Insulin Flashcards
What is normal daily insulin secretion in healthy, nonpregnant adults without obesity?
0.5-0.7 units per kg of BW
What are the mechanisms of action for insulin?
-stimulates entry of AA into cells/enhances protein synthesis
-enhances fat storage (lipogenesis) & prevents mobilization of fat for energy (lipolysis and ketogenesis)
-stimulates entry of glucose into cells for use as energy source/promotes storage of glucose as glycogen (glycogenesis) in muscle and liver cells
=inhibits production of glucose from liver/muscle glycogen (glycogenolysis)
-Inhibits formation of glucose from non CHO, such as AA (gluconeogenesis)
What are the counterregulatory hormones to insulin?
glucagon, epinephrine, norepinephrine, growth hormone, and cortisol
What are the concentrations of insulin currently available in the US?
U-100, U-200, U-300, and U-500, indicating 100 units/mL, 200 units/mL, etc
How are insulin products classified?
according to onset, peak effect, and duration of action
What are the currently available rapid acting insulin products?
lispro, aspart, glulisine, afrezza
What is the current available short acting insulin?
regular insulin
What is rapid acting insulin usually preferred to regular insulin for post prandial coverage?
b/c of very rapid onset and short duration of action (reduced risk of late onset hyperglycemia d/t its longer duration of action)
When should rapid acting insulin be administered?
Immediately prior to eating (<15 mins preprandially); injecting too early (30-60 mins before meals may result in profound hypoglycemia
What does NPH stand for?
Neutral protamine Hagedorn (named for the researcher who derived the formulation)
What are the long acting insulin analogs?
Lantus, determir, and degludec
When converting pt from NPH to glargine, how much should the glargine be reduced by?
Reduce glargine dose to 80% of previous NPH dose to avoid filling the previous glycemic “valley” with insulin and inducing hypoglycemia
Can insulin detemir be diluted or mixed with any other insulin preperations?
No
What are the commercially available premixed insulin products?
70/30, 50/50, and 75/25
May be appropriate for pt’s with DM who have difficulty mixing their own insulin, or those who do not want to commit to a strict basal/bolus regimen
What are the two fixed dose combo of basal insulin with GLP-1 RA
Insulin glargine/lixiseatide and degludec/liraglutide
Inclusion of a GLP-1 RA w/ basal insulin offers similar glycemic control, but is less likely to cause weight gain
When building an insulin regimen, what factors should be considered?
type of DM, clinical assessment of insulin deficiency and suspected insulin resistance and individual preference (eating times, meal comp, exercise, waking/sleeping patterns), A1c levels, wt/lipid goals, and variablity of lifestyle/activities
What is a “starting “dose of long acting insulin for a patient with DM2 also taking 1 or more oral agents
10 units or 0.2 units per kg administered in the morning or at bedtime
Per AACE algorithim, what is the starting dose recommendation for long acting insulin (in units per kg)
A1c < 8.0: 0.1-0.2 units per kg
A1c > 8%: 0.3-0.4 units per kg
Regardless of starting dose, how should insulin increases be made?
Every 2-3 days in fixed increments (2-4 units) or as a percentage of the current dose (10-20%)
Due the presence of insulin resistance in DM2, the ultimate TDD of basal insulin is often very high (usually 0.5 units per kg per day but may range from 0.7-2.5 units per kg per day)
What are the most three commonly used approaches when insulin is used to treat DM2 as the sole source of glycemic control?
- twice daily intermediate insulin
- split-mixed insulin (2/3rd of TDD is given before breakfast–1 part rapid/short acting to 2 parts intermediate) and 1/3rd is given before evening meal (using ratio of 1:1 or 1:2)
- semi intensive insulin (combines 1 dose long acting with i dose rapid acting with the largest meal)
when adding rapid acting insulin for prandial coverage of the largest meal, what is the recommended dose for insulin?
0.1 unit per kg or 10% of the basal dose, or 4-5 units
Subsequent adjustments of rapid acting can be made based on 1 our PPBG by either 1-2 units or 10-15% of the dose
If hypogycemia, determine cause and if consistent, reduce rapid acting by 2-4 units or 10-20%
What is the goal of insulin therapy in DM1?
To mimic (as close as possible) the physiologic profile of insulin secretion (basal/bolus)
Physiologic insulin secretion typically occurs at a rate of __ to ___ units per hour
0.5-1.0
What are insulin requirements for pt’s with DM1 who are w/in 20% of their IBW?
0.5-1.0 units per kg of body weight per day
