Insulin Flashcards
Insulin
- Insulin is a hormone
- Produced in the ß-cells of the Islets of Langerhans in the pancreas
- Formed from a substance called proinsulin
Bolus Insulin
Ultra Rapid-acting Insulin (onset 2.5min)
-Fiasp (insulin aspart, U-100)
-Lyumjev (insulin lispro-aabc, U-100)
Rapid-acting Insulin (onset less than ½ hour)
-NovoLog (insulin aspart) U-100
-Humalog (insulin lispro) U-100 and U-200
-Admelog (insulin lispro) U-100
-Apidra (insulin glulisine)
Short-acting Insulin (onset ½ - 2 hours)
-NovolinR (Regular human insulin)
-HumulinR (Regular human insulin)
Basal Insulin
Intermediate-acting Insulin (onset 1½ - 6 hours)
- NovolinN (NPH, human insulin isophane suspension)
- HumulinN (NPH human insulin isophane suspension)
Long-Acting (onset 2-10 hours)
-Lantus (U-100 insulin glargine)
-Semglee (U-100 insulin glargine-yfgn)
-Basaglar (U-100 insulin glargine)
-Toujeo (U-300 insulin glargine)
-Levemir (U-100 insulin detemir)
-Tresiba (U-100 and U-200 insulin degludec)
Insulin aspart
- Fiasp® U-100
- Can be mixed with: NPH
- Can be used in SC pumps
- Do not administer IV
- Onset: 16 - 20 minutes
- Peak: 1.5 - 2 hours
- Duration of Action: 5 - 7 hours
Insulin lispro-aabc
- Lyumjev® U-100 & U-200
- Can be mixed with: NPH
- Requires Rx
- Can be used in SC pumps
- Do not administer IV
- Onset: 15 - 17 minutes
- Peak: 2 - 3 hours
- Duration of Action: 4.5 - 7 hours
Insulin lispro, aspart, & glulisine
- Humalog® U-100 & U-200
- NovoLog® U-100
- Apidra® U-100
- Eat within 15 minutes of injection
- Can be mixed with: NPH
- Require Rx
- Can be used in SC pumps
- Do not administer IV
- Onset: 15 - 30 minutes
- Peak: 30 - 90 minutes
- Duration of Action: 5 - 7 hours
Regular Insulin
- Humulin®-R
- Novolin®-R
- Clear/colorless
- Can be given IV: DKA treatment & TPN
- SC pumps
- Onset: 30 - 150 minutes
- Peak: 30 - 150 minutes
- Duration of Action: ~5 - 8 hours
THIS IS NOT OUR GO TO BOLUS INSULIN
USE THIS WHEN PT HAS MAJOR COST CONSTRAINT
NPH Insulin
- Humulin®-NPH
- Novolin®-NPH
- Zinc and protamine
- Can mix with regular, aspart, lispro, glulisine
- Frosting = loss of potency: cannot shake (suspension: normal to be cloudy)
- Onset: 2 - 4 hours
- Peak: 4 - 10 hours
- Duration of Action: 10 - 16 hours
Insulin glargine, glargine-yfgn, detemir, and degludec
glargine
- Lantus® (U-100)
- Toujeo® U-300 & Toujeo® Max U-300
- Basaglar® U-100
- Semglee® U-100
detemir
- Levemir® U-100
degludec
- Tresiba® U-100 & U-200
- Do not dilute & mix
- Onset: 1-9 hours
- Peak: NONE*
- Duration of Action: 20 - 48 hours
Tresiba MOA
The only insulin that has a steady state. If you miss a dose, taking it early or late it will still have the same steady state (3-5 days)
Will grab onto albumin
t1/2: 42 hours
Afrezza® (inhaled regular insulin)
- Regular insulin (U-100) in dry powder form
- Mealtime insulin
- BBW: Acute Bronchospasm*****
- Not more effective than SC rapid-acting mealtime insulins
- Approved for 18 years and older
- Need baseline FEV1
- Use of Afrezza in smokers has not been studied
Afrezza® (dosing)
Comes in 3 strengths:
- 4 unit (blue)
- 8 unit (green)
- 12 unit (gold)
Toujeo Max and Tresiba U-200….
ONLY EVEN NUMBERS
Insulin (side effects)
- HYPOGLYCEMIA!!****
- Allergy extremely rare
- Injection site
- Lipohypertrophy: 2 degree repeated injections @ same site (you want to rotate injection site)
- Cough (Afrezza® only)
Insulin dosing (Start basal)
A1C < 8%: 0.1-0.2 U/kg
A1C > 8%: 0.2-0.3 U/kg
AACE-bolus
Basal Plus 1, Plus 2, Plus 3
- Patient is on a basal and you want to add bolus
- Start only ONE (1) bolus shot per day
- Start: 10% of basal or 5U
Basal Bolus
- When you want to start basal + bolus at the same time
- Start bolus before each meal
- If not on basal: sue 0.3-0.5U/kg 50/50
- If on basal: use 50% of basal dose and
divide by 3 for each meal
Needs to be onGLP1-RA or SGLT2i or DPP4i to be on one of these to start bolus
ADA - basal
Start 10U or calculate 0.1 -0.2U/day
ADA - bolus
- 4 units or 10% basal
- Start with one (1) injection a day at largest meal
Insulin (drug interactions)
- TZDs
- ACE-I, MAOI
- Thiazide-diuretics
- Hormones (estrogens/androgens/thyroid)
- Beta-Blockers
- Alpha-Glucosidase Inhibitors
monitor and see what happens
Insulin (monitoring
- FBG (basal) /PPG (bolus)
- Hypoglycemia
- Weight gain
- Injection site reactions
- Cough (Afrezza® only)
Factors affecting absorption
Insulin Type: Injectable vs. nasal inhalation
Site of injection (SC):
- Rate of absorption: abdomen > arms > thighs > buttocks
Depth of Injection:
- Rate of absorption: IV > IM > SQ
Regional Blood Flow, is affected by:
- Exercise (work faster)
- Skin temperature (hot - speed up / cold - slow down)
- Hydration status (dehydration - Slow down)
- Local heat (speed up)
Soliqua® 100U/33mcg
(insulin glargine + lixisenatide)
Dosing:
- Patients on < 30 units of glargine: start 15 units/5mcg
- Patients on 30-60 units of glargine: start 30 units/10mcg
- Only delivers doses between 15 and 60 units
- MDD: 60 units/20mcg
Administer 1 hour prior to breakfast
Does not have Thyroid C-cell tumor BBW
Only studied against insulin glargine
Xultophy® 100U/3.6mg
(insulin degludec + liraglutide)
Dosing:
- Start at 16 units/0.58mg
- MDD: 50 units/1.8mg
Pen delivers doses between 10 and 50 units
Administer anytime once-daily without regard to food
