Exam 1

Question 1

in absence of insulin you develop _____.

Answer 1

catabolism

• Can’t use glucose for energy or to make fat.
• All sugar stays in the blood causing an elevated blood sugar
• B/c no access to sugars, the body breaks down fats & protein for energy.
• The breakdown of fat releases free fatty acids into blood.
• Liver changes fatty acids to ketones causing severe acidosis= diabetic ketoacidosis (DKA) and death.

Question 2

treatment for T1DM

Answer 2

exogenous insulin

Question 3

what percent of people with T2DM need insulin to survive?

Answer 3

30% usually near the end

Question 4

describe endogenous insulin; how much is stored and released in the body on a daily basis?

Answer 4

A-B chain linkage

• Entire pancreas has about 8mg of insulin (about 200 units) at any one time
• Normally 40-60 units of insulin are released from the pancreas daily to maintain normal blood sugar between 70-120

Question 5

how is insulin removed from body?

Answer 5

kidney and liver

A diabetic in renal failure often needs decreasing doses of insulin

Question 6

short acting insulins?

Answer 6

regular human insulin (Humulin R & Novocain R)

Question 7

rapid acting insulins?

Answer 7

aspart, lispro, glulisine

Question 8

intermediate acting?

Answer 8

NPH neutral protamine Hagedorn

Question 9

long acting insulin?

Answer 9

glargine (lantus) (100U), glargine (Toujeo) (300U), detemir (Levemir)

Question 10

describe regular insulin

Answer 10

clear, neutral pH, with zinc

Question 11

onset, peak duration of regular insulin?

Answer 11

onset: 30 minutes
peak: 2-3 hours
duration: 3-6 hours

Question 12

what happens with regular insulin SQ?

Answer 12

Regular insulin aggregates under the skin when given SQ. It has to de-aggregate to be absorbed.
So regular insulin has slow absorption at first, and then faster absorption as it de-aggregates causing variable uneven absorption rate.

tis is why we have to time meals out specifically so they do not get hypoglycemia

Question 13

what happens with regular insulin IV?

Answer 13

When given IV there is no aggregation and physiologically it is similar to pancreatic secretion

Question 14

How to use regular insulin used pre-prandially?

Answer 14

At mealtime glucose rises faster than regular SQ insulin is absorbed so rapid acting insulins are better for bolus before a meal

If using regular insulin inject 30-45 minutes before a meal to minimize this effect

Question 15

how are rapid acting insulins administered?

Answer 15

IV

Question 16

peak onset duration of rapid acting insulins?

Answer 16

onset: 5-15 minutes
peak: 20 minutes
duration: 1-4 hours

Question 17

when to administer rapid acting insulins?

Answer 17

right before meal

Question 18

what insulin do we use in insulin pumps? how is this insulin administered?

Answer 18

rapid acting insulin (most like endogenous insulin)

it is administered SQ

Question 19

what prolongs half-life of insulin? onset, peak, duration?

Answer 19

Protamine was developed to extend the insulins duration of action and onset

onset: 2-5 hours
duration: 10-20

Question 20

clinical use of NPH?

Answer 20

Usually mixed with rapid acting insulin (works fast and gone fast) and given SQ 2 times a day

• As the rapid or regular insulin are wearing off NPH is kicking in

Ex: insulin lispro (Humalog 75/25)
75% is bound to protamine (delayed onset and longer duration of action)
25% is unbound (immediate onset and shorter duration of action

Question 21

why were long acting insulins made?

Answer 21

to replicate the basal secretion of insulin from the pancreas

better basal coverage than NPH (long actings have slow onset and last long)

Question 22

benefits of long acting insulins

Answer 22

These provide a relatively constant insulin profile, don’t have a pronounced peak, and the risk for hypoglycemia is reduced

Question 23

what is pH of long acting insulins? what is the consequence of this?

Answer 23

pH of 4 in the bottle once give SQ it precipitates as a crystal in the neutral pH of the body & then slowly absorbed

Can’t mix with other insulins b/c other insulins have a neutral pH. If you mix then long acting insulin precipitates in the syringe (will hurt and cause complications)

Question 24

clinical use of long acting insulin?

Answer 24

give once a day (lasts 24 hours) for basal coverage.

This doesn’t cover sugar bumps get from meals or unexpectedly high sugars.

Question 25

clarities of different insulins?

Answer 25

short acting: clear
rapid acting: clear
intermediate acting: cloudy
long acting: clear

Question 26

which insulin products are good for 28 days? which is for 42 days?

Answer 26

aspart, aspart & aspart protamine (NPA), glargine, glulisine

levemir is the only one good for 42 days

Question 27

which insulins are okay to refrigerate until opened?

Answer 27

aspart, aspart & aspart protamine (NPA), glargine, glulisine, & levemir