Anti-Diabetic Drugs Flashcards
Insulin Analogs (rapid acting and basal) vs Human Insulin preparations (Regular and NPH). What are some differences between the two?
- Insulin analogs mimic physiologic insulin profiles more closely than human insulin preparations
- Rapid acting insulin analogues are absorbed more rapidly than regular human insulin, attaining a quick peak and short duration of action, more similar to physiologic prandial beta cell insulin secretion
- Regular human insulin has to be given 30 minutes before a meal whereas rapid acting insulin analogs can be administered just before a meal
- Rapid acting analogs are associated with improved postprandial glycemic control
- Basal Analogs provide levels of glycemic control comparable to NPH insulin
- -in summary treatment regiments based on both rapid and long acting insulin analogs have resulted in improvements of HbA1C levels, better glycemic control and reduced hypoglycemia compared with regular insulin
What is the onset, peak and duration of rapid acting insulin?
Lispro: 0.25 ; 0.5-1.5 ; 2-5
Aspart: 0.25 ; 0.6-0.8 ; 3-5
Glulisine: 0.25 ; 0.5-1.5 ; 1-2.5
What is the onset, peak and duration of short acting insulin?
Regular Soluble (Crystalline): 0.5-0.7 ; 1.5-4 ; 5-8
What is the onset, peak, and duration of intermediate acting insulin?
NPH: 1-2 ; 6-12 ; 18-24
What is the onset, peak, and duration of long acting insulin?
Glargine: 2-5 ; no peak ; 18-24
Detemir: 1-2 ; no peak ; greater than 24
What are the various insulin administration methods?
SQ injection – standard
Use: conventional disposable needles and syringes, portable pen injectors and pumps
If IV needed then use regular human insulin
A new type of insulin administration is inhaled insulin, what are some features of this type of insulin method?
Dry powder formulation of regular human insulin
–after inhalation peak levels are reached in 12-15 minutes and decline to baseline in 3 hours.
Dont give to COPD and asthma and smokers
Now the goal of SQ insulin therapy is to replace the normal basal (overnight, fasting and between meals) as well as bolus or prandial (mealtime) insulin. How does insulin release work in a non diabetic person?
Pancreas secretes boluses of insulin in response to snacks and meals
–between meals and throughout the night, the pancreas secretes small amounts of insulin that are sufficient to suppress lipolysis and hepatic glucose output
What two methods are used to achieve similar pattern of insulin release in a diabetic person?
- Basal Bolus Insulin Regimens: consisting of once to twice daily doses of basal insulin coupled with pre meal doses of rapid or short acting insulin
- Insulin Pump Therapy
The regimen that most closely mimics physiological insulin release, besides the use of an insulin pump, is what?
SID basal insulin such as insulin glargine or insulin detemir
–provide basal insulin levels throughout the day, along with doses of regular insulin, insulin lispro, insulin aspart or insulin glulisine before meals.
Long acting insulin can be given at bedtime or in the morning
The use of an insulin pump is the most precise way to mimic normal insulin secretion. How does the pump work?
Program the pump to deliver predetermined amounts of insulin from a reservoir to a SQ inserted catheter or needle
- -deliver various basal amounts of insulin over 24 hours as well as meal related boluses
- -rapid acting insulin analogs are used
Hypoglycemia is a common adverse effect for long term diabetics why?
Do not produce adequate amounts of counterregulatory hormones (glucagon, epinephrine, cortisol and GH) that normally provide effective defense against hypoglycemia
Compared rapid and long acting insulin analogs in regards to hypoglycemia
Rapid Acting: associated with lower incidence of severe hypoglycemia than NPH insulin
Long Acting: associated with lower risk of nocturnal hypoglycemia than NPH insulin
Another adverse effect of insulin is allergic reactions, explain the effect?
Immediate Type HSR
- -local or systemic urticaria results from histamine release from tissue mast cells sensitized by anti-insulin IgE antibodies.
- -sensitivity is due to non insulin protein contaminants; therefore human and analog insulins have markedly reduced the incidence of insulin allergy
The last adverse effect of insulin is lipodystrophy at the injection site, what does this mean?
Atrophy of SQ fatty tissue may occur at the site of injection