Insulin

Question 1

Original rapid/short-acting insulin

Answer 1

Regular insulin

Question 2

Regular insulin preparation

Answer 2

Prepared with physiologic level of zinc and no added protein (readily soluble and rapidly absorbed)

Question 3

Regular insulin vs. isophane insulin onset, peak, duration

Answer 3

30 minutes-1 hour, 2-4 hours, 5-8 hours

vs. 1-2 hours, 6-12 hours, 18-24 hours

Question 4

An insulin complex with the protein protamine at neutral pH, slower absorption and longer action than regular insulin

Answer 4

Isophane insulin (NPH)

Question 5

IV use of regular insulin vs. isophane insulin

Answer 5

True solution (clear- okay for IV) vs. cloudy suspension (NOT okay, can clog the line)

Question 6

Injection time of regular insulin in regards to meals

Answer 6

PRIOR to meal (~30 minutes)

Question 7

Isophane insulin use

Answer 7

Between-meal use (longer duration of action than regular insulin)

Question 8

Regular insulin use

Answer 8

Pre-meal use (more immediate than isophane, shorter duration, timing is critical though…)

Question 9

3 rapid insulins

Answer 9

Insulin lispro (Homolog)
insulin aspart (Novolog)
insulin glulisine (Apidra)

Question 10

Insulin lispro:
Absorption and duration compared to regular insulin
Peak time and duration time
Injection time (timing significance)

Answer 10

• Faster absorption and shorter duration (no aggregates formed
• 30-60 min peak
• 3-4 hour duration
• injected immediately before meals (timing less critical)

Question 11

Insulin lispro and insulin aspart: less risk of ____ from delayed meal and less risk of ____ after a meal

Answer 11

HYPOglycemia

Question 12

Similar onset as lispro, somewhat longer duration
Injected @ meal-time
Kinetics are between regular insulins & insulin lispro

Answer 12

Insulin aspart (Novolog)

Question 13

Kinetics similar to regular, lispro, aspart

Injected BEFORE or IMMEDIATELY AFTER meal

Answer 13

Insulin glulisine (Apidra)

Question 14

Can you use the 3 rapid insulin analogs for IV use?

Answer 14

Yes (previously only used regular insulin)

Question 15

Isophane (NP) formulation of rapid insulin analogs are formulated with ____ to slow their action for ____ effect

Answer 15

Protamine, between-meals

Question 16

Only made in pre-formed mixtures with their non-isophane partners

Answer 16

Isophane (NP) formulations of rapid insulin analogs (70:30 NP-Aspart with Aspart)

Question 17

2 slow insulins

Answer 17

Insulin glargine (Lantus), Insulin detemir (Levemir)

Question 18

Formulated with zinc at ph=4 to slow dissolution (zinc and low pH stabilize the slowly soluble hexamer form)

Answer 18

Insulin glargine

Question 19

Clear solution that precipitates in SC tissue (ph 7.4)

Administered SC once daily, usually at bedtime

Answer 19

Insulin glargine

Question 20

Myristic acid attached, which makes it bind to albumin, which prolongs its action
Neutral pH

Answer 20

Insulin detemir (Levemir)

Question 21

Detemir difference from glargine

Answer 21

Better and less variable absorption, somewhat shorter action so may need 2 injections daily

Question 22

Why are long-acting insulins usually injected at bedtime?

Answer 22

Nighttime glucose production by liver

Question 23

Pros/Cons with intensive therapy for glucose control

Answer 23

Pros: beneficial (per Diabetes Control and Complications Trial)
Cons: closer monitoring, more frequent injections, risk for hypoglycemia

Question 24

Side effects of insulins (4)

Answer 24

1. Insulin-induced hypoglycemia
2. Immunologic reactions and injection site problems
3. Weight gain
4. Drug interactions (many)

Question 25

Sympathoadrenal symptoms of hypoglycemia:

Answer 25

Sweating, weakness, hunger, tachycardia, anxiety, tremor

Question 26

CNS symptoms of hypoglycemia:

Answer 26

Headache, blurred vision, mental confusion, incoherent speech, coma, convulsions

Question 27

Treatment for severe hypoglycemia (esp. when patient is unconscious)

Answer 27

Glucagon administered IM or SC

Question 28

Analog of amylin, a peptide hormone released from beta cells along with insulin

Answer 28

Pramlintide

Question 29

MOA of pramlintide:

Answer 29

• Decreases post-prandial glucose (decreases short-acting insulin requirement)
• decreases glucagon (limits fluctuations)
• slows gastric emptying
• increases satiety (avoids weight gain with insulin)

Question 30

Use of pramlintide:

Answer 30

Used for Type 1 or 2 diabetics already on insulin, but not controlled (also LACK of weight gain is a plus)

Question 31

Pramlintide administration

Answer 31

SC before meals along with insulin

Question 32

AEs: mild nausea, headache, increased risk of hypoglycemia

Answer 32

Pramlintide (reduce dose of short-acting insulin)

Question 33

Pramlintide avoidance in certain patients: (2)

Answer 33

1. Patients with decreased GI motility or absorption

2. Renal disease (renally excreted)