Insulin Therapy Flashcards Preview

Endocrinology > Insulin Therapy > Flashcards

Flashcards in Insulin Therapy Deck (30)
Loading flashcards...
1
Q

Where is proinsulin normally stored?

A

Gogli apparatus of Beta cell

2
Q

Products of proteolytic cleavage of proinsulin

A

C-peptide + insulin

3
Q

Regulation of Insulin: Stimulatory (3)

A

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

4
Q

Regulation of Insulin: Inhibitory (3)

A

Starvation
Hypoglycemia
Hormonal: glucagon, epinephrine, GH, cortisol

5
Q

Insulin Metabolism: Endogenous

___% Hepatic and ____% Renal

A

60% immediate hepatic via first pass effect

40% degradation in kidneys

6
Q

Insulin Metabolism: Exogenous

A

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

7
Q

Indications for Inuslin (2)

A

T1DM

Inadequately controlled T2DM

8
Q

Indications for Temporary use of insulin (5)

A
Hospitalization/surgery
Pregnancy
Renal disease
Initial glycemic control for T2DM
To overcome glucose toxicity and re-regulate decompensated patients
9
Q

Bolus Insulin: Purpose

A

Coverage of food intake or correction of hyperglycemia

10
Q

Types of Bolus Insulin

A

Short Acting: regular

Rapid Acting: aspart, lispro, glulisine

11
Q

Pharamcodynamics: Regular insulin vs. short-acting

A

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

12
Q

Short-Acting insulin structures

A

Umm

13
Q

Rapid Analogues vs. Regular: Similarities (4)

A

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

14
Q

Rapid Analogues vs. Regular: Differences (4)

A

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

15
Q

Basal insulin: Purpose

A

Maintain euglycemia in fasting state

16
Q

Types of Basal Insulin

A

Intermediate: NPH

Long acting: Glargine, detemir

17
Q

NPH: Structure and Duration

A

Suspension of Zn-insulin with positively charged protamine

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

18
Q

NPH: Pros/Cons

A

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

19
Q

Glargine Physical Characteristics: structure/pH

A

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

pH=4
Flat peak

20
Q

Deter Physical Characteristics

A

Acylation
Neural pH
Flat peak

21
Q

Insulin Administration Types:

A

IV, SubQ, inhaled

22
Q

When do you use IV insulin?

A

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

23
Q

Conventional Insulin Administration

A

Long/intermediate acting only

Twice daily mixed split: 70/30 intermediate-rapid

24
Q

Issues with Twice-Daily Split-Mixed Regimen

A

Still have periods of hyperglycemia between doses

25
Q

Intensive Basal/Bolus Therapy

A

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

26
Q

Inhaled Insulin Administration

A

Rapid acting insulin in increments for mealtime coverage

27
Q

Advantages of Insulin Pump (4)

A

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

28
Q

Exercise & Pump

A

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

29
Q

Insulin Complications (4)

A

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

30
Q

Hypoglycemia: Prevention (3), Treatment (2)

A

Prevention: awareness, plan for treatment, plan for prevention

Treatment: glucose tablets, glucagon