Endocrine: Insulin

Question 1

Where is the fastest absorption site for insulin delivery?

Answer 1

Abdomen
Then outer thighs/buttocks.

Need an area with lots of subcutaneous fat.

Question 2

Short-acting insulins have a short duration and a relatively rapid onset of action, to replicate the insulin normally produced by the body in response to glucose absorbed from a meal.

What are the short-acting insulins? (4)

Answer 2

1. Soluble insulin (human and, bovine or porcine - both rarely used).
2. Rapid-acting insulin analogues: Glulisine + Aspart + Lispro (GAL)

Question 3

When injected subcutaneously, soluble insulin has a rapid onset of action of what?

Answer 3

30-60 minutes.

Question 4

When injected subcutaneously, soluble insulin has a peak of action of what?

Answer 4

When injected subcutaneously, soluble insulin has a rapid onset of action (30 to 60 minutes), a peak action between 1 and 4 hours, and a duration of action of up to 9 hours.

Question 5

What form of insulin administered in what way is the most appropriate form of insulin for use in diabetic emergencies?

Answer 5

Soluble insulin given via IV

Question 6

The rapid-acting insulins (What are they?) have a faster onset of action (how fast?) and short duration of action (approx 2-5 hours) than soluble insulin, and are usually given SC.

Answer 6

Insulin aspart, insulin glulisine, and insulin lispro have a faster onset of action (within 15 minutes) and shorter duration of action (approximately 2–5 hours) than soluble insulin, and are usually given by subcutaneous injection.

Question 7

The intermediate-acting insulins (like what?) have an intermediate duration of action, desgined to kimic what?

Answer 7

Intermediate-acting insulins (isophane insulin) have an intermediate duration of action, designed to mimic the effect of endogenous basal insulin. When given by subcutaneous injection, they have an onset of action of approximately 1–2 hours, a maximal effect at 3–12 hours, and a duration of action of 11–24 hours.

Question 8

Isophane insulin is a suspension of insulin with what?

Answer 8

Protamine (also protamine sulfate is the reversal agent for heparins)

Question 9

Biphasic insulins (biphasic isophane insulin, biphasic insulin aspart, biphasic insulin lispro) are pre-mixed insulin preparations containing various combinations of short-acting insulin (soluble insulin or rapid-acting analogue insulin) and an intermediate-acting insulin.

The percentage of short-acting insulin varies from

Answer 9

15% to 50%

Question 10

What are the long-acting insulins? (5)

Answer 10

1. Protamine zinc insulin
2. Insulin zinc suspension
3. Detemir
4. Glargine
5. Degludec

Question 11

Which is rapid: glargine or glulisine?

Answer 11

GAL: Gulisine, aspart, lispro

Glargine, degludec, determir = long

Question 12

Long-acting insulins like protamine zinc insulin, insulin zinc suspension, insulin determir, insulin glargine and insulin degludec achieve a steady-state level after how long?

Answer 12

2-4 days

Question 13

Which long-acting insulins are given once daily only?

Answer 13

Insulin glargine and insulin degludec are given once daily and insulin detemir is given once or twice daily according to individual requirements. The older long-acting insulins, (insulin zinc suspension and protamine zinc insulin) are now rarely prescribed.

Question 14

Which long-acting insulins can be given once or twice daily according to individual requirements?

Answer 14

Insulin glargine and insulin degludec are given once daily and insulin detemir is given once or twice daily according to individual requirements. The older long-acting insulins, (insulin zinc suspension and protamine zinc insulin) are now rarely prescribed.