Insulin Flashcards
What are the aims of insulin therapy
How is this achieved
Mimic normal insulin release:
Continuous basal secretion
Surges at mealtimes
Use of different formulations that have different rate of absorption
By modifying insulin structure: add aspartate, long FA chains
How is insulin administered and why
Parenterally - Subcutaneous injection
It will be digested in GIT
What are the categories of insulin
Rapid acting Short acting Intermediate acting Long acting Very long acting
What are the types of rapid acting insulin
Humalog - insulin lispro
Novorapid - insulin aspart
What are the time of onset, peak, duration of rapid acting insulin
10 mins
1 hour
4-6 hours
When do you use rapid acting insulin
Mealtimes - bolus dose before each meal
Acute hyperglycaemia - IV admin
What are the types of short acting insulin
Actrapid
Humulin S
What are the times of onset, peak, duration of short acting insulin
30 mins
3 hours
8-10 hours
When do you use short acting insulin
Mealtimes - bolus dose 30mins before each meal
What are the types of intermediate insulin
Isophane
Isulatard
Humulin
What are the times of onset, peak, duration of intermediate insulin
2 hours
4-8 hours
12-20 hours
When do you use intermediate insulin
Between meals
Overnight
In premixed preparations with rapid acting insulin
(Basal insulin)
What precaution do you need to take with use of intermediate acting insulin for overnight control
Must eat before bed
To avoid nocturnal hypoglycaemic episode bc Peaks in the night
What are the types of long acting insulin
Glargine
Detemir
Degludec
What are the times of onset, peak, duration of long acting insulin
2 hours
24 hours
Peakless
What is the benefit of long acting insulin being peakless
Less risk of hypoglycaemia More physiological (basal insulin release)
What is insulin pump therapy
Continuous SC insulin infusions that deliver continuous basal infusion and patient-activated bolus dose
What are the indications of insulin pump therapy
When fail to achieve HbA1c despite careful management
Multiple injections caused disabling hypoglycaemia
What are the benefits of insulin pump therapy
Constant delivery of insulin
Release more adapted to daily activity
What are the main side effects of insulin therapy
Why do they occur
Hypoglycaemia - overdose, inadequate calorie intake
Lipodystrophy - insulin promotes fatty tissue growth
What are the types of premixed preparations
What are the components
Novomix 30: 30% insulin aspart, 70% insulin aspart protamine
Humalog mix25: 25% insulin lispro, 75% lispro protamine
Humulin M3: biphasic isophane insulin - 30% short acting, 70% intermediate acting
What is the mechanism of action of premixed preparations
Rapid acting insulin provides bolus release
Isophane insulin provides basal release
What are the main types insulin regimen
BD biphasic regimen
QDS regimen
Once-daily before-bed long acting regimen
What is used in the BD biphasic regimen and when is it indicated
Twice daily premixed insulin (Novomix 30)
T1 and T2 with regular lifestyle
What is used in QDS regimen and when is it indicated
Rapid acting insulin QDS before meals and long acting insulin before bed
T1 to achieve flexible lifestyle
Insulin regimen of choice for all adults
What is used in Once daily long acting insulin regimen and when is it indicated
Glargine, Detemir
Initial regimen for T2 when switching from oral hypoglycaemic agents
Basal insulin therapy for T1 when BD insulin Detemir contraindicated
