Diabetes (Slide Deck 3) Flashcards
Which cells secrete insulin?
B Cells
What is cleaved to produce insulin + C-peptide?
Proinsulin
What are the three ways one could take insulin?
- Syringes
- Pen needles
- Continuous subcutaneous insulin infusion (CSII)
What are the two types of pancreatic functions that’s release insulin?
Basal (Long term)
Bolus (Fast term)
What is the Onset of Insulin Aspart (NovoRapid) or biosimilars: Trurapi®Kirsty®)
9-20 minutes
What is the onset of insulin glulisine (s)
9-20 minutes
What is the onset of Insulin lispro (Humalog® U-100 & U-200 and biosimilar: Admelog® U- 100)
10-15 minutes
What is the onset of Faster-acting insulin aspart (Fiasp®)
4 minutes
What is the onset of insulin regular (humulin-R Novolin ge Toronto)
30 minutes
What is the onset of Insulin regular U-500 (Entuzity® (U-500)
15 minutes
When should Insulin regular (Humulin®-R, Novolin® ge Toronto, Hypurin R) be administered?
30-45 minutes prior to meal time to cover glucose excursions
When are the RAIA administered?
0-15 minutes prior to meals.
What is an advantage of RAIA vs short acting insulins?
More closely mimic endogenous insulin release
What are the advantages of RAIA’s?
- Fasteronset
- Quickerpeak
- Shorter duration of action
Convenience and decrease hypoglycemia risk
What is the importance of the Insulin Lispro as compared to other products?
Has a higher concentration of insulin, but the units that you are injecting on the dose knob will be the same as the 100 units/ml and 200 units/ml (The injections quantities will be different, but the concentration be the same)
Who should use and what is Insulin regular U-500 (Entuzity® (U-500)?
Contains 500u/mL of insulin and is for those who require >200U/D
What is the onset and duration of Intermediate-acting (cloudy) *Insulin neutral protamine Hagedorn (Humulin® N, Novolin® ge NPH)
1-3 hours and 18 hours
What is the onset of, Insulin detemir U-100 (Levemir®), Insulin glargine U-100 (Lantus®); biosimilars: (Basaglar® Semglee®), Insulin glargine U-300 (Toujeo®), Insulin degludec U-100, U-200 (Tresiba®)
90 minutes
What is the duration of U-100 glargine insulin?
24 hours
What is the duration of detemir?
16-24 hours
What is the duration of U-300 glargine
> 30 hours
What is the duration of degludec
42 hours
Which insulins do we need to hand roll and invert prior to injection?
Humulin N, Novolin NPG, Hypurin NPH
Which insulin is dose dependant based off of weight?
Insulin Detemir
How often is insulin Glargine U100 given?
OD or BID
How often is Insulin NPH given?.
BID
Which method of insulin injection is the least expensive?
Syringes and vials.
What are two of the main adverse effects of insulin?
Hypoglycemia, weight gain
What is a side effect that can occur when first starting Insulin?
Blurry Vision
What are the 7 factors affecting absorption of insulin?
Exercise of injected area
Massage
Temp
Lipohypertrophy (Fat)
Dose
Renal function
Depth of injection
Which insulins can be mixed and stored together?
R + NPH
Which insulins can be mixed but must be administered immediately?
RAIA + NPH
Which insulin cannot be mixed together?
LAIA
How much will 1U of insulin decrease BG by?
2-3mmol over the next 2-4 hours
When adjusting insulin what is the general rule of thumb?
Fix the lows first and then go from there
If glucose is <4mmol/l overnight and is high in the morning this suggests?
Somogyi effect
If glucose >4mmol/l in the morning, this suggests the
dawn phenomenon
Somogyi Effect define
*Unrecognized nocturnal hypoglycemia that patient sleeps through; as a result the body ↑’s prod’n of counter-regulatory hormones & see rebound hyperglycemia
Morning glucose less then 4mmol
