Brandl's Insulin

Question 1

Insulin Actions

Answer 1

All work to decrease plasma glucose
1) Inhibit hepatic glucose production (inhibits gluconeogenesis)
2) stimulates glucose uptake (via GLUT-4 in adipose tissue)
3) stimulates glucose uptake (via GLUT-4 in SKM)

Question 2

Regulation of insulin secretion

Answer 2

Glucose = major regulator of insulin release
increase glucose –> increase insulin

Question 3

Insulin Indication

Answer 3

T1D
- autoimmune
-beta cell destruction
-insulin deficiency
Insulin ==> ALWAY, Small doses (Insulin Sensitive)
DOSING: Basal + Bolus

T2D
-Beta cell dysfunction
-Insulin resistance
Insulin ==> SOME need insulin, Larger doses (Insulin Resistants)
-Usually start with oral meds
DOSING: Start with basal only, then basal + bolus, premixed

Acute Hyperkalemia
-Drip containing regular insulin and a solution of glucose

Question 4

Insulin Adverse Effects

Answer 4

Hypoglycemia
-depends on individual’s physical activity, alcohol consumption, and stress (stress increases the dose of insulin required)

Lipodystrophy at the injection site
-patient should regularly change injection sites to avoid lipodystrophies

Weight gain
-due to the anabolic effect insulin

Hypokalemia
-activates Na/K ATPase

Question 5

Insulin Administration

Answer 5

Subcutaneous Injection
Intravenous infusion
Insulin delivery pumps
Inhaled insulin

Question 6

Insulin Preparations

Answer 6

Rapid (Bolus)
-Lispro
-Aspart
-Glulisine

Short (Bolus)
-Regular

Intermediate (Basal)
-NPH

Long (Basal)
-Glargine
-Detemir
-Degludec (ultra-long acting)

Question 7

Insulin Preparations (Onset, Peak, Duration)

Answer 7

Rapid
-Onset: 15min
-Peak: 1h
-Duration: 2-4h

Short
-Onset: 30min
-Peak: 2-4h
-Duration: 5-8h

Intermediate
-Onset: 2h
-Peak: 6h
-Duration: 12-16h

Long
-Onset: 2h
-Peak: no peak
-Duration: 20-26h

Question 8

Insulin Dosing

Answer 8

Basal Insulin
-given once daily, 24hr insulin covers fasting state or between meals
-Low risk or hypoglycemia

Bolus Insulin
-given with meals
-2 functions
==Nutritional - reduce blood glucose rise with meals
==Correctional - rapidly correct hyperglycemia
-Higher risk of hypoglycemia

Pre-Mixed Insulin
-Basal and rapid-acting insulin combined in pre-mixed solution
-70/30 (or 75/25) ratio of basal/bolus
==70/75% basal (NPH, long-acting analog)
==25/30% bolus (regular or rapid analog)
-Given twice daily before meals
-Advantages
==reduces number of daily injections
==simplified regimen
-Disadvantages
==less physiologic

T1D: 0.4 - 0.7 U/kg/day (Basal + Bolus)
-goal 80-130mg/dL

T2D: 0.5 - 2.0 U/kg/day (Basal + Bolus)
-Basal insulin only (10units daily or 0.2 U/kg/day)
-goal <180mg/dl