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Cpt > Insulin > Flashcards

Insulin Flashcards

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1
Q

What si teh role of insulin

A
  • Stimulates uptake of glucose into liver, muscle and adipose tissue
  • Decreases hepatic glucose output via inhibition of gluconeogenesis
  • Inhibits glycogenolysis
  • Promotes uptake of fats
  • Ideal insulin treatment would be to reinstate the normal daily insulin profile to prevent both hyperglycaemia and hypoglycaemia
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2
Q

What are types of insulin available

A 
Animal Porcine and Bovine
Recombinant DNA technology
• Human short acting insulins
• Human rapid acting insulin analogues
• Isophane intermediate acting insulin
• Long acting basal analogue insulins
• Very long acting basal analogue insulins
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3
Q

What affectstheduraton of action ofisulins

A

Once absorbed, duration o action 4-5 minutes. Only difference - rate at which absorbed. Some take time to break down. Fast acti ones are more momnomeric. Some ar more bound together so slow breakdown.

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4
Q

Describe recombinant dna technology

A
  • Has allowed for the development and production of analogues – the insulin molecule structure is modified to alter the pharmacokinetic properties, primarily affecting the absorption of the drug from subcutaneous tissue
  • B26-30 region altered
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5
Q

How many types of insulin are there

A

Over 20 different types are insulin in use in various strengths and forms (vials, cartridges, disposable pens)
U100. 100 units per ml. Obesity a problem need to use u200, u300 etc
Liable to prescribing error s- could accidnetllay give too much

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6
Q

What are the 6 mai insulin categories and how are they absorbed

A 
• Ultrafast acting
• Rapid acting
• Short acting
• Intermediate acting
• Long acting
• Very long acting
• Absorption into blood stream via subcutaneous
injection
• Formulation of insulin influences rate of absorption
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7
Q

Describe ultra fast acting insulin apart

A

Ss

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8
Q

Describe rapid acting insulin

A
  • Rapid onset of action 5 to 15 minutes • Inject just before eating
  • Peaks ~ 60 minutes
  • Duration 4 to 6 hours

Humalog, Novorapid, Apidra)

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9
Q

Describe short acting insulin

A

Actrapid, Humulin S, Hypurin Bovine and Porcine Neutral)
• Starts to work 30 to 60 minutes
• Need to inject at least 15 to 30 minutes before
eating several times daily to cover meals • Peaks at 2 to 3 hours
• Duration 8 to 10hours

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10
Q

Describe intermediate acting insulin

A

Intermediate acting insulin (Insulatard, Humulin I and Insuman Basal, Hypurin Bovine and Porcine Isophane)
• Slower onset 2 to 4 hours
• Peaks 4 to 8 hours
• Duration up to 12 to 20 hours

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11
Q

Describe long and very on acting insuin

A

Long and very acting insulin (Glargine, Detemir, Degludec)
• Slow onset 2 to 6 hours
• Duration up to 24 hours
• Very long up to 50+ hours (DEGLUDEC insulin)

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12
Q

What are fixed. combination

A
  • Novomix 30
  • Humulin M3
  • Humalog Mix 25 and 50
  • Hypurin Porcine 30/70
  • Insuman Comb 15 and 25 and 50
  • And modes of delivery using syringes, insulin Pens, insulin pumps
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13
Q

Describe insulin pump therapy

A

Sensor augmented pump therapy with threshold suspend

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14
Q

What are the adverse effects of insulin

A
  • Hypoglycaemia
  • Hyperglycaemia
  • Lipodystrophy – lipohypertrophy or lipoatrophy
  • Painful injections - hypertrophy of adipose, and scarring if you keep injecting into same space
  • Insulin allergies
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15
Q

Describe the safer administration of insulin

A
  • In UK 4 to 5% population has diabetes
  • 30 to 40% treated with insulin
  • Insulin errors are very common in UK with approximately prescribing errors in ~20% cases
  • Why? Too much will lead to hypoglycaemia and too little to hyperglycaemia
  • Look online for Safer Insulin Prescribing module
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16
Q

Why does blood glucose rise

A
  • Inability to produce insulin due to beta cell failure and / or
  • Insulin production adequate but insulin resistance prevents insulin working effectively
17
Q

How do we treat type 2 diabetes

A

Type2
– Lifestyle plus non-insulin therapies
• Biguanides, sulphonylureas, thiazolidinediones, DPP4 inhibitors, α- Glucosidase inhibitors, SGLT2s, GLP1 analogues and Insulin
• Plus non pharmacologic methods via bariatric surgery and very low calorie diets
• Above require patient education and ability to monitor results of therapy

18
Q

What are the key challenges for patient with type 2 diabetes

A

Ss

19
Q

What are the nice targets in typ 2 diabetes

A
  • In general target for all is HbA1c 6.5 to 7.5%
  • HbA1c 6.5%:Diet and first 2 treatment steps
  • HbA1c 7.5%:Beyond this or if at risk of severe hypoglycaemia
  • Common sense: Limited life expectancy and Co morbid conditions
20
Q

Describe metformin

A

• decrease Insulin resistance leading to increased glucose by tissues
• decrease hepatic glucose production (reduces hepatic
gluconeogenesis)
• Limits weight gain
• decrease CVS events (UKPDS)
• Can be combined with all other diabetes medications
• Side effects include GI symptoms
• Lacticacidosisrare
• Vitamin B12 deficiency uncommon
• Stop if CKD < 30ml/min or significant comorbidities
• Dose range typically 500mg to 2.5g (also Modified Release available) and Cost low

21
Q

Describe sulphonylureas

A 
Stimulate beta cell to release insulin
• Extensive experiencedecrease Microvascular risk
(UKPDS)
• Side effects
• Weight gain
• Hypoglycaemia
• Cost low
• Commonly used include Gliclazide (Modified Release too) (hepatic metabolism so can be used in renal impairment), Glimepiride
22
Q

Wha is acarbose

A

Acarbose: α glucosidase inhibitor
• Only 1 available in the class
• Inhibits breakdown of carbohydrates to glucose by blocking action of the enzyme α Glucosidase
• Side effects are predictable! Flatulence, loose stools and diarrhoea
• Modest reduction in HbA1c ~ 0.5%
• Rarely if ever used nowadays

23
Q

What are glitazones

A

Glitazones [Pioglitazone]
• increase insulin sensitivity in muscle and adipose tissue and decrease hepatic glucose output
• They bind to and activate one or more peroxisome proliferator-activated receptors (PPARs)
• Can be used in combination with other oral agents
• Cardiovascular concerns with Rosiglitazone - Weight gain, fluid retention, cvs events such as angina - increase cholesterol.
• Pioglitazone still available but concerns regarding weight gain, fluid retention and heart failure, effects on bone metabolism and bladder cancer
• Rarely used nowadays

24
Q

Describe glucagon like peptide 1 therapies

A

• Alternative hormone system influencing glucose metabolism
• High glucose in Type 2 diabetes due to insufficient release of insulin and over production of glucagon
• GLP1therapy(Exenatide,Liraglutide, Lixisenatide)
• Increase insulin secretion from the beta cells
• Decreases production of Glucagon from alpha cells
Switches off desire to eat - safety centre in hypothalamus - promote weight loss and improve control. A to fo former medicines promote weight gain

25
Q

Descrive the physiological effects of gulp-1

A

Ss

26
Q

Describe gliptis or dpp4 inhibitors

A

Sitagliptin, Vildagliptin, Saxagliptin, Linagliptin
• Inhibits DPP-4 activity increasing postprandial active GLP-1 concentrations
• Side effects include GI symptoms, ?pancreatitis
• Low risk of hypoglycaemia
• Weight neutral
• Modest HbA1c reduction
• Cost high

27
Q

What are the adverse effects o glp1 agonists

A
  • Gastrointestinal symptoms, nausea, loose stools or diarrhoea
  • Gastro oesophageal reflux
  • Low risk of hypoglycaemia
  • Occasional painful to inject
  • ? Pancreatitis and pancreatic carcinoma
  • NICE and FDA found no evidence of pancreatitis in the reported studies
  • Generally perceived to be safe and well tolerated agents
  • Widely used
  • Avoid if eGFR < 30ml/min
28
Q

Descrive dapagliflozin

A

A novel insulin-independent approach to remove excess glucose
Dapagliflozin selectively inhibits SGLT2 in the renal proximal tubule
*Increases urinary volume by only ~1 additional void/day (~375 mL/day) in a 12-week study of healthy subjects and patients with Type 2 diabetes.4
Sodium-Glucose Co -Transp

29
Q

What are the adverse effects f glifozins

A

Glifozins: adverse side effects
• Can be used for patients with Type1 and Type 2 diabetes as add on therapy
• Dapagliflozin, Canagliflozin and Empagliflozin available
• Side effects can be predicted
• Increase risk of lower urinary tract symptoms including genital and urinary infections especially in women (5%)
• Polyuria
• Hypoglycaemia risk low

Cpt (24 decks)

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