Insulin Analogues and Anti-Obesity Agents

Question 1

What are the five main insulin categories?

Answer 1

Short acting
Rapid acting
Intermediate acting
Long acting 
Very long acting

Question 2

Give time scale of short acting insulin

• when it starts to work
• when to inject
• peak
• duration of action

Answer 2

Works in 30-60 minutes
Inject 15-30 minutes before eating
Peaks at 2-3 hours
Duration of 8-10 hours 
Injected several times a day to cover meals

Question 3

Give time scale of rapid acting insulin

• onset of action
• when to inject
• peak
• duration

Answer 3

Onset within 5-15 minutes
Inject just before eating
Peaks at 30-90 minutes
Duration of 4-6 hours

Question 4

Give timings of intermediate acting insulin

• onset
• peak
• duration
• when to inject

Answer 4

Onset of 2-4 hours
Peaks at 4-8 hours
Duration of 12-20 hours
Twice a day, before breakfast and dinner

Question 5

Give time scale of long and very long acting

• onset
• duration

Answer 5

Onset of 2-6 hours (slow)

Duration of up to 24 hours

Question 6

Give benefits of long and very long acting insulin

Answer 6

Keeps blood glucose at a more steady state
Reduced chance of nocturnal hypos
Less need for snacking between meals and before bed because there is less of a peak of insulin concentration

Question 7

Adverse effects of insulin?

Answer 7

Hypoglycaemia
Hyperglycaemia
Lipodystrophy from injecting in the same spot (hypertrophy or atrophy)
Painful injections due to acidic solutions
Insulin allergies due to preservatives

Question 8

What are the different types of insulin?

Answer 8

Porcine and bovine

Recombinant DNA technology

• human short-acting
• human rapid-acting
• isophane intermediate acting
• long-acting basal analogue insulins
• very long-acting basal analogue insulins

Question 9

What causes elevation of HbA1c?

Answer 9

Glucose non-enzymatically irreversibly glycosylates haemoglobin - rate is proportional to glucose

Question 10

What is the normal baseline HbA1c?

Answer 10

6%

Question 11

What damage can a HbA1c above 7% cause?

Answer 11

Damage of function to 
-renal
-hepatic
-CVS
-neurological 
Due to onset of microvascular disease

Question 12

Name the two main anti-obesity agents

Answer 12

Orlistat

Sibutramine

Question 13

How does orlistat work?

Answer 13

A gastric and pancreatic lipase inhibitor

-reduces dietary fat conversion to fatty acids and glycerol

Question 14

Major limitations of orlistat?

Answer 14

GI disturbance

-includes fatty stools increasing risk of flatus with unpleasant discharge or faecal incontinence

Question 15

How does sibutramine work?

Answer 15

Noradrenaline and serotonin re-uptake inhibitor

• suppresses appetite
• reduces hyperglycaemia
• reduces rate of glucose metabolism
• may increase thermogenesis

Question 16

ADRs of sertraline?

Answer 16

Increased heart rate

Increased blood pressure