity and glucose utilization. Altered renal function may also be factor. ACE inhibitors may t bradykinin levels, which i production of glucose by the liver. Hypoglycaemia is reported as a (rare) side-effect of ACE inhibitors. Suggested that occurrence of hypoglycaemia is greater with captopril than enalapril. Captopril and enalapril are used in the treatment of diabetic nephropathy... 

Estacio RO, Jeffers BW, Hiatt WR, Biggerstaff SL, Gifford N, Schrier RW. The effect of nisoldipine as compared with enalapril on cardiovascular outcomes in patients with non-insulin-dependent diabetes and hypertension. N Engl J Med 1998 338(10) 645-52. 

Whether ACE inhibitors aggravate or generate hypoglycemia is debated (216). In a case-control study of 404 cases and 1375 controls, the risk of hypoglycemia was 5.5 times greater (95% Cl = 4.0, 7.6) in insulin versus sulfonylurea users and was not influenced by use of ACE inhibitors overall (217). However, the use of enalapril was associated with an increased risk of hypoglycemia (OR = 2.4 95% Cl = 1.1, 5.3). 

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