Insulin in Diabetes Tx

Question 1

What is the only way to treat T1DM?

Answer 1

the only way to treat type I DM is by use of insulin analogs

Question 2

What are the 6 types of insulin that can be given to patients with DM?

Answer 2

Recombinant Human Insulin: recombinant human insulin, insulin: lispro, aspart, glargine, determir, glulisine, deguldec.

Question 3

What how does size of the insulin crystal correspond to duration of action?

Answer 3

General: 3 general preparations: short, intermediate, and long acting with the length of action being proportional to crystal size.

Question 4

Rank the following insulin types on their duration of action:
• comment on the steadiness of release

Aspart, determir, deguldec, utralente, regular, NPH, Glargine, Lispro, glulisine

Answer 4

**Duration of Action – this also corresponds with steadiness of release

Glargine (determir)/Degludec > Ultralente > NPH > Regular > Aspart, Lispro (glulisine)**

Question 5

What is regular insulin?
• how is it denoted?
• what do we use it for?

Answer 5

Regular insulin = any insulin with an “R” beside the name.

• soluble at room temperature and has a neutral pH and is the only type of insulin that can be injected IV. This type is soluble, clear, and very short acting. The rest is SC or IM.

Question 6

What crystal characteristics define Lente insulin?
• purpose of this?

Answer 6

Lente insulin has an extended release because it is a mixture of small and large crystals.

Question 7

What is NPH insulin?
• how is it denote?
• Purpose?

Answer 7

NPH insulin = any insulin with an “N” beside the name.

These are treated with protamine to increase crystal size and half-life

Question 8

When should you measure blood glucose if taking Regular insulin?
• what about lente insulin?

Answer 8

If you take regular insulin you should measure blood sugar before lunch and before bedtime to determine if breakfast and dinner insulin doses are adequate.

If you take NPH/Lente insulin then you should measure glucose at _dinner and before breakfas_t to determine if insulin doses are adequate. Type I Diabetics, especially children benefit the most from insulin pumps.

Question 9

What are some possible adverse effects of insulin therapy?

Answer 9

ADVERSE: Hypoglycemia, lipodystrophy, and sometimes hypersensitivity reactions happen

Question 10

What are the 3 types of monomer insulin?
Specs/ Duration of Action

Answer 10

Monomer insulin:

Insulin Lispro

Insulin Aspart

Insulin Glulisine

SPECS:
only monomers can bind to the insulin receptor. This means lispro, aspart, and glulisine has a faster onset, but shorter duration of action than Regular insulin.

Question 11

What insulins have a altered isoelectric point?
• what is the point of this modification?
• Administration?
• Advantages

Answer 11

Insulin Glargine/Determir – these have changes to the amino acid sequence that cause them to be acidic in solution and neutralized when injected leading to crystal precipitation that increases the half-life of insulin allowing for 1 a day injections and decreases the chances of nocturnal hypoglycemia.

Glargine/Determir have a stable release that doesn’t peak similar to degludec, but they are slightly shorter acting.

Question 12

What insulin other than Glargine and Determir is released steadily?
• how does the MOA of this insulin differ?
• Administration?

Answer 12

Degludec Insulin:
Insulin Degludec – altered sequence and conjugation to hexadecanedioic acid leads to hexamer formation after its injected subcutaneously. Degludec is SAFE to mix with other insulins.
Deguldec has a steady release (no peaks) that lasts for 25+ hours (similar to glargine and determir but longer acting)

Question 13

What insulin is safe to mix with other insulins?

Answer 13

Degludec Insulin:
Insulin Degludec – altered sequence and conjugation to hexadecanedioic acid leads to hexamer formation after its injected subcutaneously. Degludec is SAFE to mix with other insulins.

Deguldec has a steady release (no peaks) that lasts for 25+ hours (similar to glargine and determir but longer acting)

Question 14

What types of insulin rely on crystalization to increase duration of action?
• what is the underlying prinicple that makes crystal formation useful?

Answer 14

Modified Crystal Insulins: NPH insulin, Lente insulin
**Crystals are slow to reabsorb and lead to Depot formaiton of the drug***

Question 15

Compare NPH and ultralente insulins?

Answer 15

NPH insulin – treated with positive protamine to increase crystal size. These have a prolonged release, but are less steady than (have a higher peak concentration) with a shorter duration of action than ultralente insulin. Crystalization allows for Depot formation.

Ultralente Insulin – mixture of crystal sizes to prolong duration of action. These are long acting (up to 24 hr), but do not have the same steady release as glargine and degludec

Question 16

A patient is disoriented, tachycardic, and breathing hard. You know they have T1DM. No drugs are avaiable, so what should you do?

Answer 16

IMPORTANT: If you can’t tell if a patient is in ketoacidosis or entering a hypoglycemic coma give them glucose, it won’t hurt them in acidosis but it will help them if hypoglycemic.

Question 17

Type I DM patients have glucagon that they can use in case of hypoglycemia

Answer 17

Type I DM patients have glucagon that they can use in case of hypoglycemia

Question 18

Insulin Lispro
Duration of Action/Specs

Answer 18

Insulin Lispro – has a proline and lysine that are switched in sequence to prevent the typical hexamer formation of insulin. This is useful because only monomers can bind to the insulin receptor. This means lispro has a faster onset, but shorter duration of action than Regular insulin.

Question 19

Insulin Aspart
Duration of Action/Specs

Answer 19

Insulin Aspart – Aspartate is substituted for proline to prevent hexamer formation. This is useful because only monomers can bind to the insulin receptor. This means aspart has a faster onset, but shorter duration of action than Regular insulin.

Question 20

Insulin Glulisine
Duration of Action/Specs

Answer 20

Insulin Glulisine – amino acid substitutions with lysine and glutamate that prevent hexamer formation. This is useful because only monomers can bind to the insulin receptor. This means glulisine has a faster onset, but shorter duration of action than Regular insulin.