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Ama - Diabetes mellitus > Insulin > Flashcards

Insulin Flashcards

1
Q

What is insulin?

A

Polypeptide hormone responsible for the metabolism of carbohydrates, fat and protein.
It regulates blood sugar levels by helping cells absorb glucose for energy or storage.

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2
Q

Rapid

A
  • PRN
  • Fast onset + short duration of action
  • Injected immediately before or after eating
  • Lower risk of hypo than soluble (short acting)
  • Alternative to soluble in emergency
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3
Q

Examples of rapid acting

A
  • Aspart (Novorapid)
  • Lispro (Humalog)
  • Glulisine (Apidra)
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4
Q

Short acting (neutral or soluble)

A
  • PRN
  • Longer duration of action
  • Injected 30 mins before eating
  • Do not eat within 30 minutes = risk of hypo
  • Can be given in diabetic emergencies + surgery
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5
Q

Examples of short-acting

A
  • Actrapid
  • Humulin S
  • Insuman rapid
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6
Q

Intermediate

A
  • BD
  • Given in conjunction with short acting
  • Up to 16 hours duration
  • Roll in hands before administration to resuspend zinc-insulin particulate
  • Never use IV (may block capillary; thrombosis)
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7
Q

Examples of intermediate acting

A
  • Isophane/NPH
  • Insulatard
  • Humulin I
  • Insuman basal
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8
Q

Long acting

A
  • OD
  • Same time each day
  • Roll in hands before administration to resuspend zinc-insulin particulate
  • Never use IV (may block capillary; thrombosis)
  • Dont mix with soluble insulin
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9
Q

Examples of long acting

A
  • Detemir (Levemir)
  • Glargine (Absaglar, Lantus)
  • Degludec (Tresiba)
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10
Q

Biphasic insulin

A
  • Combination of shorter and longer acting insulin
  • More convientn
  • Less control
  • Resuspend before mixing
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11
Q

Examples of biphasic

A
  • Novomix 30
  • Humalog mix 25
  • Humulin M3
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12
Q

When is insulin used?

A

Type 1
Type 2 if oral antidiabetic medication fails
Surgery
Hospitalisation for illness e.g. DKA

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13
Q

When do insulin requirements increase?

A

Infections or intercurrent illness
Stress or accidental surgical trauma
Puberty
Pregnancy - 2nd/3rd trimester

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14
Q

When do insulin requirements decrease?

A

Endocrine disorders
e.g. Addisons disease, hypopituitarism
Coeliac disease (gluten intolerance)

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15
Q

Administration

A

S/C injection to buttocks, upper arm, abdomen or thigh
IV reserved for urgent treatment
- DKA
- During surgery
- Serious illness for fine control

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16
Q

MIR

A
  • Short/rapid acting insulin before meals
    AND
  • Intermediate/long acting insulin OD/BD
17
Q

Biphasic mixtures regimen

A
  • Short/rapid acting insulin pre-mixed with intermediate/long acting insulin
  • OD/BD before meal

Suitable for:
- Patients who have difficulty with/prefer not to use MIR
Not suitable for:
- Acutely ill patients as insulin requirements change

18
Q

Long/intermediate acting regimen

A
  • OD/BD
  • With or without short/rapid acting before meals
  • NOT suitable for Type 2 diabetes, unless in certain criteria
19
Q

Continuous S/C infusion

A

Type 1 diabetes in certain criteria

20
Q

Type 1 diabetes

A

Start with MIR

21
Q

Type 2 diabetes

A

Isophane insulin (long-acting) OD/BD
AND
Short acting (soluble) insulin
- Biphasic or MIR

22
Q

S/C infusion pump

A
  • Basal insulin and patient activated bolus doses at meal times
  • Must monitor blood glucose regularly
  • NOT recommended in Type 2
23
Q

S/C infusion pump give to…

A
  • Unpredictable hypoglycaemia with MIR
  • Glycaemic control >8.5% despite optimised MIR
  • Children under 12 (MIR is impractical) BUT they must undergo MIR trial between 12-18
24
Q

Insulin - SE

A

Hypoglycaemia
Lipodystrophy
- Rotate injection site
Local injection site reactions
- Check injection technique

25
Q

Hypoglycaemia

A

Don’t miss melbas
Right insulin, Right dose, Right time, Right route
Do not do strenuous exercise before administration - increased absorption from limb used

26
Q

Counselling - food

A

MIR
- Adjust dose according to carbohydrate intake
Biphasic
- Regulate and distribute carbohydrate intake throughout day to match regimen

27
Q

Interactions - hypoglycaemia

A
  • Oral antidiabetics
  • ACEi
  • MAOIs
  • Salicylates
  • Beta blockers (masks symptoms)
  • Alcohol
28
Q

Interactions - hyperglycaemia

A
  • Corticosteroids
  • Diuretics
  • Sympathomimetics (epinephrine, salbutamol, terbutaline)
  • Thyroid hormones
  • Oral contraceptives (oestrogen, progesterone)
29
Q

Warning

A

Recurrent hypoglycaemic episodes
- Sweating
- Palpitations
- Confusion
- Drowsiness
DKA
- N + v
- Drowsiness
Hepatotoxicity
Ulceration of foot tissue

Ama - Diabetes mellitus (17 decks)

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