Insulin Flashcards
Original rapid/short-acting insulin
Regular insulin
Regular insulin preparation
Prepared with physiologic level of zinc and no added protein (readily soluble and rapidly absorbed)
Regular insulin vs. isophane insulin onset, peak, duration
30 minutes-1 hour, 2-4 hours, 5-8 hours
vs. 1-2 hours, 6-12 hours, 18-24 hours
An insulin complex with the protein protamine at neutral pH, slower absorption and longer action than regular insulin
Isophane insulin (NPH)
IV use of regular insulin vs. isophane insulin
True solution (clear- okay for IV) vs. cloudy suspension (NOT okay, can clog the line)
Injection time of regular insulin in regards to meals
PRIOR to meal (~30 minutes)
Isophane insulin use
Between-meal use (longer duration of action than regular insulin)
Regular insulin use
Pre-meal use (more immediate than isophane, shorter duration, timing is critical though…)
3 rapid insulins
Insulin lispro (Homolog) insulin aspart (Novolog) insulin glulisine (Apidra)
Insulin lispro:
Absorption and duration compared to regular insulin
Peak time and duration time
Injection time (timing significance)
- Faster absorption and shorter duration (no aggregates formed
- 30-60 min peak
- 3-4 hour duration
- injected immediately before meals (timing less critical)
Insulin lispro and insulin aspart: less risk of ____ from delayed meal and less risk of ____ after a meal
HYPOglycemia
Similar onset as lispro, somewhat longer duration
Injected @ meal-time
Kinetics are between regular insulins & insulin lispro
Insulin aspart (Novolog)
Kinetics similar to regular, lispro, aspart
Injected BEFORE or IMMEDIATELY AFTER meal
Insulin glulisine (Apidra)
Can you use the 3 rapid insulin analogs for IV use?
Yes (previously only used regular insulin)
Isophane (NP) formulation of rapid insulin analogs are formulated with ____ to slow their action for ____ effect
Protamine, between-meals
Only made in pre-formed mixtures with their non-isophane partners
Isophane (NP) formulations of rapid insulin analogs (70:30 NP-Aspart with Aspart)
2 slow insulins
Insulin glargine (Lantus), Insulin detemir (Levemir)
Formulated with zinc at ph=4 to slow dissolution (zinc and low pH stabilize the slowly soluble hexamer form)
Insulin glargine
Clear solution that precipitates in SC tissue (ph 7.4)
Administered SC once daily, usually at bedtime
Insulin glargine
Myristic acid attached, which makes it bind to albumin, which prolongs its action
Neutral pH
Insulin detemir (Levemir)
Detemir difference from glargine
Better and less variable absorption, somewhat shorter action so may need 2 injections daily
Why are long-acting insulins usually injected at bedtime?
Nighttime glucose production by liver
Pros/Cons with intensive therapy for glucose control
Pros: beneficial (per Diabetes Control and Complications Trial)
Cons: closer monitoring, more frequent injections, risk for hypoglycemia
Side effects of insulins (4)
- Insulin-induced hypoglycemia
- Immunologic reactions and injection site problems
- Weight gain
- Drug interactions (many)
Sympathoadrenal symptoms of hypoglycemia:
Sweating, weakness, hunger, tachycardia, anxiety, tremor
CNS symptoms of hypoglycemia:
Headache, blurred vision, mental confusion, incoherent speech, coma, convulsions
Treatment for severe hypoglycemia (esp. when patient is unconscious)
Glucagon administered IM or SC
Analog of amylin, a peptide hormone released from beta cells along with insulin
Pramlintide
MOA of pramlintide:
- Decreases post-prandial glucose (decreases short-acting insulin requirement)
- decreases glucagon (limits fluctuations)
- slows gastric emptying
- increases satiety (avoids weight gain with insulin)
Use of pramlintide:
Used for Type 1 or 2 diabetics already on insulin, but not controlled (also LACK of weight gain is a plus)
Pramlintide administration
SC before meals along with insulin
AEs: mild nausea, headache, increased risk of hypoglycemia
Pramlintide (reduce dose of short-acting insulin)
Pramlintide avoidance in certain patients: (2)
- Patients with decreased GI motility or absorption
2. Renal disease (renally excreted)
