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Flashcards in Insulin Therapy Deck (29):
1

Precursor to insulin

proinsulin - a chain + b chain bonded by 2 disulfide bonds

2

cpeptide

portion of proinsulin that is cleaved in formation of insulin --> clinical marker of endogenous insulin production

3

insulin production

proinsulin packaged in golgi --> proteolytic cleave to insulin + c peptide --> zn added forming hexameric crystalline insulin --> stored in granules

4

Insulin binds to _____ receptors with strong affinity and specificity.

insulin and igf1 -->tyrosine kinase and protein phsphorylation cascade

5

endogenous insulin metabolism

B cell --> bloodstream --> portal vein --> liver (60% degrade via first pass, 40% in kidneys)

6

exogenous insulin metabolism

subcutaneous tissue --> bloodstream --> kidney (60%) --> liver (40%)

7

Insulin promotes/inhibits triglyceride synthesis and storage

promotes

8

Insulin promotes/inhibits lipolysis

inhibits

9

Insulin promotes/inhibits glycogen synthesis in muscle

promotes

10

Insulin promotes/inhibits aa uptake in muscle

promotes

11

Insulin promotes/inhibits protein synthesis in muscle

promotes

12

Insulin promotes/inhibits glycogen synthesis in liver

promotes

13

Insulin promotes/inhibits fa synthesis in liver

promotes

14

Insulin promotes/inhibits glucose output in liver

inhibits

15

Insulin promotes/inhibits ketogenesis in liver

inhibits

16

T/F human synthetic insulin is packaged at neutral pH

F --> all except glargine

17

Rapid-acting human analogs/bolus are used for

coverage of food intake and correction of hyperglycemia
short acting = regular
rapid acting = aspart, lispro, glulisine

18

short-acting regular insulin are used for

mealtime hyperglycemia

19

long-acting insulins/basal

maintain euglycemia in the fasting state (NPH = 2x per day, long acting = glargine, detemir)

20

Aspart and lispro are ___ with regular human insulin

homologous --> single exchanges in each --> disrupt monomer-monomer interactions = less hexamer formation = more rapid absorption after subq injection

21

Compare glucose lowering effects of aspart/lispro vs. normal insulin

similar (affinity, induction, bioavailability)

22

Compare pharmacokinetics of aspart/lispro vs. normal insulin

aspart/lispro 2x faster, 2x higher peak concentration, faster onset of action, shorter duration of action

23

NPH

neutral protamine hagedorn/humulin/novolin/isophane --> suspension of crystalline zinc insulin with positively charged polypeptide proamine

24

Glargine

long-acting insulin analogue with a few changes that create an acidic pH --> precipitates in subcutaneous tissue --> slow breakdown

25

Detemir

soluble long acting basal insulin analog --> binds to albumin and dissolves slowly

26

Which of NPH/glargine/detemir is intermediate duration?

nph

27

Insulin administration modes

subq and IV

28

IV insulin indications

hospitalized patients and acute management of metabolic crises --> rapid onset/decay

29

Complications of insulin delivery

hypoglycemia, inuslin lipatrophy/hyerptrophy at injection sites, allergy, resistance