• In the general population, pharmacological treatment should be initiated when blood pressure is 150/90 mm Hg or higher in adults 60 years and older, or 140/90 mm Hg or higher in adults younger than 60 years.
• In patients with hypertension and diabetes, pharmacological treatment should be initiated when blood pressure is 140/90 mm Hg or higher, regardless of age.
• Initial anti hypertensive treatment should include a thiazide diuretic, calcium channel blocker, ACE inhibitor, or ARB in the general non black population or a thiazide diuretic or calcium channel blocker in the general black population.
• If the target blood pressure is not reached within one month after initiating therapy, the dosage of the initial medication should be increased, or a second medication should be added.

These guidelines better known as Relaxing the Standards as changes are made to make practice flexible. Hypertension is one of the most important preventable contributors to disease and death in the United States, leading to myocardial infarction, stroke, and renal failure when it is not detected early and treated appropriately. The Eighth Joint National Committee (JNC 8) recently released evidence-based recommendations on treatment thresholds, goals, and medications in the management of hypertension in adults.
In the general population of adults 60 years and older, pharmacologic treatment should be initiated when the systolic pressure is 150 mm Hg or higher, or when the diastolic pressure is 90 mm Hg or higher. Patients should be treated to a target systolic pressure of less than 150 mm Hg and a target diastolic pressure of less than 90 mm Hg. Treatment does not need to be adjusted if it results in a systolic pressure lower than 140 mm Hg, as long as it is not associated with adverse effects on health or quality of life.
In the general population younger than 60 years, pharmacologic treatment should be initiated when the systolic pressure is 140 mm Hg or higher, or when the diastolic pressure is 90 mm Hg or higher. The target systolic pressure in this population is less than 140 mm Hg, and the target diastolic pressure is less than 90 mm Hg.

For persons 18 years or older with chronic kidney disease (CKD) or diabetes mellitus, the treatment threshold and target blood pressures are the same as those for the general population younger than 60 years (i.e., threshold systolic pressure of 140 mm Hg or threshold diastolic pressure of 90 mm Hg; target systolic pressure of less than 140 mm Hg; target diastolic pressure of less than 90 mm Hg). There is no evidence that treating patients with CKD to a lower blood pressure goal slows the progression of the disease. Similarly, there is no evidence from randomized controlled trials showing that treatment to a systolic pressure of less than 140 mm Hg improves health outcomes in adults with diabetes and hypertension.

In the general nonblack population, including those with diabetes, initial anti-hypertensive treatment should include a thiazide diuretic, calcium channel blocker, angiotensin-converting enzyme (ACE) inhibitor, or angiotensin receptor blocker (ARB). In the general black population, including those with diabetes, initial treatment should include a thiazide diuretic or calcium channel blocker. If the target blood pressure is not reached within one month after initiating therapy, the dosage of the initial medication should be increased or a second medication should be added (thiazide diuretic, calcium channel blocker, ACE inhibitor, or ARB; do not combine an ACE inhibitor with an ARB). Blood pressure should be monitored and the treatment regimen adjusted until the target blood pressure is reached. A third drug should be added if necessary; however, if the target blood pressure cannot be achieved using only the drug classes listed above, antihypertensive drugs from other classes can be used (e.g., beta blockers, aldosterone antagonists). Referral to a physician with expertise in treating hypertension may be necessary for patients who do not reach the target blood pressure using these strategies.
Adults with CKD and hypertension should receive an ACE inhibitor or ARB as initial or add-on therapy, based on moderate evidence that these medications improve kidney-related outcomes in these patients.

​Dr. Suddle currently heads Safer Communities Foundation (SCF), a Not-For-Profit civil society organization registered with the Securities and Exchange Commission of Pakistan. SCF’s purpose is to promote rule of law and democratic policing in Pakistan principally through higher education and research in criminological and juridical sciences. He is a Senior Fellow of Global Think Tank Network (GTTN), National University of Science and Technology; Member, Steering Committee for the Assessment of Quality of Governance in Pakistan, Pakistan Institute of Legislative Development and Transparency; President, International Police Association Pakistan; International Director, Asia Crime Prevention Foundation, Tokyo; and Executive Director, Asia Crime Prevention Foundation Pakistan.  
 
Dr. Suddle is a veteran public servant, who has served Pakistan with distinction for over forty years. He began his law enforcement career in 1973 as Assistant Superintendent of Police and has held various key positions both at operational and strategic levels. He is highly regarded for effectively taming the dinosaur of terrorism as Police Chief of Karachi (1995-1996). As Criminal Justice Consultant in the National Reconstruction Bureau, he co-authored the Police Order 2002, which replaced the 141-year-old police law in Pakistan. Three days after 9/11, he was appointed Inspector General Police, Balochistan. He ably met the challenge, and, during his three-year stint, the Balochistan Police underwent historic transformation, not least its exceptional extension in jurisdiction from just 5 percent to entire Balochistan. In 2004, he was appointed Director General, National Police Bureau, Ministry of Interior. In this key strategic position, he contributed extensively to reshaping policing and counterterrorism policy in Pakistan. In 2008, following his stint as Inspector General Police, Sindh, he was appointed Director General, Intelligence Bureau (Pakistan's premiere civilian intelligence agency). The last public service appointment he held was the constitutional post of Federal Tax Ombudsman of Pakistan (2009-13). In a 2011 independent report card study published by Transparency International Pakistan, the Office of Tax Ombudsman received an exceptionally high approval rating of over 90%, declaring it the cleanest and the most efficient public sector organisation in Pakistan.
 
Dr. Suddle is regarded as a leading criminal justice reform and counterterrorism expert in South Asia. He is a visiting criminal justice expert at the United Nations Asia and Far East Institute on Crime Prevention and Treatment of Offenders (UNAFEI), Tokyo, and a resource person with many national and international organisations, including United Nations Office on Drugs and Crime.
 
Dr. Suddle has an MSc (Econ.) in criminology and a PhD in white-collar crime from Cardiff University; an MSc in Physics from Government College University, Lahore; and an LLB from University of Punjab. He is author of several publications and articles, published both in Pakistan and abroad.
 
Dr. Suddle is most highly decorated public servant in Pakistan. His civil awards include Hilal-e-Shuja’t (HSt), top national award for gallantry and service beyond the call of duty, 1996; Hilal-e-Imtiaz (HI), top national award for performance excellence, 2008; Quaid-e-Azam Police Medal (QPM), 1993; and President’s Police Medal (PPM), 1981.

Dr Saleem Qureshi Congratulates Dr Musarrat Iqbal and Getz Pharma on Installing the first CGSM & Insulin Pump in Islamabad in a Type 1 Diabetic Patient named Himala at Center for Diabetes and Liver Disease. (CDLD) located at 11 Hill Road F-6/2, Islamabad.

Diabetes, the silent killer, is directly linked with other body malfunctions like renal failure, blindness and cardiovascular diseases. Thus a diabetic patient should be seen as a potential case of other malfunctions and be treated as such.

Dr Saleem Qureshi, Head of the Department of Medicines KRL Hospital said this while addressing a seminar held at the end of a walk commemorating the World Diabetes Day held at the Aiwan-e-Quaid, F-9 Park here on Saturday. Alliance for Diabetes and Liver Diseases had organized the event. A large number of diabetic patients, members of civil society, health professionals and general public had turned up to get awareness about the deadly disease and its prevention.

Former Inspector General of Police and ex-Tax Ombudsperson Dr Shoaib Suddle who is also patron-in-chief of the Alliance, eminent nutritionist Dr Salma Badruddin, noted artist Zeba Bakhtiar and Imran Abbas also attended the seminar and shared with the audience their views regarding how to control the rising incidence of diabetes in Pakistan.

Dr Qureshi said in Pakistan the number of diabetes patients is steadily increasing. At present there are seven million diabetes patients and in next twenty years, the number can reach almost double i.e. 13 million. In the developing countries out of every 4 patients, three are diabetic, deplored Dr Saleem Qureshi calling upon the people to adopt a healthy lifestyle and avoid fats and sweetened dishes.

He attributed bulkiness as the major cause of diabetics. “Unless we start exercise and be mindful of our diet we cannot get rid of this looming threat on our heads,” said he.

Dr Shoaib Suddle drew the audience’s attention towards the grim fact that 10 persons are dying every one hour due to diabetes related complications. Incidence of diabetes is highest in South Asia because of the unregulated eating patterns of the people of this region, said he. However he expressed optimism that diabetes is preventable and total cost for the treatment of diabetic patient is around $55. Regular walk and healthy (not excessive) diet are the two main factors to check diabetes, he said.

He wished Dr Saleem Qureshi and his team good luck and commended their efforts for generating awareness about the disease among people.

Earlier, Dr Salma Burhanuddin gave a detailed presentation of diabetes and its impact on human health. Diabetes not only affects men’s health, women especially pregnant women become an easy target of the disease, she said. Diabetes affects women’s ability to conceive and most of its victims are from average income groups, she said. Like Dr Suddle she said awareness is the first step towards prevention of diabetes. She asked the families that were present in the Aiwan-e-Quaid in large number to discourage their children from excessive intake of potato chips, French Fries, noodles which are generally considered normal healthy food for kids.

Similarly, she said dry fruit in excess can also raise the sugar level in blood. Flour should be used instead of maida and rice should be taken with pulses, she advised. Imran Abbas TV and film star shared with the audience that his mother was a sugar patient and in the beginning she was scared of insulin, but when she came to know how effective it is in sugar control, she is taking it willingly. He asked the youth to promise that they would adopt a healthy life style and avoid late and excessive food. Dr Amir Awan the eye specialist warned the audience about diabetes’ bad effects on eyesight. Zeba Bakhtiar said she supported the noble cause Alliance for Diabetes and Liver Diseases was taking along for awareness about and prevention of diabetes. 

An insulin pump is a medical device used for the administration of insulin in the treatment of diabetes mellitus, also known as continuous subcutaneous insulin infusion therapy. It is an alternative to multiple daily injections of insulin and allows for intensive insulin therapy when used in conjunction with blood glucose monitoring and carb counting. The device configuration may vary depending on design. A traditional pump includes:

• the pump (including controls, processing module, and batteries)
  
• a disposable reservoir for insulin (inside the pump)
• a disposable infusion set, including a cannula for subcutaneous insertion (under the skin) and a tubing system to interface the insulin reservoir to the cannula. 
  

 

Main advantages of pump therapy are:

1.     Increased flexibility in lifestyle.
2.     Predictable insulin delivery.
3.     Precise insulin delivery.
4.     Ability to accurately deliver 1/10th of a unit of insulin.
5.     Tighter blood glucose control, while reducing the risk of low blood glucose.
6.     Reducing episodes of severe hypoglycemia.
7.     Reducing wide fluctuations in blood glucose.
8.     Helping manage the "dawn phenomenon."  

Click Here >> To visit ADLD Forum having "Diabetes support group" to discuss your queries and to learn more from the people who are using it. And Let us know your views about insulin pump in the comment section below.