Diabetes Mellitus Type 1 Flashcards
(25 cards)
Rapid Acting Insulin Preparations- Available Drugs
insulin aspart
insulin lispro
insulin glulisine
Rapid Acting Insulin Preparations- Kinetics
amino acid substituted insulin variants that are monomeric for faster absorption
onset= 5-15 min peak= 45-75 min duration= 2-4 hr
Rapid Acting Insulin Preparations- Clinical Use
prior to meal (immediately before) for control of POSTPRANDIAL HYPERGLYCEMIA
also for acute hyperglycemia
Rapid Acting Insulin Preparations- Drug Rxns
drugs w/ hyperglycemic effects:
corticosteroids
Ca channel blockers
thiazide diuretics
Regular Insulin- Kinetics
zinc ions added for stability
onset= 30-60 min peak= 2-4 hrs duration= 6-8 hrs
Regular Insulin- Clinical Use
prior to meal (30-45 min.) for control of POSTPRANDIAL HYPERGLYCEMIA
also for acute hyperglycemia
Intermediate Acting Insulin- Available Drugs
NPH INSULIN lente insulin (discontinued)
Intermediate Acting Insulin- Kinetics
conjugated w/ protamine peptide which delays absorption until it is cleaved by tissue proteases
onset= 1.5-2 hrs peak= 6-10 hrs duration= 16-24 hrs
Intermediate Acting Insulin- Clinical Use
MAINTAIN BASAL INSULIN
overnight coverage
Long Acting Insulin- Available Drugs
INSULIN GLARGINE
INSULIN DETMIR
Ultralente insulin (discontinued)
Long Acting Insulin- Kinetics
Insulin glargine - amino acid substituted insulin that forms large precipitate in body pH that slows absorption
onset= 2hrs peak= N/A duration= 20-24 hrs
Insulin detmir - insulin w/ fatty acid side chain that associates with tissue bound albumin that slows absorption
Long Acting Insulin- Clinical Use
MAINTAIN BASAL INSULIN
overnight coverage
Insulin Preparations- Mech of Action
replace deficient insulin
replicate normal physiological production of insulin by the pancreas–> basal insulin produced under fasting conditions + postprandial insulin released after a meal
act on tyrosine kinase receptor:
liver- glucose uptake, inhibit glucose production
muscle- glucose uptake; increase AA uptake and protein synthesis
adipose- glucose uptake, inhibit lipolysis, increase TG storage
Insulin Preparations- Notes on Administration
SubQ by intermittent injections or continuous infusion
inhaled form discontinued
rotate injection sites (upper arm, thigh, abdomen, buttock) to avoid lipodystrophy
Insulin Preparations- Side Effects/Contraindications
MILD HYPOGLYCEMIA:
tremor, palpitations, sweating, intense hunger
MODERATE HYPOGLYCEMIA:
headache, mood change, irritability, decreased attention, drowsiness, patients may require assistance
SEVERE HYPOGLYCEMIA:
unresponsiveness, unconsciousness, convulsions, patients require assistance, death
Conventional Insulin Therapy- Typical Combination
NPH Insulin + Regular Insulin
NPH Insulin + Regular Insulin- Mech of Action
mimic normal insulin action with basal insulin + postprandial peaks
NPH Insulin + Regular Insulin- Kinetics
twice daily mixed injections- before breakfast and before dinner
NPH Insulin + Regular Insulin- Clinical Use
DM type 1 or late stage type 2
DM type 2 requires larger doses of insulin than type 1 due to insulin resistance
NPH Insulin + Regular Insulin- Side Effects/Contraindications
risk of hypoglycemia between lunch and dinner, and again between dinner and breakfast due to NPH peaks between meals
risk of hyperglycemia in the morning due to dawn phenomenon
Intensive Insulin Therapy- Typical Combination
Rapid Insulin + NPH or Glargine
Rapid Insulin + NPH or Glargine- Mech of Action
provide a more physiologic profile or insulin by administration
Rapid Insulin + NPH or Glargine- Kinetics
once or twice daily basal insulin plus pre meal boluses of rapid acting insulin to control postprandial glucose
Rapid Insulin + NPH or Glargine- Clinical Use
DM type 1 or late stage type 2
determine dose of premeal bolus by blood glucose level, size and composition of the meal, and degree of anticipated activity
