13. Insulins

Question 1

how are insulins classified ?

Answer 1

-according to onset and duration of effect

-short acting insulins -rapid acting analogues and short acting human insulins (Neutral insulin solutions)
-intermediate acting human insulins
-long acting insulin analogues
-insulin mixtures >-combined human insulins and biphasic analogues

Question 2

Short acting human insulins

Answer 2

intact normal human insulin
-clear molecular sol , possible IV admin
-can be given 20-30mins before meals
-time needed for effect 20-30 mins
-tmax -1-2h
-clearance- 6-8hrs
-effect can be prolonged by-> protamine or Zinc

Question 3

short acting human insulins

Answer 3

neutral aqueous sol of insulins
can be given IV
30 min onset
max 1-3hrs
effective 4-6hrs

Question 4

what are the rapid acting insulin analogues

Answer 4

LISPRO, ASPRO , GLULISINE

Question 5

lispro , aspro, glulisine

Answer 5

-admin right before meal
-onset of effect is mins
-tmax after 30mins
effect ends in 3-4h
-closely mimics POST PRANDIAL INSULIN SECRETION

Question 6

what are the intermediate acting human insulins ?

Answer 6

NPH insulin (isophane insulin)

Question 7

NPH insulin…

Answer 7

-never given IV
-it is a suspension formula
insulin release from SC is slow
onset of effect is 102.5h
tmax- 4-12h
effect lasts 12-16h

Question 8

what are the long acting analogues

Answer 8

-GLARGINE
-DETEMIR
-DEGLUDEC

Question 9

glargine, detemir, degludec

Answer 9

-administered once a day
-1-2 hr effect starts, tmax 10-18h, lasts 24-36h
-steady state after 3 days
-mimic basal insulin secretion WITHOUT ANY PEAK
-lower risk of hypoglycemia than NPH

Question 10

Insulin mixtures are classified as

Answer 10

-combined human insulins
-biphasic analogues

Question 11

combined human insulins

Answer 11

-two different types of insulin combined in a stabilised preparation
-usually composed of short acting human insulin and NPH
-used in regimens which require both short and long acting insulins
-good for old people-> reduces the risk of confusion and makes admin easier

Question 12

biphasic analogues

Answer 12

-a combo of ultra short analongue with prolonged release insulin in a protamine complex
=given twice a day
-substitutes both post prandial and basal secretion

Question 13

what are the insulin regimens ?

Answer 13

-conventional
-intensified
-pump

Question 14

Conventional regime

Answer 14

-for pts that can produce insulin
sc admin once or twice a day
-intermendiate acting or long acting or biphasic analogue x1
stabilised mix of human insulin x1

Question 15

Intensified regime

Answer 15

-mimic and completely substitute endogenous insulin
-3 or more injections or delivery via an insulin pump -> more demanding for the pt

Question 16

Insulin pump

Answer 16

-continuously delivers ultra short acting insulin in a form of basal bolus
-maintains basal level at a preset
-batteries , cartridge and cannula have to be changed 3-5 days
-inserted in abdomen and gluteus

Question 17

insulin ae

Answer 17

hypoglycemia
rebound hyperglycemia
lipodystro[hy
allergic reactions

Question 18

ABSOLUTE indications of insulin

Answer 18

DM
ketosis
serious dm infection/gangrene

Question 19

RELATIVE indications of insulin

Answer 19

DM 2 when OADs and diet don’t work
DM2 with coticosteroid/kidney impairment

Question 20

delivery systems insulin

Answer 20

insulin pen
insulin pump
insulin syringe