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3: Drugs for Clinical Medicine > Insulin > Flashcards

Insulin Flashcards

1
Q

On what basis is insulin prescribed?

A

By brand name

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2
Q

Give 2 examples of rapid-acting insulins

A
  • Insulin lispro

- Insulin aspart

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3
Q

What is the onset of action of rapid-acting insulin?

A

Within 5 minutes

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4
Q

What is the duration of action of rapid-acting insulin?

A

2-5 hours

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5
Q

Give an example of a short-acting insulin

A

Soluble insulin (idk what this means)

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6
Q

What is the onset of action of short-acting insulin?

A

30-60 minutes

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7
Q

What is the duration of action of short-acting insulin?

A

Up to 9 hours

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8
Q

Give an example of an intermediate acting insulin

A

Isophane insulin

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9
Q

What is the onset of action of intermediate acting insulin?

A

1-2 hours

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10
Q

What is the duration of action of intermediate acting insulin?

A

11-24 hours

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11
Q

Give 2 examples of long-acting insulin

A
  • Insulin glargine

- Insulin determir

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12
Q

What is the onset of action of long-acting insulin?

A

Within 1 hour

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13
Q

What is the duration of action of long-acting insulin?

A

Consistent activity for 24 hours+

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14
Q

What is the mode of action of insulin?

A

Exogenous insulin mimics the action of endogenous insulin

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15
Q

What is endogenous insulin?

A

A naturally occurring hormone

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16
Q

What does endogenous insulin do?

A

It binds to the alpha subunit on the insulin receptor. This activates tyrosine kinase on the beta subunit. This results in the recruitment of glucose cell transporters to muscle and fat tissues, which increases glucose uptake by target tissues, increases glycogen synthesis in the liver, inhibits glycogenolysis and gluconeogenesis in the liver

17
Q

What are the routes of delivery of insulin?

A
  • SC

- IV

18
Q

When is insulin given IV?

A

Only in diabetic emergencies

19
Q

Why can insulin not be given orally?

A

Insulin is inactivated by GI enzymes

20
Q

What are the indications for insulin?

A
  • T1DM
  • T2DM
  • Diabetic ketoacidosis and hyperglycaemic hyperosmolar non-ketotic coma (HONK)
  • Hyperkalaemia
21
Q

When is insulin used in T2DM?

A

Used when diet and other anti-diabetic agents have failed

22
Q

How is insulin normally prescribed in ketoacidosis and HONK?

A

Sliding scale regimen, or as per protocol

23
Q

What are the cautions/contraindications for insulin?

A
  • Hypoglycaemia

- Allergy to porcine or bovine insulins, or personal objections

24
Q

What is an alternative for people who are allergic to porcine/bovine insulins?

A

Human and analogue insulins

25
Q

When might dose adjustment of insulin be required?

A
  • Renal or hepatic impairment (requirements may decrease)

- Pregnancy and breastfeeding

26
Q

What should be done when patients who are pregnant or breastfeeding are on insulin?

A

It is advisable that the patient’s insulin doses are reviewed by an experienced diabetes physician

27
Q

What monitoring is required with insulin?

A

Monitor blood glucose and HbA1c as per local guidelines

28
Q

What might insulin interact with?

A
  • ACEi
  • Beta blockers
  • Corticosteroids
  • Alcohol
29
Q

What are the common side effects of insulin?

A
  • Hypoglycaemia
  • Lipoma at injection site
  • Local reactions at injection sites, e.g. transient oedema
30
Q

How is the development of a lipoma at injection site avoided?

A

Rotation of injection sites

31
Q

What patient counselling is required with insulin?

A
  • Compliance
  • How to take insulin
  • Lifestyle measures
  • Insulin devices
  • Provide verbal and written advice to patient regarding insulin use, hypoglycaemia, and sick day rules
  • Driving advice
32
Q

What should the patient be told regarding how to take insulin?

A

Explain how to inject insulin safely and to dispose of sharps. Should be injected into SC tissue in arms, thighs, abdomen, and buttocks, and injection site should be rotated

33
Q

What should the patient be told regarding insulin device?

A

Never extract insulin from pen device, as can lead to fatal overdose

34
Q

What driving advice should a patient on insulin be given?

A

Patients taking insulin or anti-diabetic drugs must inform the DVLA and their insurers about their diabetes. HGV drivers and drivers of public service vehicles must inform DVLA of diabetes, even if diet-controlled

35
Q

What should patients be told about managing illness while on insulin therapy?

A
  • Stay well hydrated
  • Make contact with diabetes team as soon as possible
  • Don’t stop taking insulin or other medications even if eating less than normal (apart from SGLT2 inhibitors)
  • Test blood sugar at least every 4 hours in illness
  • If blood sugar is 15mmol/L or more, check urine for ketones. If ketones present, contact diabetes team
  • If appetite is reduced or feeling sick and struggling to keep food down, replace meals with snacks or drinks containing carbs
  • If vomiting and unable to keep fluids down, seek medical help immediately

3: Drugs for Clinical Medicine (79 decks)

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