05 Thera VI Insulin and Injectables Lee Flashcards Preview

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1

How is insulin stored?

Insulin molecules form inactive storage hexamers (2 Zn and 6 insulin molecules). Insulin hexamers dissociate back into monomers (active form) in order to be diffused into the blood stream (results in delay in insulin onset of action). Newer insulin analogs have minimal hexamerization and diffuse faster

2

What is the physiological action of insulin?

Binds to its receptor. Translocation of Glut-4 transporters to plasma membrane. Influx of glucose into cell (most prominently muscle and adipose tissue)

3

What are the physiological effects of Insulin?

Increase: glucose uptake, glycogen synthesis, protein synthesis, triglyceride synthesis, potassium uptake. Decrease: gluconeogenesis, glycogenolysis, proteinolysis, lipolysis

4

What are the pharmacokinetics of insulin?

Cleared primarily by liver and kidneys. Half-life: 3-5 minutes

5

What is the normal basal insulin release in your body?

About 1 unit/hour

6

What is the advantage of using insulin therapy?

Decrease microvascular risk. Minimal side effects. No max dose. Unlimited efficacy

7

What are the disadvantages of insulin therapy?

Frequent monitoring. Injectables only (risk of lipodystrophy with incorrect technique). Weight gain. Hypoglycemia. Requires extensive patient education and dedication

8

What are the different types of insulin?

Rapid-acting. Short-acting. Intermediate-acting. Long-acting. Premixed

9

Which types of insulin are bolus/meal insulin?

Rapid- and short-acting

10

Which types of insulin are basal insulin?

Intermediate- and long-acting

11

What are the Rapid-Acting insulins?

Aspart (Novolog). Lispro (Humalog). Glulisine (Apidra)

12

What is the onset time for rapid-acting insulin?

5-15 minutes

13

What is the peak time for rapid-acting insulin?

30-90 minutes

14

What is the duration for rapid-acting insulin?

3-5 hours

15

What are the advantages of Rapid-Acting insulin?

Stimulates physiologic insulin relative to meals. More flexibility in meal timing. Can mix with insulin NPH. Can be given IV (aspart, glulisine)

16

What are the disadvantages of Rapid-Acting insulin?

High cost. Frequent injections. Provides only prandial coverage, still need basal insulin

17

What are the Short-Acting insulin drugs?

Regular (Humilin R, Novolin R)

18

What is the onset time for Short-Acting insulin?

30 minutes

19

What is the peak time for Short-Acting insulin?

2-4 hours

20

What is the duration of Short-Acting insulin?

4-8 hours

21

What are the advantages of Short-Acting insulin?

Cheaper. Can mix with NPH. Can be given IV/IM

22

What are the disadvantages of Short-Acting insulin?

Requires proper timing of injection relative to meals. Variable PK

23

What are the Intermediate-Acting Insulins?

NPH (Humulin N, Novolin N). CLOUDY appearance

24

What is the onset time of Intermediate-Acting Insulin?

2 hours

25

What is the peak time of Intermediate-Acting Insulin?

4-12 hours

26

What is the duration of Intermediate-Acting Insulin?

14-24 hours

27

What are the advantages of Intermediate-Acting Insulin?

Cheaper. Can mix short- or rapid-acting insulin --> fewer # of injections

28

What are the disadvantages of Intermediate-Acting Insulin?

In most patients, require BID injections for basal coverage. Causes more hypoglycemic events due to peaks (nocturnal hypoglycemia)

29

How often is Intermediate-Acting Insulin given?

Inject SQ QD-BID (timing of SQ injection depends upon the insulin with which it is administered)

30

What are the Long-Acting Insulins?

Detemir (Levemir). Glargine (Lantus)