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Pharmacy Pre-Registration Notes > Insulins > Flashcards

Insulins Flashcards

1
Q

Name the 3 rapid acting insulins

Can you think of their brand names?

A

Insulin Glulisine Apidra®

Insulin Aspart Novorapid®

Insulin Lispro Humalog®

That GAL is RAPID!

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2
Q

What type of insulin is Novorapid?

A

Insulin Aspart

Rapid-acting

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3
Q

When should the rapid acting insulins be injected?

A

Immediately before eating

(0- 15 mins before food)

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4
Q

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

A

~10 - 20 minutes

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5
Q

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

A

around 2 - 5 hours

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6
Q

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

A

300 units

3ml pens containing 100 units/ ml

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7
Q

Are patients more or less at risk of hypglyceamia when using rapid-acting insulins compared to other insulins?

A

Less at risk of hypoglyceamia as it is only in body for a few hours and is used with meals

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8
Q

What type of insulin are short acting insulins?

A

Short acting insulin= Soluble insulin (S S)

Can get different types of soluble insulins:

Soluble human

Soluble bovine (‘neutral’) Beef

Soluble porcine (‘neutral’) Pig

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9
Q

What kind of insulin is Actrapid?

A

Insulin soluble (human)

Short- acting

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10
Q

When should short acting insulins be injected?

A

15 - 30 mins before food

  • Must eat food within 30 mins of injecting to avoid hypoglyceamia*
  • They start working after 30 mins*
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11
Q

How long do short acting insulins work for and when is their peak activity?

A

Duration of action: 4 - 8 hours

Peak activity: 2 - 4 hours

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12
Q

What type of insulin is intermediate acting?

A

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

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13
Q

Can you think of any brands of Intermediate acting insulins?

A

Isophane insulins:

Insulatard®

Humulin I®

(all of the i’s!)

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14
Q

When should intermediate acting (isophane) insulins be injected?

A

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

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15
Q

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

A

Insulin Detemir Levemir®

Insulin Glargine Lantus ®

Insulin Degludec Tresiba®

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16
Q

How long do the long-acting insulins usually work for?

Which one works for up to 42 hours?

A

around 18 - 24 hours

42 hours: Degludec (tresiba)

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17
Q

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

A

Soluble insulin

18
Q

What is the rational behind biphasic insulin preparations?

A

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
Q

NovoMix is a Biphasic insulin (intermediate acting). It contains a mixture of which insulins?

A

Insulin aspart (rapid acting)
Insulin aspart protamine (long acting)

Together it becomes intermediate acting- injected twice daily

20
Q

What do Biphasic insulins look like in appearance?

A

Cloudy

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

21
Q

Can you name 4 brands of Biphasic insulins, and their ingredients?

A

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
Q

What electrolyte disturbance can insulins cause?

A

HypoKaleamia

23
Q

When should Biphasic insulins be injected?

A

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
Q

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?

A

Protamine

25
Q

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?

A

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
Q

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

A

Over 11 mmol/L

27
Q

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

A

Fasting= over 7 mmol/L

28
Q

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

A

Two hour post food/ glucose: Over 11 mmol/L

29
Q

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

A

HbA1c of over 48 mmol/mol

or 6.5%

30
Q

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

A
  • 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
31
Q

Which insulins are cloudy in appearance?

A

Intermediate acting (Isophane)

Biphasic preparations- Novomix, Humulin M3, Humalog Mix, Insuman Comb

32
Q

For a driver of a car/ motorbike, who has been deemed fit to drive due to the presence of only 1 episode of severe hypoglyceamia in the last year, how often should you advise them to check their BG levels?

A

Within 2 hours of starting their journey

Every 2 hours whilst driving

If a hypo occurs: stop, pull over, get out of drivers seat, eat sugar, wait 45 mins after BG has returned to normal to continue driving

33
Q

How many months worth of BG readings must Lorry drivers provide to the DVLA if they are to drive?

A

3 months

34
Q

How often should Lorry/ Bus drivers test their blood glucose whilst driving, and on days when theyre not driving?

A

Within 2 hours of starting to drive

every 2 hours whilst driving

at least twice daily when not

35
Q

What are the side effects of insulin?

A

Fat hypertrophy at injection site

Local reactions at injection site

Transient oedema

36
Q

What are the insulin sick day rules?

A

Just because the patient is ill and not eating does not mean they should stop injecting their insulin

ill/ infection= stress hormones/ steroids released
steroids increase blood glucose
stay well hydrated to avoid DKA
patient should monitor their BG and urine ketones more frequently and be prepared to inject accordingly

37
Q

When should insulin be resuspended before use?

A

For all insulin preparations, except rapid- and short-acting insulin and insulin glargine (Lantus), the vial or pen should be gently rolled in the palms of the hands (or shaken gently) to resuspend the insulin.

38
Q

First line insulin used in Type 2 diabetes?

NB: Insulin chosen if persons BG inadequately controlled by metformin + sulfonylurea or triple therapy: 3 oral antidiabetic drugs together has failed

A

Intermediate acting: Human isophane insulin

39
Q

Novomix is a biphasic insulin with an onset of action of _____ mins and peak activity of ______ hours.

A

Onset of action of 10-20 mins

Peak acivity of 1-4 hours

40
Q

What is it that makes Insulin Degludec (tresiba) different from all the other insulins licensed in the UK?

A

It is the first insulin to be available in two different strengths:

100 units/ml
200 units/ml

Pharmacy Pre-Registration Notes (82 decks)

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