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Flashcards in Insulins Deck (40)
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1

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!

2

What type of insulin is Novorapid?

Insulin Aspart

Rapid-acting

3

When should the rapid acting insulins be injected?

Immediately before eating

(0- 15 mins before food)

4

How long does it generally take rapid acting insulins to start working?

~10 - 20 minutes

5

How long is the duration of action of rapid acting insulins?

around 2 - 5 hours

6

How many units of insulin do the Flexpen, Flextouch, Kwikpen and Solostar (all pre-filled disposable pens) tend to contain?

300 units

3ml pens containing 100 units/ ml

7

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

8

What type of insulin are short acting insulins?

Short acting insulin= Soluble insulin (S S)

Can get different types of soluble insulins:

Soluble human

Soluble bovine ('neutral') Beef

Soluble porcine ('neutral') Pig

9

What kind of insulin is Actrapid?

Insulin soluble (human)

Short- acting

10

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

11

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

12

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

13

Can you think of any brands of Intermediate acting insulins?

Isophane insulins:

Insulatard®

Humulin I®

(all of the i's!)

14

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

15

What are the three types of long- acting insulins? Do you know their brand names?

Insulin Detemir     Levemir®

Insulin Glargine       Lantus ®

Insulin Degludec       Tresiba®

16

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)

17

Which type of insulin is used in medical emergencies such as diabetic ketoacidosis and before surgery?

Soluble insulin

18

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.

19

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

20

What do Biphasic insulins look like in appearance?

Cloudy

Need to be resuspended before use- tell patient this- by rolling in their hands (not shaking)

 

21

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)

22

What electrolyte disturbance can insulins cause?

HypoKaleamia

23

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

24

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?

Protamine

25

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)

26

To diagnose diabetes, a random venous plasma glucose concentration would need to read > __ mmol/L

Over 11 mmol/L

27

To diagnose diabetes, a fasting plasma glucose concentration would need to read over __ mmol/L

Fasting= over 7 mmol/L

28

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

29

a HbA1c of __ mmol/mol or __% is needed to diagnose diabetes

HbA1c of over 48 mmol/mol

or 6.5%

30

What situations would a HbA1c test be inappropriate to diagnose diabetes? (try and think of around 5)

  • Children/ young adults
  • Suspected Type 1 diabetes
  • Symptoms less than 2 months
  • Medication related glucose effects e.g. steroids, antipsychotics
  • Pancreas damage
  • Pregnancy
  • Acutely unwell/ in hospital