Insulin

Question 1

Where is endogenous insulin produced?

Answer 1

In the islets of Langerhans by the beta cells of the pancreas

Question 2

How do insulin and glucose affect one another?

Answer 2

Beta cells have channels in their plasma membrane that serve as glucose detectors
The beta cells secrete insulin in response to rising levels of circulating glucose

Question 3

Rapid acting insulin: Names, Onset, Peak, Duration, and Usage

Answer 3

Lispro (Humalog)
Aspart (Novolog)
Glulisine (Apidra)

Onset: 5-15mins
Peak: 45-75mins
Duration: 2-4hrs
Usage: Meals or acute hyperglycemia

Question 4

Short acting insulin: Names, Onset, Peak, Duration, and Usage

Answer 4

Regular (Humulin R, Novolin R)

Onset: 30-60mins
Peak: 2-4hrs
Duration: 5-8hrs
Usage: Meals or acute hyperglycemia

Question 5

Intermediate acting insulin: Names, Onset, Peak, Duration, and Usage

Answer 5

NPH (Humulin N, Novolin N)

Onset: 1-2hrs
Peak: 4-12hrs
Duration: 18-24hrs
Usage: Provide basal insulin, overnight

Question 6

Long -acting insulin: Glargine, Onset, Peak, Duration, and Usage

Answer 6

Onset: 2hrs
Peak: NO peak
Duration: 24hrs
Usage: Provide basal insulin, overnight

Question 7

Long acting insulin: Detemir, Onset, Peak, Duration, and Usage

Answer 7

Onset: 2hrs
Peak: 3-9hrs
Duration: 6-24hrs
Usage: Provide basal insulin, overnight

Question 8

How can insulin be administered?

Answer 8

SubQ or IV

Question 9

How can R/NPH or rapid/NPH be used when injected before breakfast or dinner?

Answer 9

Before breakfast: R/rapid covers breakfast and NPH the rest of the day
Before dinner: R/rapid covers dinner and NPH covers ON

Question 10

Which insulins cannot be mixed in the same syringe with other insulins?

Answer 10

Glargine and detemir (long acting)

Question 11

What is usually used in conjunction with long acting insulins to cover meals?

Answer 11

Rapid acting

Question 12

AE of Insulin:

Answer 12

Hypoglycemia (also the CI of insulin)
Injection site reactions
Weight gain

Question 13

When is the most danger of hypoglycemia associated with insulin intake?

Answer 13

Administration of insulin in the absence of adequate carb intake

Question 14

If patients are skipping meals how should their rapid or regular acting insulin be doses?

Answer 14

Skip meal, skip dose

Question 15

More convenient insulin delivery methods include:

Answer 15

Insulin pens
Insulin pumps
Jet injectors

Question 16

Afrezza is what type and form of insulin?

Answer 16

Inhaled, rapid-acting

Question 17

When should Afrezza be administered?

Answer 17

At the beginning of a meal

Onset ~1hr, Effects last ~2.5hrs

Question 18

When does Afrezza require an addition of long-acting insulin?

Answer 18

Type 1 DM

Question 19

What is one benefit to Afrezza?

Answer 19

It may better mimic normal insulin response to a meal

Question 20

AE of Afrezza common/less common:

Answer 20

Common: Hypoglycemia, cough, throat pain/irritation

Less common: Declin in lung function, lung cancer (unknown)

Question 21

Which patients is Afrezza CI in?

Answer 21

Chronic lung disease -perform spirometry on all patients before initiating treatment.
Acute brochospasm has been observed in patients with asthma and COPD
(unknown safety/efficacy in smokers)