Insulin Therapy Flashcards Preview

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Flashcards in Insulin Therapy Deck (29)
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1
Q

Precursor to insulin

A

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

2
Q

cpeptide

A

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

3
Q

insulin production

A

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

4
Q

Insulin binds to _____ receptors with strong affinity and specificity.

A

insulin and igf1 –>tyrosine kinase and protein phsphorylation cascade

5
Q

endogenous insulin metabolism

A

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

6
Q

exogenous insulin metabolism

A

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

7
Q

Insulin promotes/inhibits triglyceride synthesis and storage

A

promotes

8
Q

Insulin promotes/inhibits lipolysis

A

inhibits

9
Q

Insulin promotes/inhibits glycogen synthesis in muscle

A

promotes

10
Q

Insulin promotes/inhibits aa uptake in muscle

A

promotes

11
Q

Insulin promotes/inhibits protein synthesis in muscle

A

promotes

12
Q

Insulin promotes/inhibits glycogen synthesis in liver

A

promotes

13
Q

Insulin promotes/inhibits fa synthesis in liver

A

promotes

14
Q

Insulin promotes/inhibits glucose output in liver

A

inhibits

15
Q

Insulin promotes/inhibits ketogenesis in liver

A

inhibits

16
Q

T/F human synthetic insulin is packaged at neutral pH

A

F –> all except glargine

17
Q

Rapid-acting human analogs/bolus are used for

A

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

18
Q

short-acting regular insulin are used for

A

mealtime hyperglycemia

19
Q

long-acting insulins/basal

A

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

20
Q

Aspart and lispro are ___ with regular human insulin

A

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

21
Q

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

A

similar (affinity, induction, bioavailability)

22
Q

Compare pharmacokinetics of aspart/lispro vs. normal insulin

A

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

23
Q

NPH

A

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

24
Q

Glargine

A

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

25
Q

Detemir

A

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

26
Q

Which of NPH/glargine/detemir is intermediate duration?

A

nph

27
Q

Insulin administration modes

A

subq and IV

28
Q

IV insulin indications

A

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

29
Q

Complications of insulin delivery

A

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