Type I DM & Insulin

Question 1

Traditional Insulin Preps

Answer 1

Regular and NPH

Question 2

Regular Insulin PK

Answer 2

Rapidly absorbed & short acting
Onset: 30-60mins
Peak: 2-4 hours
Duration: 5-8 hours

Question 3

Regular Insulin Use

Answer 3

~30 mins before meal

critical to March dose w/ glucose load

Question 4

Regular Insulin Admin

Answer 4

IV (clear solution)

Question 5

NPH Insulin PK

Answer 5

Slower absorption and longer DOA (than regular insulin), neutral pH
Onset: 1-2 hours
Peak: 6-12 hours
Duration: 18-24 hours

Question 6

NPH Insulin Admin

Answer 6

Cloudy suspension, NOT IV

Question 7

NPH Insulin use

Answer 7

Between meals

Question 8

Synthetic Modified Insulin Analogs

Answer 8

Lispro
Aspart
Glulisine

Question 9

Insulin Lispro PK

Answer 9

Faster onset and shorter DOA (than regular insulin)
Peak: 30-60mins
Duration: 3-4hours

Question 10

Insulin Lispro Use

Answer 10

Immediately before meals

Question 11

Insulin Aspart PK

Answer 11

Longer DOA than Lispro

Question 12

Insulin Aspart Use

Answer 12

Injected @ mealtime

Question 13

Insulin Glulisine use

Answer 13

Injected before OR after meals

Question 14

Synthetic Modified Insulin Analog dose/admin

Answer 14

Must have Rx and given IV

Question 15

Isophane form of rapid insulin analogs

Answer 15

NPA

NPL

Question 16

NPA/NPL purpose

Answer 16

Combined with protamine to slow action b/w meals

Question 17

What is the dosing for synthetic ultra-long + rapid analog?

Answer 17

Basal + bolus

Question 18

Insulin Glargine MOA

Answer 18

Enhanced hexamer formation (to slow absorption and low, constant DOA)

Question 19

Insulin Glargine vial vs. tissue pH

Answer 19

Vial - 4

Tissue - 7.4

Question 20

Insulin Glargine PK

Answer 20

Slow absorption, slow and constant DOA

Question 21

Insulin Glargine Dose

Answer 21

1x/day; usually @ bedtime

Question 22

Insulin Determir MOA

Answer 22

Myristic acid attached to hind to albumin (prolongs DOA)

Question 23

Insulin Detemir pH

Answer 23

Neutral

Question 24

Insulin Detemir Dose

Answer 24

2x/day; somewhat shorter DOA than Glargine

Question 25

Insulin Detemir

Answer 25

Shorter DOA than Glargine, but still longer than regular

Question 26

Insulin Degludec MOA

Answer 26

FA chain to promote aggregation & slow release

Question 27

Insulin Degludec PK

Answer 27

Longer lasting than Glargine & Detemir | DOA: 42 hours

Question 28

Insulin Degludec Dose

Answer 28

1x/day; anytime of day

Question 29

PK from rapid/short to slow/long for insulin

Answer 29

Lispro/Aspart/Glulisine —> regular —> NPH (& NP analogs) —> Detemir/Glargine/Degludec

Question 30

Best method to reduce long term complications of DM? Inherent risk of this approach?

Answer 30

Tight control of Glucose Hypoglycemia

Question 31

Type of insulin used by pumps for continuous SC insulin infusion?

Answer 31

Synthetic analogs

Question 32

Side effects of insulin

Answer 32

Hypoglycemia Lipodystrophy Weight gain

Question 33

Treatment of mild hypoglycemia

Answer 33

Juice, candy, honey, syrup

Question 34

Treatment of severe hypoglycemia

Answer 34

Glucose prep (tablets, gels, IV)

Question 35

Counter regulatory hormone of insulin

Answer 35

Glucagon (IM or SC)

Question 36

Drug that is analog of amylin

Answer 36

Pramlintide

Question 37

What is amylin?

Answer 37

Peptide hormone released from beta cells with insulin

Question 38

Pramlintide MOA

Answer 38

Decrease glucagon —> decrease liver glucose —> limit glucose fluctuation

Question 39

Pramlintide Use

Answer 39

Decrease post-prandial glucose and decrease need for short acting insulin

Question 40

Pramlintide PK

Answer 40

Slows gastric emptying to improve satiety

Question 41

Pramlintide dose

Answer 41

3x/day; SC before meals w/ insulin

Question 42

Why is Pramlintide not frequently used?

Answer 42

Not very powerful and requires lots of injections

Question 43

Pramlintide contraindications

Answer 43

``` Decreased GI motility/absorption Renal disease (drug is excreted here) ```