5. Insulin treatment - insulin preparations, types of regimens Flashcards
treatment of diabetic retinopathy ?
tight glucose and blood pressure control
laser treatment
intraviterous anti -VEGF
what is the treatment of diabetic nephorpathy ?
regulation of blood glucose
hypertension control
ACE = lower intraglomerular pressure and decreases hyerfiltration while also lowering systemic blood pressure
and renal protection
ARB - diabetic nephorpathy
renal protection
both combinlly used
treatment of diabetic neuropathy ?
glucose control
reduce oxidative stress =
aldose reductase inhibitors
alpha lipoic and gamma linolenic acid
what is the treatment for macroangipathy such as congestive heart disease and arteriosclerosis ?
aspirin
statins
clopidrogel
lifestyle modification
what are the side effects of insulin injections ?
Lipoatrophy is an immune-mediated condition resulting in loss of fat at insulin injection sites
occurs rarely with purified human insulins
Lipohypertrophy is a common, non-immunological side effect repeated injections of insulin into the same subcutaneous site
weight gain = due to freq hypoglycaemic episodes , adore eat in response to hunger
how is regular human insulin administered ?
short acting
subcutaneous , intramuscular or intravenous
what are the analogs of human insulin?
RAPID short ACTING :
insulin aspart= NOVOLOG
glulisine = APIDRA
lispro = HUMALOG
how are insulin aspart , glulisine and lispro administers ?
subcuteneous
when given intravenously =these rapid acting insulin becomes identical to regular insulin
what are the long acting insulin ?
their characteristics of ph ?
AND HOW ARE THEY ADMINISTERED ?
onset of action ?
duration ?
glargine = the only insulin with NOT a neutral ph
PH=4
onset = 1.5
duration = 24 hr
————
insulin determir
onset 3-4 hrs
duration 20-24hr
no big peak = therefore basal inulin
both only subcutaneously
how long des it take for regular human insulin to taken action ?
what is the duration of action
and side effects
SHORT ACTING
30 minutes - taken 30 min prior to meal
postprandial hyperglycaemia if not taken 30 min prior
the duration of action 5-8 hours (peaking at 2-4) = late post prandial hypoglycemia = NEED TO TAKE ANOTHER MEAL
2 times faster rate of absorption from abdomen then subcutaneous
what is the benefit of rapid acting insulin such as lispro insulin aspart and glulisine ?
what is the onset of rapid acting insulin ?
and want is the duration ?
less risk developing post prandial hyperglycaemia and hypoglycemia
within 15 mins
duration 3-5 hours
what is an intermediate acting insulin ?
onset of action ?
duration ?
NPH insulin
suspension of regular insulin and ptomaine = therefore not IV administered
onset = 1-2 hours
duration = 14hrs and plus
(no big peak = therefore called basal insulin)
what is the regimes for type 1 diabetes ?
require replacement dose of 0.5-1 unit per kg per day of insulin
early stages of type 1 diabetes = les insulin required = beta cells producing some insulin = honeymoon period
- conventional insulin therapy
- intensive insulin therapy
in type 2 diabetes when are the long acting insulin prescribed ?
when patient not achieved target glucose level or hb1ac (more than 8.5 percent) despite triple medication therapy
Initiate basal insulin supported oral therapy (BOT).
long-acting insulin injection (e.g., glargine) before bedtime combined with with metformin
glucagon-like-peptide-1 (GLP-1) /short acting insulin before meal
what is the conventional insulin therapy ?
disadvantage ?
2x a day subcutaneous injection of insulin mixture
(intermediate NPH AND short acting in a 70:30)
with a self monitoring of blood glucose level
2/3 of daily dose injected in morning before breakfast and 1/3 in the evening before dinner
:( strict diet adherence and exercise plan , snack between meals t avoid hypoglycemia
