Midterm

Question 1

Rapid acting insulins

- Onset/peak/duration time

Answer 1

LAG
Lispro
Aspart
Glulisine
- 5-15 min onset, peak 1 hr, duration 4-5 hrs

Question 2

Intermediate acting insulin

- Times

Answer 2

NPH (neutral protamine Hagedorn)
Onset 2-5 hrs, duration 4-12 hrs
Least predictable insulin

Question 3

Long acting insulin

-Times

Answer 3

GLArgine (=LAntus)
- Onset 1.5-2hrs; peak 4-6, duration 11-24
- Crystalline at depot injection
Detemir
- Onset 1-2, duration 24

Question 4

Insulin side effects, things to note

Answer 4

Hypoglycemia
Weight gain
Insulin allergy
Monitor carefully if pt has renal or liver disease
In pregnancy, detemir preferred (class B whereas Glargine is class C)

Question 5

Insulin delivery

Answer 5

• Basal-bolus therapy mimics physiologic insulin secretion after meals (24 h basal insulin + meal bolus insulin)
• Various pre-mixed combinations (NPH +short acting in combos)
• Insulin pump, continuous monitoring system, closed loop systems