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Insulins Flashcards

(44 cards)

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1
Q

Which cells secrete insulin?

A

Pancreatic beta cells

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2
Q

What is the natural insulin secretion profile?

A

Basal insulin - slow and steady secretion of background insulin that controls glucose continuously; released from liver

Bolus insulin - secreted in response to glucose absorbed from food and drink

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3
Q

What are the three types of insulins available in the UK?

A
  • Human insulin
  • Human insulin analogue
  • Animal insulin (bovine or porcine)
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4
Q

What inactives Insulin?

A

G.I enzymes inactivates it, therefore it cannot be taken orally. Therefore given by injection.

Best route is S.C route

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5
Q

Where do patients inject themselves?

A

In areas with most subcutaneous fat.

  • Abdomen (fastest absorption rate)
  • Inner thigh
  • Outer thigh/buttock (slower absorption compared to abdomen or inner thigh)
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6
Q

What must be done to avoid lipohypertrophy? And why?

A

Rotate sites to minimise risk.

Injection in the same place can cause area to be infected, bruised, swollen.

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7
Q

What are the three insulin preparations?

A
  1. Short acting insulins (soluble & rapid acting)
  2. Intermediate-acting insulins
  3. Long acting insulins
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8
Q

When are short rapid acting insulin used?

A

Injected immediately before meals

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9
Q

Examples of short, rapid insulin?

A

LAG
- Lispro (Humalog)
- Aspart (Novorapid, fiasp)
- Glulisine (apidra)

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10
Q

What is the onset time and duration for short, rapid acting insulin?

A

Onset - 15 mins

Duration - 2-5hrs

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11
Q

When is short soluble acting insulin used?

A

Used in diabetic emergencies like ketoacidosis & perioperatively

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12
Q

What are some examples of short soluble acting inuslin?

A

Actrapid - Humulin S, Insuman

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13
Q

What is the onset and duration for short soluble acting inuslin?

A

Onset - 30-60 mins (SC admin)

Duration - 9 hours

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14
Q

What is intermediate insulin? What are the different types? And when is it used?

A

Different types of insulins mixed together - biphasic - to mimic basal insulin

  • Isophane = insulin & protamine
  • Mix/pre-mix = has to be mixed up

Injected before meals

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15
Q

What are some examples of Intermediate acting inuslin?

A

Isophane/NPH - Humulin I

Biphasic - Novomix, Humalogmix, Humulin M3

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16
Q

What is the onset and duration of Intermediate acting insulin?

A

Onset - 1-2hrs

Duration - 11-24hrs

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17
Q

What are some examples of long acting insulin?

A

DGD
Detemir - Levemir, added unto to Liraglutide (OD-BD)

Glargine - Lantus, Toujeo (OD)

Degludec - Tresiba (OD)

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18
Q

Which insulins are given to type 2 diabetes?

Study These Flashcards
A

Determir & lantus

19
Q

What are the 4 types of insulin regimens?

Study These Flashcards
A
  • Basal-bolus
  • Mixed/biphasic regimen
  • Once daily regimen
  • Continuous subcutaneous insulin infusion (insulin pump)
20
Q

What is first line recommendation for newly diagnosed type 1 diabetes?

Study These Flashcards
A
  • Basal Bolus regimen
21
Q

What are the advantages and disadvantages of basal-bolus regimens?

Study These Flashcards
A

Advantages:
- Very flexible regimen, as you can eat when you like and what you like as doses can be adjusted based on carbohydrate content

  • Close to natural secretion profile
  • Can be used in type 2 diabetes

Disadvantages:
- Multiple injections needed each day

22
Q

Example of the basal bolus reigmen?

Study These Flashcards
A

Includes both basal and bolus insulin, so resembles natural insulin profile.

Basal - Long acting or intermediate insulin is used. Taken OD or BD (usually bed time)

Bolu - Short, rapid acting insulin is used

23
Q

What is the basal bolus regimen for type 1 n type 2 diabetes?

Study These Flashcards
A

Type 1 - Short acting at meal times and Long acting (OD or BD) at bed time

Type 2 - Short acting & intermediate acting

24
Q

What is the once daily regimen?

Study These Flashcards
A

When a single dose of insulin is taken

25
Who normally uses the once daily regimen?
Type 2 diabetic patients Taken alongside oral tablets
26
Which insulins are given for once daily regimen?
- Long acting OR - Intermediate Isophane/NPH Long acting - for people who experience hyperglycaemia throughout the day & night Intermediate - for people who experience hyperglycaemia at night or morning but fine in the day. So taken before bed.
27
Explain the Mixed/biphasic regimen?
Injected once, twice or three times a day before meals - for those who have a consistent daily routine that includes 3 meals a day Biphasic = short acting & intermediate insulin Usually pre-mixed / mixed with syringe
28
Which diabetic patients use mixed/biphasic regimen?
Type 1 n type 2 Recommended for new type 2 diabetes (NOT NEWLY TYPE 1)
29
What is continuous insulin pump? Who’s this normally given to?
When a pump gives a regular / continuous amount of insulin. This is only for adults who suffer disabling hypoglycaemia or high HbA1c (60mmol/mol +) Only initiated by specialist
30
Which factors can affect insulin requirements and cause poor glucose control?
- Adherence - Injection technique - Injection site problems - Blood glucose monitoring skills - Lifestyle issues (diet, alcohol, exercise) - Psychological issues - Renal disease - Thyroid disorders
31
Which activities increase and decrease insulin requirements?
Increases: - Infection - Stress - Accidental or surgical trauma - Pregnancy (2n & 3rd trimester) Decreases: - Physical activity - Vomiting - Reduced food intake - Impaired renal function - Certain endocrine disorders (e.g. Addisons disease) - Fasting
32
What must be advised and given with hypodermic equipement?
- Advise on safe disposal of lancets, single use syringes and needles and provide suitable disposable containers - Advise on disposal of these containers
33
Explain the sick day rules of diabetic patients?
SICK Sugar - you'll have to measure your blood glucose levels more, because they tend to rise when sick, even if the person is not eating. And medications may need to be increased temporarily during illness to manage these glucose levels. Insulin - Never stop insulin or oral diabetes medications; these may need to be increased, especially if ketones are present. Carbohydrate - ensure patient maintains carbs intake and hydration. If vomiting, replace meals with sugary fluids. If glucose levels are high, maintain fluid intake with sugar-free fluids. If low, have regular intake of sugary fluids. Ketones - Type 1 diabetes must check for ketones every 2-4 hours. Give extra rapid-acting insulin doses (in addition to regular doses) based on total daily insulin dose, if ketones are present. Advise to drink plenty of water to flush ketones and remain hydrated.
34
What are SADMAN rules?
The medications that must be stopped when a diabetic patient is sick. S - SGLT2 A - ACE inhibitors D - Diuretics M - Metformin A - ARBs N - NSAIDs
35
What medications must be stopped temporarily when sick, and why?
- SGLT2 = Can cause dehydration, and increase risk of developing euglycaemic DKA - ACE inhibitors = Can cause dehydration, and increase risk of developing AKI due to reduced renal efferent vasoconstriction. - Diuretics = Can cause dehydration, and increase risk of developing AKI - Metformin = Can cause dehydration, and increase risk of developing lactic acidosis - ARBs = Can cause dehydration, and increase risk of developing AKI - NSAIDs = Can cause dehydration, and increase risk of developing AKI due to reduced renal afferent vasodilation.
36
When can a person start taking the SADMAN medications again?
Once the person is feeling better and able to eat n drink for 24-48 hours.
37
Which SADMAN medications can increase risk of developing AKI?
ACE inhibitors Diuretics ARBS NSAIDs
38
What should be done to reduce errors with insulin?
- Provide them with more adequate information - Explain difference in appearance of different insulin - Training programmes for health care staff - Always check insulin container, pen, and needle size.
39
What are some important safety information for insulin?
- MHRA advice = risk of cutaneous amyloidosis at injection site. Injection can lead to deposits of amyloid proteins under the skin, which interferes with insulin absorption and affects glycaemic control. So advise, if a lump is present at injection site, avoid injecting there; frequently rotate sites. - Advise patients to not withdraw insulin pens or cartridges devices, with a syringe. You use the pens n cartridges devices as they are. - On prescriptions, words like 'units' or 'international units' should not be abbreviated.
40
What are the insulin monitoring levels?
For most time = 4-9mmol/litre Before meals = 4-7mmolL After meals = <9mmol/L Stop levels falling before 4mmol/l. Keep it around 5mmol/l.
41
What are some further advice given to patients n carers for all insulin?
- Instruct on how to avoid hypoglycaemia - Offer insulin passports and PILs to all patients receiving insulin. - Drivers told to avoid hypoglycaemia
42
What is bovine insulin?
Cow insulin
43
What is Porcine insulin?
Pig insulin
44
What is the dose change when changing from animal insulin to human insulin?
Bovine to human - reduce dose by 10% to avoid hypoglycaemia Porcine to human - no dose change

Endocrine (7 decks)

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