Exam 1 Flashcards
in absence of insulin you develop _____.
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.
treatment for T1DM
exogenous insulin
what percent of people with T2DM need insulin to survive?
30% usually near the end
describe endogenous insulin; how much is stored and released in the body on a daily basis?
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
how is insulin removed from body?
kidney and liver
A diabetic in renal failure often needs decreasing doses of insulin
short acting insulins?
regular human insulin (Humulin R & Novocain R)
rapid acting insulins?
aspart, lispro, glulisine
intermediate acting?
NPH neutral protamine Hagedorn
long acting insulin?
glargine (lantus) (100U), glargine (Toujeo) (300U), detemir (Levemir)
describe regular insulin
clear, neutral pH, with zinc
onset, peak duration of regular insulin?
onset: 30 minutes
peak: 2-3 hours
duration: 3-6 hours
what happens with regular insulin SQ?
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
what happens with regular insulin IV?
When given IV there is no aggregation and physiologically it is similar to pancreatic secretion
How to use regular insulin used pre-prandially?
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
how are rapid acting insulins administered?
IV
peak onset duration of rapid acting insulins?
onset: 5-15 minutes
peak: 20 minutes
duration: 1-4 hours
when to administer rapid acting insulins?
right before meal
what insulin do we use in insulin pumps? how is this insulin administered?
rapid acting insulin (most like endogenous insulin)
it is administered SQ
what prolongs half-life of insulin? onset, peak, duration?
Protamine was developed to extend the insulins duration of action and onset
onset: 2-5 hours
duration: 10-20
clinical use of NPH?
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
why were long acting insulins made?
to replicate the basal secretion of insulin from the pancreas
better basal coverage than NPH (long actings have slow onset and last long)
benefits of long acting insulins
These provide a relatively constant insulin profile, don’t have a pronounced peak, and the risk for hypoglycemia is reduced
what is pH of long acting insulins? what is the consequence of this?
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)
clinical use of long acting insulin?
give once a day (lasts 24 hours) for basal coverage.
This doesn’t cover sugar bumps get from meals or unexpectedly high sugars.
clarities of different insulins?
short acting: clear
rapid acting: clear
intermediate acting: cloudy
long acting: clear
which insulin products are good for 28 days? which is for 42 days?
aspart, aspart & aspart protamine (NPA), glargine, glulisine
levemir is the only one good for 42 days
which insulins are okay to refrigerate until opened?
aspart, aspart & aspart protamine (NPA), glargine, glulisine, & levemir
