exam 2: insulins

Question 1

very rapid onset/very short action insulins

Answer 1

• lispro (Humalog)
• aspart (Novolog)
• glulisine (Apidra)

Question 2

rapid onset/short action insulins

Answer 2

regular

Question 3

intermediate onset/action insulins

Answer 3

NPH

Question 4

slow onset/long action insulins

Answer 4

• glargine (Lantus)
• detemir (Levemir)
• degludec (Tresiba)

Question 5

“lente” insulins

Answer 5

insoluble insulin complexes
- zinc/insulin precipitates
- larger complex size -> prolonged absorption from SC injection site
- (semilente, lente, ultralente)

Question 6

semilente

Answer 6

small amorphous particles (non-crystalline)

Question 7

lente (L)

Answer 7

small amorphous and large crystalline complexes
- slow absorption, long action

Question 8

ultralente (U)

Answer 8

only large crystalline complexes
- very slow absorption, very long action

Question 9

NPH insulin (N)

Answer 9

• bound insulin on protamine -> tissue proteases -> free insulin
• slow absorption, long action
• SC injection

Question 10

insulin lispro

Answer 10

(Humalog)
- reversing positions of P28 and K29 on insulin b-chain results in self-association

Question 11

insulin aspart

Answer 11

(Novolog)
- Pro 28 in b-chain switched to Asp

Question 12

insulin glulisine

Answer 12

(Apidra)
- Asn 3 and Lys 29 in b-chain switched to Lys and Glu

Question 12

insulin glargine

Answer 12

(Lantus)
- Asn 21 of b-chain changed to Gly
- 2 Arg residues added to end of b-chain
- clear solution at pH 4
- precipitates when neutralized (post-injection)

Question 12

insulin detemir

Answer 12

(Levemir)
- Thr 30 of b-chain deleted
- Lys 29 is myristylated
- binds serum albumin extensively
- clear solution

Question 13

insulin degludec

Answer 13

(Tresiba)
- Thr 30 of b-chain replaced by g-Glu/C16 fatty acid
- binds serum albumin extensively
- clear solution

Question 14

insulin mixtures

Answer 14

• NPH + regular (Humulin 70/30, 50/50)
• NPL + lispro (Humalog 75/25, 50/50)
• Ryzodeg (70% degludec + 30% aspart)

transient preprandial bolus and prolonged basal level in single injection

Question 15

Afrezza

Answer 15

inhaled regular human insulin in dry powder
- rapid onset, shortER duration of action than SC
- preprandial insulin
- contraindicated in patients with asthma and COPD
- may reduce lung function (decreased FEV)

Question 16

types of patients using insulin

Answer 16

• type I diabetics
• pts with ketosis and hyperosmolar coma
• some type II diabetics

Question 17

mode of action of insulin in diabetics

Answer 17

• decreased liver glucose output
• increased fat storage
• increased glucose uptake

Question 18

adverse reactions to insulin

Answer 18

• hypoglycemia
• lidodystrophy
• lipohypertrophy
• lipoatrophy

Question 19

hypoglycemia

Answer 19

blood glucose < 60 mg/dL
- too much insulin and/or not enough food
- weakness, sweating, hunger, tachycardia, increased irritability, tremor, blurred vision, seizures, coma, increased sympathetic output
- treated with glucose of glucagon

Question 20

lipodystrophy

Answer 20

changes in fat on upper leg at overused injection site

Question 21

lipohypertrophy

Answer 21

accumulation of fat in subcutaneous tissue

Question 22

lipoatrophy

Answer 22

loss of fat in subcutaneous tissue

Question 23

agents that increase blood glucose

Answer 23

• catecholamines
• glucocorticoids
• oral contraceptives
• thyroid hormone
• calcitonin
• somatropin
• isoniazid
• phenothiazines
• morphine

Question 24

agents that may increase risk of insulin hypoglycemia

Answer 24

• ethanol
• beta adrenergic blockers
• ACE inhibitors
• fluoxetine
• somatostatin
• anabolic steroids
• MAO inhibitors