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Flashcards in FN: Diabetes Insulin Deck (29):
1

Short acting soluble insulin exampes

Actrapid and Human S

2

Short acting soluble insulin onset

30-60mins

3

Short acting soluble insulin peak

2-4hrs

4

Short acting soluble insulin duration

6-8 hrs

5

Short acting soluble insulin uses

Maintenance: 15-30mins before meals
DKA
Sliding scales

6

Short acting insulin analogues examples

Aspart: Nonorapid
Lispro: Humalog

7

Short acting insulin analogues onset

15 mins

8

Short acting insulin analogues peak

1-3 hrs

9

Short acting insulin analogues duration

2-5hrs

10

Short acting insulin analogues uses

Maintenance: 15-30mins before meals
DKA
Sliding scales

11

Intermediate and long acting insulin isophane insulin

Insulatard
Humulin I

12

Intermediate and long acting insulin insulin analogues

Glargine: lantus
Determir: Levemir

13

Intermediate and long acting insulin onset

1-3hrs

14

Intermediate and long acting insulin peak

4-12hrs

15

isophane insulin duration

12 hrs

16

Glargine duration

24hrs

17

Detemir duration

20 hrs

18

Intermediate and long acting insulin uses

Glargine is given OD (noct) as basal therapy
Long acting analogues reduced nocturnal hypoglycaemia

19

Effects of insulin in adipose tissue

increase lipoprotein lipase activity - reduced TGs
Increase GLUT-4 activity and raised glucose storage as fat
reduced lipolysis - reduce fatty acids released into circulation

20

Insulin effects on liver

Reduced glycogenolysis
reduced gluconeogeneis
increased glcyoneogeneis
Inhibition of ketogenesis

21

Insulin in muscles

reduced ptoelysis
Increased GLUT4 activity - increase glucose uptake

22

Factors affecting absorption

Temperature
Excercise
Preparation: actrarapid vs. glargine
Delivery method problems:
IV:1 min peak conc
SC: 90min peak conc

Injectino site and depth

23

Adminisitration

s/c: typical route
IVI:
1. DKA
2. Control in critical illness
3. Control in peri-operative period

24

Side effects

Hypoglycaemia
Liphypertrophy
Wt. gain in T2DM

25

Hypoglycaemia

At riskL EToH binge, beta lockers (mask symptoms), elderly

26

Lipohypertrophy

Rotte injection site: abdomen and thighs

27

Wt. gain in T2DM

reduced wt gain if insulin given with metformin

28

Problems with actrarapid in the basal-bolus regime

1. absorbed over 3-4hrs: not physiological
2. Must give 15 mins before meal
3. Can - late post prandial hypoglycaemia
4. Immediate post-prandial hyperglycaemia may increase risk of DM complications

29

Short acting insulin analogues

Fast onset and shorted duration
Can be given just before start of meal
Less chance of post-prandial hypoglycaemia

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