Diabetes and Insulin Preparations

Question 1

Regular insulin

Answer 1

GOLD STANDARD
RAPID, SHORT-acting insulin
prepared w/ zinc (rapid absorbed)
*Injected prior to meal (30 mins)*
Onset 30min-1hr, peak 2-4 hr, duration 5-8hr
Clear, can be given IV

Question 2

Iso-pH-ane Insulin

Answer 2

Insulin complex w/ protamine at neutral pH
SLOW absorption, LONG action
Between meal use w/ protamine
Onset 1-2hrs, peak 6-12, duration 18-24hr
Cloudy = NO IV

Question 3

Insulin lispro

Answer 3

Proline-lysine amino acid change
Aggregates less than normal insulin, absorbed faster, still short duration
Can be injected IMMEDIATELY before meals

Question 4

Insulin aspart

Answer 4

Proline -> aspartic acid
Similar to lispro, but LONGER duration
injected at meal time

Question 5

Insulin glulisine

Answer 5

Glutamate and lysine replacement
Similar to regular, lispro, and aspart
Injected at meal time

Question 6

Insulin glargine

Answer 6

Formulated w/ zinc at pH=4 = LONG duration
clear solution, precipiate in tissue
VERY LONG, LOW CONSTANT
between meals
SC x1/day
opposite properties of lispro, aspart and gluisine

Question 7

Insulin detemir

Answer 7

Myristic acid attached “-mir”
neutral pH
less variable absorption than glargine and shorter action (need 2 injection)

Question 8

Inhaled insulin

Answer 8

complications - withdrawal
Afrezza - fewer lung problems, still cough and throat irritation
rapid - use right before meal

Question 9

Side effects of insulin

Answer 9

Hypoglycemia (sympathoadrenal symptoms and CNS symptoms)

Tx: mild - anything with sugar; severe - glucose preparation

Question 10

Glucagon

Answer 10

Treat SEVERE insulin-induced hypoglycemia
Injected (IM or SC) = good for unconscious
Increases glucose and decrease insulin

Question 11

What other concerns with insulin/considerations

Answer 11

Weight gain type 2
drug interactions that increase/decrease glucose or insulin
propanolol and beta blockers mask symptoms of hypoglycemia

Question 12

Pramlintide

Answer 12

ANALOG of amylin (Peptide hormone)
NON-INSULIN approved for type I
decrease post-prandial glucose, decrease short-acting insulin requirement
decrease glucagon
slow gastric emptying
Used for type 1 and 2 already on insulin
7 injections a day!!!!

Question 13

Type 2 diabetes

Answer 13

Insulin resistant

can be treated with oral

Question 14

Sulfonylureas: Glimepiride

Answer 14

Enhance secretion of insulin
BLOCK ATP/K+ channel — cause insulin release, increase tissue sensitivity to insulin
decrease glucagon production
cause weight gain, contraindicated in liver or kidney disease

Question 15

Meglitinides: RepalGLINIDE

Answer 15

Bind ATP-K+ channels at different site than SUs and cause increase in insulin release
FASTER, shorter duration
safer for kidney disease

Question 16

Biguanides: METFORMIN

Answer 16

MOST WIDELY USED, 1st choice
Target AMP kinase, and lier enzymes, possibly microbiome
Work mainly in liver to decrease gluose production, increase uptake, increase insulin effectiveness
Does NOT cause hypoglycemia or weight gain
lactic acidosis can occur

Question 17

Acarbose

Answer 17

microbial sugar that inhibit sugar metabolizing enzymes in the gut - inhibit hydrolysis of disaccharides and complex carbs
slow absorption of glucose
take before meals
NOT powerful
can cause hypoglycemia (need to tx w/ glucose only), flatuence

Question 18

Thiazolidinediones: “glitazones”
Pioglitazone
Rosiglitazone

Answer 18

Bind and activate peroxisome PPAR-y

Nuclear TF that enhances insulin responsivness genes