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Endocrine/Women's Health Exam 1 > Insulin > Flashcards

Insulin Flashcards

1
Q

Insulin

A
  • Insulin is a hormone
  • Produced in the ß-cells of the Islets of Langerhans in the pancreas
  • Formed from a substance called proinsulin
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2
Q

Bolus Insulin

A

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)

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3
Q

Basal Insulin

A

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)

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4
Q

Insulin aspart

A
  • 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
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5
Q

Insulin lispro-aabc

A
  • 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
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6
Q

Insulin lispro, aspart, & glulisine

A
  • 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
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7
Q

Regular Insulin

A
  • 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

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8
Q

NPH Insulin

A
  • 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
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9
Q

Insulin glargine, glargine-yfgn, detemir, and degludec

A

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
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10
Q

Tresiba MOA

A

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

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11
Q

Afrezza® (inhaled regular insulin)

A
  • 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
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12
Q

Afrezza® (dosing)

A

Comes in 3 strengths:
- 4 unit (blue)
- 8 unit (green)
- 12 unit (gold)

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13
Q

Toujeo Max and Tresiba U-200….

A

ONLY EVEN NUMBERS

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14
Q

Insulin (side effects)

A
  • HYPOGLYCEMIA!!****
  • Allergy extremely rare
  • Injection site
  • Lipohypertrophy: 2 degree repeated injections @ same site (you want to rotate injection site)
  • Cough (Afrezza® only)
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15
Q

Insulin dosing (Start basal)

A

A1C < 8%: 0.1-0.2 U/kg
A1C > 8%: 0.2-0.3 U/kg

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16
Q

AACE-bolus

A

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

17
Q

ADA - basal

A

Start 10U or calculate 0.1 -0.2U/day

18
Q

ADA - bolus

A
  • 4 units or 10% basal
  • Start with one (1) injection a day at largest meal
19
Q

Insulin (drug interactions)

A
  • TZDs
  • ACE-I, MAOI
  • Thiazide-diuretics
  • Hormones (estrogens/androgens/thyroid)
  • Beta-Blockers
  • Alpha-Glucosidase Inhibitors

monitor and see what happens

20
Q

Insulin (monitoring

A
  • FBG (basal) /PPG (bolus)
  • Hypoglycemia
  • Weight gain
  • Injection site reactions
  • Cough (Afrezza® only)
21
Q

Factors affecting absorption

A

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)

22
Q

Soliqua® 100U/33mcg
(insulin glargine + lixisenatide)

A

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

23
Q

Xultophy® 100U/3.6mg
(insulin degludec + liraglutide)

A

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

Endocrine/Women's Health Exam 1 (10 decks)

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