Insulin Flashcards
Give the 3 common clinical indications for the use of insulin.
1) Insulin replacement in people with T1DM and control go blood glucose in people with T2DM where oral hypoglycaemic treatment is inadequate or poorly tolerated.
2) Give IV in the treatment of diabetic emergencies such as DKA and HHS and also for peri-operative glycemic control in selected diabetic patients.
3) Alongside glucose to treat Hyperkalaemia while other measures such as treatment of the underlying cause are initiated.
1) What does exogenous insulin stimulate?
2) What does exogenous insulin increase?
3) Insulin stimulates synthesis of what 3 substances?
4) What does insulin inhibit?
1) Glucose uptake from circulation into tissues (skeletal muscle and fat).
2) Insulin increases use of glucose as an energy source.
3) Glycogen, lipid and protein.
4) Gluconeogenesis and Ketogenesis.
How does insulin work in the treatment of hyperkalaemia?
Insulin drives K+ into cells, reducing serum K+ concentrations.
Why is insulin a short term measure for treatment of hyperkalaemia?
`Because once the insulin treatment is stopped, K+ leaks back out of the cells and into circulation, so insulin is a short term measure until other treatment is commenced.
What are the 4 classes of insulin preparations that are available?
1) Rapid acting: immediate onset, short duration.
2) Short acting: early onset, short duration.
3) Intermediate acting: Intermediate onset and duration
4) Long acting: flat profile with regular administration
Give examples of the following types of insulin:
1) Rapid acting
2) Short acting
3) Intermediate acting
4) Long acting
1) Insulin aspart (Novorapid)
2) Soluble insulin (Actrapid)
3) Isophane (NPH) insulin (Humulin I)
4) Insulin Glargine (Lantus) and insulin detemir (Levemir)
Describe biphasic insulin preparations.
They contain a mixture of rapid and intermediate acting insulins (e.g. Novomix 30 - insulin aspart/ insulin aspart protamine).
30% rapid-acting and 70% intermediate-acting.
1) What type of insulin is used where IV insulin is required?
2) What is the main adverse effect of insulin?
3) What can insulin cause when administered by repeated subcutaneous injection at the same site?
4) Why is there an increased risk of hypoglycaemia when using insulin in patients with renal impairment?
1) Soluble insulin is usually used such as Actrapid.
2) Hypoglycaemia
3) It can cause fat overgrowth (lipohypoertrophy) which may be unsightly or uncomfortable.
4) Because insulin clearance is reduced in patients with renal impairment.
1) Combining insulin with what increases the risk of hypoglycaemia?
2) Concurrent therapy of insulin with what can increase insulin requirements?
3) What is the overall goal of insulin treatment?
1) Other hypoglycaemic agents.
2) Concurrent therapy with systemic corticosteroids increases insulin requirements.
3) To attain good blood glucose control without problematic hypoglycaemia.
1) What is the normal daily insulin requirement?
2) What does insulin treatment normally include?
1) about 30-50 units, but this varies considerably between individuals depending on weight, diet and activity.
2) once or twice daily long-acting insulin to meet basal requirements, with intermittent rapid or short acting insulin injected with meals to control post-prandial glucose.
1) What is the prescription of insulin used for diabetic emergencies and peri-operative glycemic control.
2) Why is glucose given with insulin when insulin is being use to treat hypoglycaemia.
3) Give an example of a prescription used for the treatment of hyperkalaemia.
1) 50 units of Actrapid are diluted in 50mL of 0.9% sodium chloride to a concentration of 1 unit/mL. Insulin is infused with IV fluids and potassium at a rate determined by blood glucose concentration.
2) It is essential to give glucose when giving insulin for hyperkalaemia in order to avoid hypoglycaemia.
3) Actrapid 10 units added to 20% glucose 100mL and infused over 15 minutes.
Rather than correcting hyperglycaemia quickly using insulin, what is a more effective manner of management?
Instead, try to understand why hyperglycaemia has occurred (for example, infection) and make small alterations to the patient’s regular insulin regimen.
1) Name the P drugs for human quick acting insulins.
2) Name the P drugs for analogue quick acting insulins.
3) Name the analogue long-acting insulin P drugs.
1) Humulin-S® and Actrapid®
2) Insulin lispro (Humalog®) and Insulin aspart (Novorapid®)
3) Insulin glargine (Lantus®) and Insulin degludec (Tresiba®)
1) Name the human isophane (NPH) insulin P drugs.
2) Name the human biphasic insulin P drugs (mixtures).
3) Name the analogue biphasic insulin P drugs (mixtures).
1) Insulatard® and Humulin-I®
2) Humulin M3®
3) Humalog Mix25® and Novomix 30®
