Drug Effects

Insulin Pump, Advanced Tools for People with Diabetes Mellitus

What’s Disease Diabetes (Diabetes Mellitus)?

Diabetes is a disease state in which there are excessive levels of sugar in the blood circulation. This occurs because the body is something we lack a hormone called “insulin” is needed to convert blood sugar (glucose) into energy. Insulin is a type of hormone produced by the organ called the pancreas which lies below the stomach. Our bodies need energy from food to perform our daily tasks. In our stomach, carbohydrate foods is converted to blood sugar or glucose and enter the blood stream where it will be used by the body to produce energy. Glucose is the main producer of the body’s energy.

In normal circumstances, insulin helps glucose in the blood to enter body cells to convert into energy. For patients with diabetes, organ pancreas can not produce enough insulin or the insulin released can not act as usual. As a result, glucose or blood sugar can not enter body cells. Glucose levels in the blood circulation becomes high. This excess glucose will be eliminated by the body through urine. This is why, the disease is identified as a “disease Diabetes. Without insulin, the body’s cells do not receive enough glucose, although very high levels in the blood circulation. This causes the body will lack energy.

Anyone can contract this disease?
The disease can diidap by anyone. But those who come from families who get this disease or even the tendency of the disease, age above 40 years old and have excessive body weight (fat) have a greater risk for getting diabetes. To note also that diabetes (Diabetes Mellitus) under the “gene X from the mother’s lineage,” and this disease there are two types of type I and type II. Most people with diabetes is of type II.

How is the handling of this disease?
Diabetes has long been known to humans. Thousands of the world population in both developed or developing countries suffering from this disease. Diabetes should not be a barrier to normal life. With increasing knowledge about diabetes and the presence of drugs for this disease as well as modern medical equipment such as blood sugar control tools as well as “insulin pump”, not the cause why you should not live like a normal human being and longevity.

Diseases of insulin pumps for people with diabetes, whether this also?
In general, diabetes disease management is how to keep glucose levels in the blood circulation remains in a state of balance. To maintain a balanced state that need special efforts such as:

1. control the levels of high carbohydrate foods (in the early stages of this illness)

2. when glucose levels which can not be controlled by diet (at an advanced stage of this disease) it is necessary to carefully control the levels of glucose with glucose control device (if needed every day) and provide coverage of insulin to the body by taking specific medications for diabetics, for example “Daonil”, or with injections of insulin preparations with a syringe or insulin pen, or by means of a super-sophisticated “insulin pump”.

Why Insulin Pump?
Insulin pump is a device that is designed specifically for people with diabetes in which patients can control their own coverage of insulin per day is given to her after controlling glucose levels daily. Insulin pumps have many benefits compared to conventional tools such as insulin through a syringe or insulin pen. Its advantages include:

1. Easy to carry anywhere because of size of mobile phones.

2. Can be done by anyone following the instructions given by medical doctors or nurses.

3. It does not hurt to put in your body, because the needle is very small and delicate so easily planted in the skin of the abdomen and with a hose connected to an insulin pump.

4. Easily control the insulin requirement as it can be seen on the screen is how the need for insulin pump day after checking the daily glucose.

5. Stored data can be controlled carefully because this tool can be connected to a personal computer via a USB cable, so that people with diabetes need insulin can see the graph in a certain period and this data can be met with a doctor.

6. Highly recommended for use in patients with type II diabetes with glucose uncertain.

What this tool there are also disadvantages?
Although these tools have a weakness but more of the benefits, the main weakness is a technical problem, when the battery is discharged, must be replaced as soon as possible within 24 hours, so there must always be a backup battery, so when the vial of insulin was gone as soon as may be replaced with a new . Attention to people with diabetes who frequently travel by airplane, this tool should not be passing the door of the detector because it can damage the insulin pump, so the tool is always accompanied by insulin Card for sufferers to be disclosed to officials at the airport.

Does this tool can reduce the symptoms of diabetes?
Diabetes is a hereditary disease that has no solution. Existing drugs is to reduce the symptoms caused as well as provide a balance of glucose. By maintaining glucose balance is what can give a normal life in people with diabetes. So it can be said that with Insulin Pump as one tool to balance the blood glucose so it can reduce the symptoms caused by this disease.
Where known that high glucose in the blood for a long time and are not controlled can cause the symptoms of a severe illness such as:

1. Blind, due to damage to blood vessels in the retina

2. Kidney damage

3. Heart disease and paralysis disease

4. High blood

5. Neurological disease, this can lead to pain sufferers lost in Courant feet and hands, so do not feel pain or heat, and with this can happen to an unconscious wounds that ultimately can lead to gangrene, so the foot or hand can be amputated

6. Fainting, and if not rescued immediately can cause sudden death.

Conclusion:
Insulin Pump is a sophisticated tool that can be used to help people with diabetes can live a normal life. Insulin pump is simply a choice to be better, but everything is back to his own people with diabetes. Doctors only give the best advice for sufferers.

Patients can avoid the adverse consequences of this disease, if it is able to keep yourself well.
Suffering from diabetes is not a punishment such as imprisonment.

If people follow the steps in the treatment of this disease, patients can enjoy a happy life.

Source:Statin

Definition
Simvastatin is a group of drugs called HMG CoA reductase inhibitors, or statins. Simvastatin lowers “bad” cholesterol in the blood (low-density lipoprotein or LDL) and triglycerides in the blood and increase levels of “good” cholesterol (high-density lipoprotein or HDL).

Simvastatin is used to lower cholesterol and triglycerides (a type of fat) in the blood.

Simvastatin is used to reduce the risk of stroke, heart attack and other cardiovascular complications in those with diabetes, coronary heart disease, or other risk factors.

Simvastatin is used in adults and children aged 10 years and over.

Simvastatin is also used for other needs that are not listed here.
Important Information
Do not use this medication if you have an allergy to simvastatin, if you are pregnant or breastfeeding, or if you have liver disease. Stop using this medicine and inform your doctor immediately if you become pregnant during the treatment period.

Before using simvastatin, tell your doctor if you ever have liver or kidney disease, diabetes, thyroid disorders or diseases, and if you drink alcohol more than 2 bottles per day.

In rare cases, simvastatin can cause a condition that produces muscle damage bone tissue, leading to kidney failure. Contact your doctor immediately if you have unusual muscle pain, numbness, or weakness especially if you also have a fever, unusual fatigue and dark urine.

Avoid eating foods that are high in fat or cholesterol. Simvastatin will not be effective for lowering cholesterol if you do not keep eating.

Avoid drinking alcohol. These drugs may increase triglyceride levels and may increase the risk of liver damage.

There are many drugs that can increase the risk of serious medical problems if you use it in conjunction with simvastatin. Tell your doctor about all medications you use. Do not start using a new medication without telling your doctor.

Simvastatin is a part of a complete treatment program that also includes diet, exercise, and weight control.

Side Effects
Call emergency medical help if you have any signs of allergic reaction is:
• Itching with a rash
• Difficulty breathing
• Swelling of the face, lips, tongue or throat

Stop using simvastatin and call your doctor if you have the following serious side effects:
• unusual muscle pain, numbness or weakness
• Fever, fatigue that is not fair and dark urine
• Pain or burning when urinating
• Swelling, weight gain, urine less than usual
• Nausea, itching, loss of appetite, dark urine, clay-like dirt, jaundice (yellowing of the skin or eyes)

Other side effects:
• Headache
• Muscle pain mild
• Joint pain
• Constipation
• Stomach pain
• mild skin rash
• Difficulty sleeping
• Symptoms of a cold such as nasal congestion, sneezing, sore throat

Symptoms of the above side effects may appear incomplete and other symptoms.

Accompanied by High-Dose Simvastatin Increased Risk of Myopathy

High dose of simvastatin is accompanied by an increased risk of myopathy and rhabdomyolysis. This statement was delivered by the FDA (Food and Drug Administration) U.S. based on the results of research SEARCH (Study of the Effectiveness of Additional Reductions in Cholesterol and Homocysteine), which showed an increased risk of myopathy and rhabdomyolysis in patients treated with simvastatin 80 mg. Now, other data from previous studies, observational studies, as well as reports of side effects involving the use of simvastatin is being reviewed by the FDA.

SEARCH study conducted to evaluate the number of cardiovascular events (heart attack, revascularization and cardiovascular death) in 12,064 patients. The results of this study showed that 80 mg of simvastatin is accompanied by an additional reduction in LDL cholesterol of 0.35 mmol / L and the incidence of myocardial infarction, stroke and fewer revascularization compared with 20 mg simvastatin therapy. What about the incidence of side effects? The experts continued research to examine the comparison of the side effects of simvastatin 80 mg in 6031 patients, compared with the side effects of simvastatin 20 mg of 6033 patients treated with simvastatin 20 mg.

The results showed that patients treated with simvastatin 80 mg experienced myopathy greater than for patients treated with simvastatin 20 mg. It also reported incidence of rhabdomyolysis, which occurs more frequently in groups of patients treated with simvastatin 80 mg.

Dr. Eric Colman, director of FDA’s Division of Metabolism and Endocrinology Products, said that the review will be conducted on astu simvastatin is one of FDA’s efforts to evaluate the risk of muscle damage due to statin therapy, and to provide information to the public on simvastatin therapy.

Now there are some things that need to be considered by health workers when providing simvastatin therapy in patients, including:

* Side effects rhabdomyolysis is a “class effect” that rarely occurs because statin therapy.
* Increased risk of muscle damage with simvastatin 80 mg simvastatin dose is comparable with the lower, and also when compared with other statins.
* Prior statin administered, whether giving statins is clinically appropriate?
* Discussing with pasein about the benefits and risks of simvastatin.
* The potential for interaction between simvastatin with other drugs.

Until now, the risk of myopathy side effects experienced by patients treated with statins has not been clearly understood. Accepted theory until now is the occurrence of apoptosis miofiber and decreased biosynthesis of coenzyme Q10 in the muscle. In penelititan, coenzyme Q10 supplementation with a dose of 100 mg daily for 30 days to reduce symptoms of myopathy in patients treated with statins.

Conclusion:

SEARCH * Based on research results, the FDA said that high doses of simvastatin (80 mg) along with an increased risk of myopathy.
* Now the FDA is doing the review by collecting research data and reports of side effects of simvastatin therapy.
* The announcement was enumerated by the FDA encourages health professionals to consider when providing risk-benefit of simvastatin therapy in patients.

Source:Benefit of Statin

Superior Statins lower LDL-C, but less effective in reducing triglycerides and raising HDL-C. Statins should “embrace” other anti-cholesterol in order to achieve maximum results.

The presence of statins at the end of 1980 gave a fresh breeze in the treatment of vascular disease. Because the statins proved superior to lower low-density lipoprotein cholesterol (LDL-C), approximately 30-55%. This fact is particularly important given the “bad fats”, the main culprit in vascular disease. Moreover, LDL-C occupies a portion 2 / 3 of serum cholesterol. By inhibiting the formation of LDL-C in the liver, the levels of serum cholesterol can be reduced to 75%.

In 1994, Scandinavian SimvastatinSurvival Study (4S) succeeded in proving the clinical benefits of statins. In this study appear, simvastatin effective than placebo, improving survival (mortality and morbidity) patients with coronary heart disease (CHD). Therefore, since then various guidelines put statins as cholesterol-lowering therapy major. As the target is to reduce levels of LDL-C to <100 mg / dL. Nevertheless, various studies on statin continued and unremitting done. A series of large studies, both to see the effect of statins on the prevention of primary and secondary vascular disease, has been carried out and published. (See also: Landmark Statin Study).

One of the largest statin study, the Heart Protection Study (HPS) in 2002, shows the results enough to attract attention. According to this study, the incidence of coronary risk reduction 25%, can occur due to the reduction of LDL-C cholesterol levels about 40 mg / dL (1.03 mmol / L). Surprisingly, the benefits of statins are not only scooped by patients with high cholesterol levels, but also those with normal cholesterol levels. And National Cholesterol EducationProgram Adult Treatment Panel III (NCEP III) LDL-C levels translate to normal, ie <100 mg / dL. This finding is quite surprising the experts. There’s something intriguing, namely whether the benefits of statins is exclusively the effects of decreased levels of LDL-C? Or maybe the statins have other effects that can repair survival?
Statin pleiotropic effect?

Statins are a class of drugs competitively inhibit hydroxymethyl glutaryl coenzyme A reductase (HMG Co-A reductase), a rate limiting step enzyme in the synthesis of endogenous cholesterol. Inhibition of this enzyme would decrease endogenous synthesis of cholesterol and ultimately reduce serum cholesterol levels. Decrease in endogenous cholesterol could spur an increase in the number of active LDL receptors on liver cells, so that the binding of LDL-C and LDL-C precursor increases. As a result, LDL-C levels in the blood and prekusornya be dropped.

According to Drs. Armen Muchtar, SpFK, from the Department of Pharmacology and Therapeutic FKUI RSUPNCM, statins are thought to also inhibit the synthesis of apolipoprotein B-100 and reduce the formation and secretion of lipoproteins transport triglycerides. “Although the primary mechanism is increased clearance of LDL decreased LDL through its receptor, but the decline in production and secretion of lipoproteins to be considered are also involved. This is seen in patients with homozygous familial hypercholesterolaemia who have no functional LDL receptors,” said Armen at the 5th Scientific Meeting of the Department of Pharmacology and Therapeutic FKUI.

Armen said further, in addition to lowering cholesterol, statins have also estimated the effect of other anti-arteriosclerotic. The effect, known as non-lipid effect is thought to arise because of the influence of statins on endothelial function, inflammatory responses, plaque stability, and thrombus formation. Decrease in the synthesis of isoprenoid sebgai allegedly the basis of the non-lipid effects. Isoprenoid is the result of mevalonate in addition to cholesterol metabolism. Isoprenoid plays an important role in cell migration and proliferation.

Statins could improve endothelial physiology by affecting the synthesis of nitric oxide, so that production increases. The addition of nitric oxide synthesis can reduce oxidized LDL cholesterol, which then can stimulate the formation of nitric oxide synthesis further. But, until now not clear whether the improvement of endothelial nitric oxide production through this, is another direct effect of statins or statin-induced effects of the reduction in LDL-C.
Statin Pharmacokinetics

Compared with other cholesterol-lowering (binding bile acids, nicotinic acid, fibrates acids, cholesterol absorption inhibitors), statins have the effect of the largest reduction in LDL-C. No doubt if the statin drug used to overcome hiperkolesterolnemia major. Currently, there are several statins on the market, ie simvastatin, lovastatin, pravastatin, fluvastatin, atorvastatin, and rosuvastatin. While its circulation cerivastatin was withdrawn in August 2001 for reported any toxic effects on the muscles (rhabdomyolysis).

Structurally, lovastatin and simvastatin have in common. Both are chemical compounds with lactone rings and is a prodrug, a new active after the open lactone ring in the liver. Whereas the other statins directly inhibit active HMG-CoA reductase after absorbed.

The absorption of the statin in the gastrointestinal tract ranges from 30-98%. Statins have first-pass metabolism in the liver are quite extensive, mainly through the bile. As a result, bioavailabilitasnya in low systemic circulation. All statins are metabolized through pathways cytochrom P450 (CYP), except pravastatin (by a cytosolic enzyme). Lovastatin, simvastatin and atorvastatin is a CYP3A4 substrate. As a result, all three levels of this drug in the blood will be increased by various enzyme inhibitors, namely cyclosporine, protease inhibitors, erythromycin, clarithromycin, ketoconazole, itraconazole, verapamil, diltiazem, fluvoksamin, fluoxetine, and grapefruit juice.

Meanwhile, fluvastatin is primarily an enzyme CYP2C9 substrate. Both levels will be increased by various enzyme inhibitors, such as phenytoin, amiodarone, tolbutamid, glipizid, diclofenac, ibuprofen, fluvoksamin, fluoxetine, cimetidine, and omeprazole. While rosuvastatin is only slightly (<10%) metabolized by CYP2C9, so do not be influenced by the presence of inhibitors of this enzyme.
Need Combination

Although superior to lower LDL-C, statins have an effect but fewer lower triglycerides and increase high-density lipoprotein cholesterol (HDL-C) than the fibrates or nicotinic acid (niacin). Therefore, for cases of severe hyperlipidemia, to consider granting a combination of anti-cholesterol. The combination of statins and niacin was considered quite safe, even at high doses. But the combination of statins and fibrates on high doses can have a record of increased risk of side effects, such as myopathy, miolisis, and rhabdomiolisis.

In addition to these combinations, is currently also considered collaboration with statin cholesterol-lowering drug ezetimibe that is new. Although this drug also shot primarily LDL-C such as statins, but its mechanism of action is different. Ezetimibe works by inhibiting absorption of cholesterol without memempengaruhi absorption of triglycerides or fat-soluble vitamins.

The combination of both highly effective and synergistic. Moreover, as seen by the Atorvastatin Comparative Cholesterol Efficacy and Study (Access), use of statins is still not optimal. CHD patients with atorvastatin to achieve NCEP targets (53%), simvastatin (38%), pravastatin (15%), lovastatin (28%), and fluvastatin (15%). Only 43% of CHD patients who received the initial dose is sufficient, as well as other statins. Adanmya possible interference liver and muscle physiology of resistance to increase the dose up to maximum. By adding ezetimibe to statins, the cholesterol fell 20% larger than a single statin. The safety profile similar to statin combination of both single.