Insulin Anti-Diabetics Flashcards
Which type of diabetes is more common? How many of these patients are on insulin?
90% pts have type II
20% on insulin to reach goals, most don’t need it
How do you differentiate between type I and type II diabetes?
Type II does not have ketoacidosis
What percent of beta cells in pancrea must be destroyed to seem symptoms in diabetes?
80-90%
How do the levels of insulin released vary between glucose given orally and glucose given iv? Why?
More insulin released when given orally due to the effect of incretins
What are the three stimuli that lead to the release of insulin? Which is most important?
Glucose (most important)
Amino acids
Incretins
Describe the mechanism of how glucose in the blood leads to insulin release
Glucose enters beta cells in pancreas via GLUT-2 receptors and undergoes glycolysis and TCA producing ATP. Intercellular ATP closes ATP-dependent K+ channels, less K+ leaves cell and cell depolarizes. This leads to opening of Ca+2 channels and calcium entry triggers exocytosis of preformed insulin.
Describe the shape of the insulin receptor. What type of receptor is this? Discuss subunits
Tyrosine kinase receptor
Composed of two heterodimers, each with an alpha and beta subunit. Beta subunits span membrane and have the tyrosine kinase activity. Alpha subunits contain recognition site for insulin
Name 5 cellular processes insulin up regulates and one it downregulates
Upregulates: glu entry into muscle and fat via GLUT4, glycogen syn in muscle and liver, FA syn and TAG storage in adipose, glycolysis, amino acid uptake/protein syn in muscle
Downregs: gluconeogenesis
Name the three rapid acting insulins. Why are they rapid acting?
Insulin lispro, aspart, and glulisine
Don’t form hexamers
When is rapid acting insulin given? How is it delivered?
Given 15 min before a meal with a longer acting insulin
SC or IV
Which insulin can be given IV in emergency ketoacidosis?
Regular insulin - short acting (soluble crystalline zinc insulin)
Name the only short acting insulin. When should it be given? How is it delivered?
Regular insulin (soluble crystalline zinc insulin) 30 min before a meal SC or in emergency ketoacidosis IV
Which insulin can never be given IV? Why?
NPH - neutral protamine hagedorn
It’s a suspension of regular insulin and protamine, not a solution!
When choosing an insulin for a pt, you notice one type is cloudy. What is it and when is it used?
NPH - neutral protamine hagedorn (regular insulin + protamine)
Give with rapid or short acting for mealtime control
Name the two long acting insulins
Insulin glargine and insulin detemir
Which insulin is soluble in acidic solution but precipitates in neutral pH after SC injection forming a reservoir?
Insulin glargine
Which long acting insulin cannot be combined in the same prep with shorter acting insulins? Why?
Insulin glargine
Must be prepped and stored in acidic pH and shorter acting insulins are in neutral pH
Which insulin has a highly unpredictable rate of absorption?
NPH - neutral protamine hagedorn
Which insulin has a peakless absorption profile and can be given once daily?
Insulin glargine
Which insulin has the threonine removed from B30 position and myristate attached to terminal B29 lysine?
Insulin detemir
Which insulin has peakless absorption but must be given twice a day?
Insulin detemir
What is the only insulin prep that does NOT have zinc?
Insulin glulisine
What delivery method of insulin is the most precise way to mimic normal insulin secretion?
Insulin pump
How does the risk of hypoglycemia compare between rapid acting insulins and regular insulin?
Risk is LESS with rapid acting (higher risk of hypoglycemia with regular insulin)
Three treatments for insulin induced hypoglycemia
Give sugar (oj or candy) IV glucose (unconscious) Inject glucagon
What was a severe side effect of using animal insulin?
Immediate type hypersensitivity - systemic urticaria due to histamine release from mast cells sensitized by anti-insulin IgE
Name three important drugs that can interact with insulin therapy and cause HYPOglycemia
Ethanol - inhibits gluconeogenesis
Beta-blockers - block effects of catecholamines and mask symptoms
Salicylates - potentiate insulin secretion
Name four types of drugs that can interact with insulin therapy and cause HYPERglycemia through direct effects on peripheral tissues that counteract insulin
Epi
Glucocorticoids
Atypical antipsychotics (clozapine and olanzapine)
HIV protease inhibitor
Name 4 drugs that can interfere with insulin therapy and cause HYPERglycemia by inhibiting insulin secretion
Phenytoin
Clonidine
Ca channel blockers
Diuretics (K+ depletion)
How should insulin therapy change in acute illness?
Stop oral agents and give regular insulin
Drug of choice to treat diabetes in pregnancy?
Regular insulin
