A.13- pancreatic hormones

Question 1

what is Human insulin? give examples

Answer 1

original amino acid sequence
regular insulin
NPH insulin

Question 2

what is an analogue insulin? give examples

Answer 2

amino acid sequence that has been modified (accelerated entry into the circulation)
rapid acting- lispro
long acting- glargine

Question 3

classify the insulin agents

Answer 3

rapid acting
short acting
intermediate acting
long acting

Question 4

list the rapid acting agents

Answer 4

“GAL”
insulin Lispro
insulin Aspart
insulin Glulisine

Question 5

onset of action of the agents

Answer 5

rapid: 5-15 min
short: 30min- 1 hour
intermediate: 1-2 hours
long acting: 2 hours

Question 6

peak of agents

Answer 6

rapid: 1h
short: 1-3h
intermediate: 4-6h
long: flat

Question 7

name the human insulin agents

Answer 7

short acting- regular insulin

intermediate acting- NPH insulin

Question 8

duration of action of the agents

Answer 8

rapid: 3-4h
short: 4-8h
intermediate: 8-12h
long acting: 12-24h

Question 9

name the long acting agents

Answer 9

“GDD”
insulin Glargine
insulin Detemir
Insulin Degludec

Question 10

clinical applications for rapid acting insulin? (lisprio, aspart, glulisine)

Answer 10

1. pre-prandial injections in ordinary maintenance regimens
2. preferred insulin for continuous subcutaneous insulin infusion devices
3. emergency treatment for diabetic ketoacidosis (IV)

Question 11

clinical applications for regular insulin?

Answer 11

1. pre-prandial injections in ordinary maintenance regimens

2. emergency treatment for diabetic ketoacidosis (IV)

Question 12

clinical applications for NPH insulin?

Answer 12

combined with short/rapid acting insulin preparations

Question 13

clinical applications for long acting insulin (glargine, detemir, degludec)?

Answer 13

provides basal insulin levels in ordinary maintenance regimens

Question 14

SE of insulin

Answer 14

hypoglycemia, weight gain, hypokalemia, edema
risk of neurological damage in severe hypoglycemia (risk groups: renal disease, elderly, children<7)
insulin-induced immunologic complication (rare)

Question 15

modes of insulin administration

Answer 15

1. SC injections
2. portable pen-sized injections
3. continuous SC insulin infusion devices (provide flexibility and avoids multiple daily injections)
4. IV, in cases of Ketoacidosis, ICU

Question 16

total daily insulin needs

Answer 16

type 1: ≈0.55 unit/body weight (kg)

type 2: >1 unit/ body weight (kg)

Question 17

what are the therapeutic goals of glycemic control in diabetic patients?

Answer 17

HbA1c<7%
pre-prandial plasma glucose<7.2mmol/L
2h post prandial plasma glucose <10 mmol/L