Myocardial infarction insulin

Diabetes mellitus is a complicated, chronic disorder characterized by either insufficient insulin production by the beta cells of die pancreas or by cellular resistance to insulin. Insulin insufficiency results in elevated blood glucose levels, or hyperglycemia As a result of the disease, individuals with diabetes are at greater risk for a number of disorders, including myocardial infarction, cerebrovascular accident (stroke), blindness, kidney disease, and lower limb amputations. 

Renal disease or renal dysfunction (eg, as suggested by serum creatinine levels greater than or equal to 1.5 mg/dL [males], greater than or equal to 1.4 mg/dL [females], or abnormal Ccr) that may also result from conditions such as cardiovascular collapse (shock), acute myocardial infarction (Ml), and septicemia CHF requiring pharmacologic treatment hypersensitivity to metformin acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma. Treat diabetic ketoacidosis with insulin. 

Reconsideration of contraindications has also been proposed in a prospective study in patients with serum creatinine concentrations of 130-220 pmol/1 and coronary heart disease (n — 226), congestive heart failure (n = 94) and chronic obstructive pulmonary disease (n = 91). Half of the patients continued to take metformin and the other half stopped (39). Bodyweight and HbAic increased over 4 years in those who stopped taking metformin. Lactic acid concentrations were similar in the two groups. Deaths were similar in the two groups (62 and 64 respectively). The incidences of myocardial infarction, all cardiovascular events, and cardiovascular mortality were the same. Changes in additional therapy were only significant for insulin (30% versus 45% respectively) and diet (25% versus 0% respectively). 

Glucagon has also been used to stimulate insulin and C-peptide secretion, to see whether the islets still produce insulin, as a stimulatory test during pheochromocytoma, hyperinsulinism, and Zollinger-Ellison syndrome, or as an additive in upper gastrointestinal X-ray investigations (0.5-1 mg). It has been used in myocardial infarction, although its inotropic effects may present a risk. It has also been used to treat overdoses with beta-blockers (3) and calcium channel blockers (4), although its efficacy in such cases has only been demonstrated in animals (5) and to treat overdose with tricyclic antidepressants (6,7). 

People with diabetes have a much worse outcome after acute myocardial infarction, with a mortality rate at least twice that in non-diabetics. However, tight control of blood glucose, with immediate intensive insulin treatment during the peri-infarct period followed by intensive subcutaneous insulin treatment, was associated with a 30% reduction in mortality at 1 year, as reported in the DIGAMI study. In addition, the use of beta-blockers in this group of patients had an independent secondary preventive effect (198). The use of beta-blockers in diabetics with ischemic heart disease should be encouraged (199). 

Diabetes Mellitus Insulin Glucose Infusion in Acute Myocardial Infarction Study Group. Prospective randomized study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus. British Medical Journal 1997, 314, 1512. 

Fath-Ordoubadi p Beatt KJ. Glucose-insulin-potassium therapy for treatment of acute myocardial infarction an overview of randomized placebo-controlled trials. Circulation 1997 96 1 152-1 156. 

Ceremuzynski L, Budaj A, Czepiel A, et al. Low-dose glucose-insulin-potassium is ineffective in acute myocardial infarction results of a randomized multicenter Pol-GIK trial. Cardiovasc Drugs Ther 1999 13 191-200. 

Malmberg K, Ryden L, Efendic S, et al. Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study) effects on mortality at I year. J Am Coll Cardiol 1995 26 57-65. 

Malmberg K, Ryden L, Wedel H, et al. DIGAMI 2 Investigators. Intense metabolic control by means of insulin in patients with diabetes mellitus and acute myocardial infarction (DIGAMI 2) effects on mortality and morbidity. Eur Heart J 2005 26 650-661. 

Insulin is an endogenous hormone produced by fi-cells of islets of Langerhans of the pancreas, which consist of two chains of amino acids. It is required to be administered by a parenteral routes as it is destroyed when given orally. Insulin is used for the control of IDDM and in the emergency management of diabetic ketoacidosis.30 Insulin promotes the intracellular uptake of potassium and is used in hyperkalemia. Baker et al.31 have used insulin and glucagon in the treatment of liver disorders. Recent evidence indicates that the effects of insulin with glucose and potassium in ischemic heart disease have proved beneficial.32 It also is used in acute myocardial infarction.32... 

Individuals with type 1 diabetes are also at risk of subsequent ketoacidotic crises. One common cause of DKA is noncompliance with insulin therapy. Infections, (including subclinical infections) and physiological stressors (such as myocardial infarction) can also precipitate DKA. Since the mortality rate associated with DKA can be as high as 10%, successfully educating patients about the early warning signs of the condition and providing a plan for early intervention is crucial to its effective prevention. 

Mr CD, a 75-year-old man, 1.7 m tall, is admitted to hospital very short of breath. He used to work in the docks as a clerk and has smoked 40 cigarettes daily for 30 years and stopped 2 years ago. His previous medical history includes COPD, recurrent infective exacerbations since 1991, no LTOT type 2 diabetes mellitus on insulin 14 IU b.d. for 20 years, retinopathy ischaemic heart disease - coronary artery bypass graft (twice), hypertension myocardial infarction 1986 atrial fibrillation high cholesterol. 

Adipocytes have vitamin D receptors, and there is evidence that vitamin D may act as a suppressor of adipocyte development (Kawada et al., 1996). It has been suggested that vitamin D inadequacy may be a factor in the development of the metabolic syndrome ( syndrome X, the combination of insulin resistance, hyperlipidemia, and atherosclerosis associated with abdominal obesity). Sunlight exposure, and hence vitamin D status, may be a factor in the difference in incidence of atherosclerosis and myocardial infarction between northern and southern European countries in addition to effects on adipocyte development, calcitriol also enhances insulin secretion through induction of calbindin-D (Section 3.3.7.1), and there is some evidence vitamin D supplements can improve glucose tolerance (Boucher, 1998). 

The insulin response to injury is a nonspecific response to stress and is similar after surgery, myocardial infarction or brain hemorrhage or hypothermia (Al). 

The insulin resistance and hyperglycemia of severe bums has been observed to persist for 1-2 weeks and has been described as pseudodiabetes. Apart from insulin antagonism of endocrine origin some cell membrane defect may be present and increased levels of the antagonist syn-albumin has been found in a significant number of patients recovering from myocardial infarction (VI). 

Adult respiratory distress syndrome occurred after the intravenous infusion of dextran 40 in a 30-year-old woman, a smoker with a history of insulin-dependent diabetes mellitus, who had sustained an acute inferior myocardial infarction the dextran was given in... 

A series of trials in elderly hypertensive subjects has shown a very pronounced reduction in cardiac events as a result of treatment based on thiazide diuretics. In the European Working Party on Hypertension in the Elderly (EWPHE) trial (13), total cardiovascular deaths were reduced by 38%, all cardiac deaths by 43%, and deaths due to myocardial infarction by 60%. Benefits in the Systolic Hypertension in the Elderly Program (SHEP) included a reduction in fatal and non-fatal myocardial infarction of 25% and major cardiovascular events of 32% (14) and were seen in those with and without electrocardiographic abnormalities at entry. The risk of heart failure was also reduced in patients taking chlortalidone-based therapy (15). Relative risk was similar in patients with and without non-insulin dependent diabetes meUitus absolute risk reduction was twice as great in the diabetic subjects (16). The Swedish Trial of Old Patients with Hypertension (STOP-Hypertension) reported a significant reduction in myocardial infarction and all-cause mortahty (17). In the MRC Trial in elderly adults (18), diuretic treatment reduced coronary events by 44% and fatal cardiovascular events by 35%. 

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