Insulin Flashcards
(26 cards)
Types of Insulin
Rapid acting-Insulin Lispro (Humalog)
Short acting-Regular Insulin
Intermediate acting- Lente or NPH
Long-acting - Ultralente, Insulin Glargine (Lantus), Detemir (T1DM and T2DM)
Rapid acting insulin
Insulin Lispro (Humalog)
- Onset: 0-15 minutes
- Peak: 30-90 minutes
- Duration: <5 hours
Covers insulin need for meals eaten at time of injection.
Used with longer acting insulin
Short acting insulin
Regular insulin
- Onset: 30-45 minutes
- Peak: 2-4 hours
- Duration: 5-7 hours
Covers insulin need for meals eaten within 30-60 minutes
Intermediate acting insulin
Lente or NPH
- Onset: 1-4 hours
- Peak: 6-14 hours
- Duration: 18-24 hours
Covers insulin need for half of the day or overnight.
Often combined with rapid or short acting insulin
Long acting insulin
Ultralente
- Onset: 4-6 hours
- Peak: 18-26 hours
- Duration: >30 hours (varies)
Covers insulin needs for one full day.
Often combined with rapid or short acting insulin
Long acting insulin
Insulin Glargine (Lantus)
- Onset: 1-2 hours
- Peak: None (Steady level)
- Duration: 20-24 hours
Covers insulin needs for one full day.
Often combined with rapid or short acting insulin
Long acting insulin
Determir (T1DM and T2DM)
- Peak: 6-8 hours
- Duration: Up to 24 hours
Covers insulin needs for one full day.
Often combined with rapid or short acting insulin
Complications of Diabetes
Acute
-Hypoglycemia (complication from treatment), ketoacidosis, diabetic coma
Long-term
-CV disease, blindness, difficultly healing
Chronic complications
retinopathy-most common cause of blindness in woking age people
nephropathy-16% of new pts needing renal repl. therapy
erectile dysfunction-up to 50% men w/long standing diabetes
foot problems-15% develop ulcers and 5-15% of those pts require amputations
neuropathy-20% diabetic pts and 50-75% non traumatic amputations
Coronary and CV disease-2-4x more likely to have stroke and coronary heart disease
T1DM characteristics
- High to very high plasma glucose
- low to absent insulin levels
- age of onset is 1-20 y/o
- Islet antibodies present
- Obesity not common
- Ketosis and diabetic coma
- 10% Prevalence
- require insulin therapy (oral drugs ineffective)
T2DM characteristics
- High plasma glucose
- high to normal insulin levels
- age of onset is 12 y/o or older
- No Islet antibodies
- Obesity (60-90%)
- Ketosis variable
- 90% prevalence
- can require insulin therapy, but oral hypoglycemics are effective
Classes of oral hypoglycemic agents
Secretagogues: Sulfonylureas, Meglitinides
Sensitizers: Biguanides, Thiazolidinedione
alpha glucosidase inhibitors: Acarbose, Voglibose, Miglitol
Incretins and DPP-4 inhibitors
Peptide analogs: Glucagon-like peptide (GLP) agonists, Dipeptidyl peptidase-4 inhibitors, Amylin analogues
SGLT2 blockers
Oral hypoglycemic agents
Secretagogue: Sulfonylureas
Tolbutamide/Glyburide
-increase insulin release
-decrease glucagon
-increase sensitivity to insulin
-increase weight gain
-no effect on lipid panel
ofton used in combo with metformin
Side effect: Hypoglycemia
Oral hypoglycemic agents
Secretagogue: Meglitinides
Repaglinide/Nateglinide
- close K channels in islet cells which increases release of insulin
- take before meal, but not without a meal!
- half life 1hr so multiple uses (i.e. after meals)
- use alone or in comination with Metformin
- metabolized in liver (caution with impaired liver)
- increase weight gain
- no effect on lipid panel
Oral hypoglycemic agents
Sensitizers: Biguanides
Metformin
-decrease glucose production by liver
-decrease glucose absorption in gut
-increase insulin sensitivity in muscle & adipose
-does NOT cause insulin release
-no hypoglycemia when used alone
-DO NOT give to renal, liver, or heart failure pts
-GI distubances: diarrhea
-decrease in weight
-Increase HDL
decrease LDL/TG
Oral hypoglycemic agents
Sensitizers: Thiazolidinedione
Rosiglitazone (Avendia) / Pioglitazone (Actos)
-Agonists for nuclear peroxisome proliferator-activated receptor gamma (PPARgamma)
-decrease insulin resistance in peripheral tissues
-upregulation of genes that regulate carbohydrate and lipid metabolism (GLUT4 transporters)
-increase glucose transport in muscle and adipose
-increase weight
-increase HDL
Rosiglitazone increase in LDL
Oral hypoglycemic agents
Sensitizers: Thiazolidinedione
Rosiglitazone (Avendia) / Pioglitazone (Actos)
Use
Use: monotherapy or combo with insulin or sulfonylureas
- takes 6-12 wks for full effect
- watch liver function
- Rosiglitazone (Avendia) black box in US due to increased risk of heart failure; banned in Europe
Oral hypoglycemic agents
Alpha-glucosidase inhibitors
Acarbose, Voglibose, Miglitol
- inhibit alpha-glucosidase in gut (Give with a meal)
- decreases absorption of starch, dextrin, disaccharides
Side effect: gas & bloating
can be used alone or in combination
-no effect on weight
-no effect on lipid panel
Oral hypoglycemic agents
Incretins and DPP-4 inhibitors
Incretin
- incretin is a glucagon like peptide-1 (GLP-1)
- stimulates insulin release
- inhibits glucagon release
DPP-4 inhibitors
- block DPP-4 enzyme to inactivate GLP-1
- results in decreased blood glucose
Peptide analogs: glucagon-like peptide agonists
Exenatide (Byetta, Bydureon)
Liraglutide (Victoza)
given by injection
- GLP-1 agonsts: increased 1/2 life
- augment glucose-dependent insulin secretion
- decrease glucagon release
- use with diet and exercise
Exenatide injection: Byetta twice daily
Bydureon once per week
Liraglutide injection once daily
Interaction: reduce absorption of drugs that are taken orally
Side Effects: n/v, headache, pancreatitis, hypoglycemia, thyroid C-cell tumors, and (MI?)
Oral hypoglycemic agents
Peptide analogs: Dipeptidyl peptidase-4 inhibitors
Sitaglipten (Januvia)
Saxaglipten (Onglyza)
Linagliptin (Tradjenta)
- inhibit DPP-4 and increase blood concentration of the incretin GLP-1
- can be used alone or in combination w/ Metformin (combo is Janumet)
- administered PO
- hypoglycemia when combined with glimepiride (Amaryl) or a sulfonylurea
- DDP-4 targets tumors, so watch for tumors with these drugs
Side effects: nausea, pancreatitis?, cancer? due to tumor suppression, respiratory infection, sore throat, muscle pain
Peptide analogs: Amylin analogues
Pramlintide (Symlin)
given by injection
- a synthetic amylin (Islet amyloid polypeptide secreted by beta cells and is deficient in diabetics)
- slows gastic emptying and increases glucose absorption, promotes satiety, suppresses glucagon
- used for type 1 and type 2
- sub q administration before meals
- contraindicated in pts with delayed gastric emptying
- side effects: hypoglycemia 3 hrs after injection, nausea
Oral hypoglycemic agents
SGLT2 blockers
Dapagliflozin
- not yet approved
SGLT2 (sodium-glucose transport proteins responsible for 90% glucose reabsorption in kidney)
MOA: blocks reabsorption of glucose and promotes elimination of glucose in urine
(associated with a small weight loss)
Use: Will likely be approved for type 1 and type 2 diabetes
May be used as a combination if approved
Side Effects: breast and bladder cancers? liver damage?
How is insulin secreted?
- increase bg
- glucose enters beta cells via glut 2
- glycolysis via kreb’s cycle And respiratory cycle
- beta cell formation ATP
- close k channels
- increased membrane potential(inside cell) b/c if hyper polarization
- depolarization
- open ca 2 channels
- release ca2 from ER
- release insulin
