Name the 3 rapid acting insulins
Can you think of their brand names?
Insulin Glulisine Apidra®
Insulin Aspart Novorapid®
Insulin Lispro Humalog®
That GAL is RAPID!
What type of insulin is Novorapid?
When should the rapid acting insulins be injected?
Immediately before eating
(0- 15 mins before food)
How long does it generally take rapid acting insulins to start working?
~10 - 20 minutes
How long is the duration of action of rapid acting insulins?
around 2 - 5 hours
How many units of insulin do the Flexpen, Flextouch, Kwikpen and Solostar (all pre-filled disposable pens) tend to contain?
3ml pens containing 100 units/ ml
Are patients more or less at risk of hypglyceamia when using rapid-acting insulins compared to other insulins?
Less at risk of hypoglyceamia as it is only in body for a few hours and is used with meals
What type of insulin are short acting insulins?
Short acting insulin= Soluble insulin (S S)
Can get different types of soluble insulins:
Soluble bovine ('neutral') Beef
Soluble porcine ('neutral') Pig
What kind of insulin is Actrapid?
Insulin soluble (human)
When should short acting insulins be injected?
15 - 30 mins before food
Must eat food within 30 mins of injecting to avoid hypoglyceamia
They start working after 30 mins
How long do short acting insulins work for and when is their peak activity?
Duration of action: 4 - 8 hours
Peak activity: 2 - 4 hours
What type of insulin is intermediate acting?
Intermediate acting = Isophane insulin (i,i)
Human isophane insulin usually used
Isophane insulin is a suspension of Insulin with protamine: bovine porcine or human insulin in the form of a complex obtained by the addition of protamine
Usually found in biphasic preparations
Can you think of any brands of Intermediate acting insulins?
(all of the i's!)
When should intermediate acting (isophane) insulins be injected?
They usually need to be injected twice daily, sometime once daily in eldery
No need to inject with meals
They have a peak action at 4 - 12 hour and last for around 21 hours
What are the three types of long- acting insulins? Do you know their brand names?
Insulin Detemir Levemir®
Insulin Glargine Lantus ®
Insulin Degludec Tresiba®
How long do the long-acting insulins usually work for?
Which one works for up to 42 hours?
around 18 - 24 hours
42 hours: Degludec (tresiba)
Which type of insulin is used in medical emergencies such as diabetic ketoacidosis and before surgery?
What is the rational behind biphasic insulin preparations?
These are basically pre-mixed preparations of a rapid or short acting insulin plus a intermediate acting insulin (either the protamine [longer chain version of the short/ rapid acting one] or isophane insulin).
They are to be injected twice daily, and are good for patients who don't like multiple injecting regimens ( also called basal bolus- where people have to inject short acting with meals plus a long acting insulin)
Disadvantages of these are that there may be less control as proportions are fixed- if unwell and need to boost their insulin they cannot use these and would need a rapid or short acting insulin for this.
NovoMix is a Biphasic insulin (intermediate acting). It contains a mixture of which insulins?
Insulin aspart (rapid acting)
Insulin aspart protamine (long acting)
Together it becomes intermediate acting- injected twice daily
What do Biphasic insulins look like in appearance?
Need to be resuspended before use- tell patient this- by rolling in their hands (not shaking)
Can you name 4 brands of Biphasic insulins, and their ingredients?
Novomix 30 (insulin aspart+ aspart protamine)
Humalog Mix 25 / Humalog Mix 50 (Insulin Lispro + lispro protamine)
Humulin M3 (soluble insulin + isophane insulin)
Insuman Comb 50 (soluble insulin + isophane insulin)
What electrolyte disturbance can insulins cause?
When should Biphasic insulins be injected?
Think about what each one contains: short or rapid acting?
The ones containing rapid acting (NovoMix 30, Humalog Mix) should be injected 0-15 mins before a meal
Containing short acting (Humulin M3, Insuman Comb) inject 15 - 30 mins before a meal
What substance in some insulins can cause injection site reactions and therefore is important to make patients aware the importance of rotating the site of action?
The fridge on one of your wards is broken, therefore the not-in-use pens are having to be stored at room temperature. What should inform staff/ label these with?
These will now have a 28 day expiry, as not-in-use pens need to be in the fridge to be used by their original expiry date (i.e. now follow the same rules that In-use pens have)
To diagnose diabetes, a random venous plasma glucose concentration would need to read > __ mmol/L
Over 11 mmol/L
To diagnose diabetes, a fasting plasma glucose concentration would need to read over __ mmol/L
Fasting= over 7 mmol/L
To diagnose diabetes, a two hour plasma glucose concentration (two hours after eating/ two hours after 75g glucose in a glucose tolerance test) would need to read over __ mmol/L
Two hour post food/ glucose: Over 11 mmol/L
a HbA1c of __ mmol/mol or __% is needed to diagnose diabetes
HbA1c of over 48 mmol/mol
What situations would a HbA1c test be inappropriate to diagnose diabetes? (try and think of around 5)