ILE I U2 D2 Flashcards
Regular insulin onset
Rapid, 30 min
Reg insulin duration
1.5 hour
Reg insulin duration IV
30-60 min, HEXAMERS -> DIMERS
Reg insulin use
Ketoacidosis, surgery, diabetic coma
Reg insulin class
Rapid acting, short duration
Rapid acting insulin contains
Clear, small amount of zinc to improve stability and shelf life
Intermediate acting insulin contains
Protamine
Long acting insulins
Detemir, glargine
NPH
Neutral protamine hagedorn (from fish testes)
Protamine Insulin works by creating a ___
PZI - protamine:zinc complex
PZIs are more/less readily absorbed?
Less
Protamine insulin (PZI) onset
4-8 hours
Protamine insuline (PZI) duration
> 36 hours (peak at 14-28)
Use protein insulin in emergencies?
No
NPH insulin is ___ injection only
Intermittent (not continuous)
NPH has ___ duration
Intermediate
NPH onset
1-3 hours
NPH has ___ duration
short
NPH duration
12-16 hours
70/30, 50/50 mixes are usually associated with which type of insulin
NPH
NPH insulin use
Day-to-day
NPH insulin in emergencies?
No
Reg insulin type
rapid acting, short duration
aspart insulin type
rapid acting, short duration
lispro insulin type
rapid acting, short duration
Glulisine insulin type
rapid acting, short duration
NPH insulin types
intermediate acting
Detemir/levemir type
long acting, slow onset
glargine/lantus insulin type
long acting, slow onset
ultralente insulin type
long acting, slow onset
Insulin aspart
proline at position B28 has been replaced with an aspartate. This substitution, like with lispro, results in reduced hexamer formation and more rapid dissolution
Novolog70/30 contains
70% insulin aspart protamine suspension and 30% insulin aspart.
Insulin glulisine
B3 is replaced by lysine and the lysine in position B29 is replaced by glutamic acid, less hexameter formation, rapid dissolution
aster onset of action, higher initial plasma concentrations, and shorter duration of action than regular human insulin..
Glulisine brand
Apidra
Aspart brand
Novolog
Which rapid acting insulin is intended for subcutaneous administration and to be used by an external infusion pump?
Glulisine
Lantus (glargine)
A21 is replaced by glycine and two arginines are added to the C-terminus of the B-chain. Glargine has 86% the activity of human insulin.
Injected lantus is what pH? Why is this important?
4, allowing for complete solubility for basic insulin derivative
Insulin glargine administration
once, subq, at bedtime
Levemir (detemir)
amino acid threonine in position B30 has been omitted, and a C14 fatty acid chain (myristic acid) has been attached to the amino acid B29 (Thr), imparting its long-acting properties.
which insulin tightly binds to albumin?
levemir
Triseba duration
up to 42 hours
Triseba
Engineered human insulin with the deletion of Thr B30 and the addition of hexadecanoic acid to Lys B29 via a γ -L-glutamic acid linker
Triseba pathway
DiHEXamers -phenol-> MultiHEXamers -Zn-> monomers
Sliding Scale definition
progressive increase in the pre-meal or nighttime insulin dose, based on pre-defined blood glucose ranges. Sliding scale insulin regimens approximate daily insulin requirements
What factors determine a sliding scale?
- Amount of carbs
- Basal (background) insulin doesn’t change
- Bolus insulin based on BG before meal or at bedtime
- Pre-mixed insulin based on BG before meals
3 problems with sliding scales
- doesn’t accommodate changes in needs related to snacks, stress and activity.
- Counting carbs
- less effective in covering a pre-meal high blood sugar, because the high blood glucose correction and food bolus cannot be split.
