Unit 5 - Diabetes 1

Question 1

What do all patients with type 1 diabetes need treatment with?

Answer 1

Insulin

Question 2

How is insulin used to manage type 1 diabetes?

Answer 2

Prevent the development of severe hyperglycaemia
- ketosis
- ketoacidosis
- coma
- death
Decrease microvascular complications
- retinopathy
- nephropathy
- neuropathy
Avoid macrovascular complications in later life
- cardiovascular
- peripheral vascular problems

Question 3

What is used to mimic the normal physiological secretion of insulin?

Answer 3

Exogenous insulin

Question 4

What are the principle insulin types?

Answer 4

• rapid acting
• short acting
• intermediate acting
• long actingGIve

Question 5

Give an example of an ultrarapid acting insulin

Answer 5

Insulin aspart

Question 6

Describe the onset, timing and duration of insulin aspart

Answer 6

Onset - 5-10 minutes
Timing - 2 minutes before and up to 20 minutes after meals
Duration - 3-5 hours

Question 7

Give three examples of rapid acting insulins

Answer 7

Insulin lispro
Insulin aspart
Insulin glulisine

Question 8

Describe the onset, timing and duration of rapid acting insulins

Answer 8

Onset - 10-20 minutes
Timing - 0-15 minutes before or soon after meals
Duration - 2-5 hours

Question 9

Give two examples of short acting insulins

Answer 9

Insulin soluble

Insulin porcine

Question 10

Describe the onset, timing and duration of short acting insulins

Answer 10

Onset - 15-30 minutes
Timing - 15-30 minutes before meals
Duration - 6-12 hours

Question 11

Give an example of an intermediate acting insulin

Answer 11

Isophane insulin

Question 12

Describe the onset, timing and duration of intermediate acting insulins

Answer 12

Onset - 1-2 hours
Timing - once or twice daily
Duration - 10-12 hours

Question 13

What are intermediate acting insulins complexed with?

Answer 13

Conventially, insoluble, cloudy suspensions of insulin complexed with either protamine (isophane or NPH insulin) or zinc (lente insulin)

Question 14

Why do intermediate acting insulins take longer to work?

Answer 14

In order to be active, the insulin must dissociate from the protamine

Question 15

What are the advantages of using intermediate acting insulins?

Answer 15

Do not need to be co-ordinated with meals

Question 16

How are long acting insulins administered?

Answer 16

Basal-bolus regimes

Question 17

How are long acting insulins used?

Answer 17

Alongside rapid-acting insulin analogues in basal-bolus

Question 18

How are insulin glargine and insulin determir produced?

Answer 18

Using recombinant technology

Question 19

What is the duration of action of long acting insulins?

Answer 19

Around 24 hours

- a very flat PK profile

Question 20

What are the advantages of long acting insulins?

Answer 20

Limited peak/trough effects

Limited inter- or intra- patient variability

Question 21

Describe the onset, timing and duration of insulin detemir

Answer 21

Timing - once or twice daily
Onset - steady state after 2-3 doses
Duration - 24 hours

Question 22

Describe the onset, timing and duration of insulin glargine

Answer 22

Timing - once daily
Onset - 1.5-2 hours
Duration - 24 hours

Question 23

Give an example of ultralong acting insulin

Answer 23

Insulin degludec

Question 24

Describe the onset, timing and duration of insulin degludec

Answer 24

Timing - once daily
Onset - steady state after 2-3 hours
Duration - beyond 42 hours

Question 25

What is a combination insulin?

Answer 25

Combination of a short/rapid acting insulin with an intermediate acting insulin