5. Insulin treatment - insulin preparations, types of regimens Flashcards Preview

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1
Q

treatment of diabetic retinopathy ?

A

tight glucose and blood pressure control

laser treatment

intraviterous anti -VEGF

2
Q

what is the treatment of diabetic nephorpathy ?

A

regulation of blood glucose

hypertension control
ACE = lower intraglomerular pressure and decreases hyerfiltration while also lowering systemic blood pressure
and renal protection

ARB - diabetic nephorpathy
renal protection

both combinlly used

3
Q

treatment of diabetic neuropathy ?

A

glucose control

reduce oxidative stress =
aldose reductase inhibitors
alpha lipoic and gamma linolenic acid

4
Q

what is the treatment for macroangipathy such as congestive heart disease and arteriosclerosis ?

A

aspirin
statins
clopidrogel
lifestyle modification

5
Q

what are the side effects of insulin injections ?

A

Lipoatrophy is an immune-mediated condition resulting in loss of fat at insulin injection sites
occurs rarely with purified human insulins

Lipohypertrophy is a common, non-immunological side effect repeated injections of insulin into the same subcutaneous site

weight gain = due to freq hypoglycaemic episodes , adore eat in response to hunger

6
Q

how is regular human insulin administered ?

A

short acting

subcutaneous , intramuscular or intravenous

7
Q

what are the analogs of human insulin?

A

RAPID short ACTING :

insulin aspart= NOVOLOG
glulisine = APIDRA
lispro = HUMALOG

8
Q

how are insulin aspart , glulisine and lispro administers ?

A

subcuteneous

when given intravenously =these rapid acting insulin becomes identical to regular insulin

9
Q

what are the long acting insulin ?

their characteristics of ph ?

AND HOW ARE THEY ADMINISTERED ?

onset of action ?

duration ?

A

glargine = the only insulin with NOT a neutral ph
PH=4

onset = 1.5
duration = 24 hr
————

insulin determir
onset 3-4 hrs
duration 20-24hr

no big peak = therefore basal inulin

both only subcutaneously

10
Q

how long des it take for regular human insulin to taken action ?

what is the duration of action

and side effects

A

SHORT ACTING

30 minutes - taken 30 min prior to meal
postprandial hyperglycaemia if not taken 30 min prior

the duration of action 5-8 hours (peaking at 2-4) = late post prandial hypoglycemia = NEED TO TAKE ANOTHER MEAL

2 times faster rate of absorption from abdomen then subcutaneous

11
Q

what is the benefit of rapid acting insulin such as lispro insulin aspart and glulisine ?

what is the onset of rapid acting insulin ?

and want is the duration ?

A

less risk developing post prandial hyperglycaemia and hypoglycemia

within 15 mins

duration 3-5 hours

12
Q

what is an intermediate acting insulin ?

onset of action ?

duration ?

A

NPH insulin
suspension of regular insulin and ptomaine = therefore not IV administered

onset = 1-2 hours

duration = 14hrs and plus

(no big peak = therefore called basal insulin)

13
Q

what is the regimes for type 1 diabetes ?

A

require replacement dose of 0.5-1 unit per kg per day of insulin

early stages of type 1 diabetes = les insulin required = beta cells producing some insulin = honeymoon period

  • conventional insulin therapy
  • intensive insulin therapy
14
Q

in type 2 diabetes when are the long acting insulin prescribed ?

A

when patient not achieved target glucose level or hb1ac (more than 8.5 percent) despite triple medication therapy

Initiate basal insulin supported oral therapy (BOT).

long-acting insulin injection (e.g., glargine) before bedtime combined with with metformin
glucagon-like-peptide-1 (GLP-1) /short acting insulin before meal

15
Q

what is the conventional insulin therapy ?

disadvantage ?

A

2x a day subcutaneous injection of insulin mixture
(intermediate NPH AND short acting in a 70:30)

with a self monitoring of blood glucose level

2/3 of daily dose injected in morning before breakfast and 1/3 in the evening before dinner

:( strict diet adherence and exercise plan , snack between meals t avoid hypoglycemia

16
Q

what are the intensive insulin therapies ?

A

Basal-bolus regimen: basal insulin 1–2 times daily, + bolus insulin (short and rapid acting , normal insulin) injection 30–45 minutes before meals

Insulin pump
Continuous subcutaneous insulin infusion (regular or rapid-acting insulin analogs)
Basal and bolus insulin may be managed individually