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Flashcards in Insulin Therapy Deck (30):
1

Where is proinsulin normally stored?

Gogli apparatus of Beta cell

2

Products of proteolytic cleavage of proinsulin

C-peptide + insulin

3

Regulation of Insulin: Stimulatory (3)

Nutrient load: glucose>fat/protein
Autonomic nervous system: vagal stimulation and cephalic phase
Hormonal: incretins (GLP-1, GIP)

4

Regulation of Insulin: Inhibitory (3)

Starvation
Hypoglycemia
Hormonal: glucagon, epinephrine, GH, cortisol

5

Insulin Metabolism: Endogenous
___% Hepatic and ____% Renal

60% immediate hepatic via first pass effect

40% degradation in kidneys

6

Insulin Metabolism: Exogenous

Subcutaenous tissue-->bloodstream--> renal (60%)-->liver (40%)

7

Indications for Inuslin (2)

T1DM
Inadequately controlled T2DM

8

Indications for Temporary use of insulin (5)

Hospitalization/surgery
Pregnancy
Renal disease
Initial glycemic control for T2DM
To overcome glucose toxicity and re-regulate decompensated patients

9

Bolus Insulin: Purpose

Coverage of food intake or correction of hyperglycemia

10

Types of Bolus Insulin

Short Acting: regular
Rapid Acting: aspart, lispro, glulisine

11

Pharamcodynamics: Regular insulin vs. short-acting

Onset: 30-60min vs. 5-15min
Peak: 2-4hr vs. 1-2hr
Duration: 6-10hr vs. 4-6hr

12

Short-Acting insulin structures

Umm

13

Rapid Analogues vs. Regular: Similarities (4)

Glucose lower effects
Affinity of insulin receptor
Induction of receptor mediated cellular signals
Bioavailability

14

Rapid Analogues vs. Regular: Differences (4)

Faster absorption
Higher peak concentration
Faster onset of action
Shorter duration of action

15

Basal insulin: Purpose

Maintain euglycemia in fasting state

16

Types of Basal Insulin

Intermediate: NPH
Long acting: Glargine, detemir

17

NPH: Structure and Duration

Suspension of Zn-insulin with positively charged protamine

Intermediate duration of action (10-20hr)-->Must be admin 2x daily

18

NPH: Pros/Cons

Pros: can be combined with other insulins
Cons: peak in action increases risk of hypoglycemia

19

Glargine Physical Characteristics: structure/pH

Substitution of glycine on A and addition of two arginines on B

pH=4
Flat peak

20

Deter Physical Characteristics

Acylation
Neural pH
Flat peak

21

Insulin Administration Types:

IV, SubQ, inhaled

22

When do you use IV insulin?

Hospitalized patients or metabolic crisis (due to rapid onset/decay)

23

Conventional Insulin Administration

Long/intermediate acting only
Twice daily mixed split: 70/30 intermediate-rapid

24

Issues with Twice-Daily Split-Mixed Regimen

Still have periods of hyperglycemia between doses

25

Intensive Basal/Bolus Therapy

Injections of rapid-acting insulin before each meal + long acting insulin once daily

26

Inhaled Insulin Administration

Rapid acting insulin in increments for mealtime coverage

27

Advantages of Insulin Pump (4)

Uses only regular/rapid insulin
1 Injection site
Eliminates subcutaenous insulin depot
Simulates normal pancreatic function

28

Exercise & Pump

Must educate people about lowering insulin dose before exercise (since it induces GLUT4)

29

Insulin Complications (4)

Hypoglycemia (at time of peak insulin)
Insulin Lipodystrophies: lipoatrophy or lipohypertrophy at injection site
Allergy: local or systemic
Insulin resistance

30

Hypoglycemia: Prevention (3), Treatment (2)

Prevention: awareness, plan for treatment, plan for prevention

Treatment: glucose tablets, glucagon