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PR - ENDOCRINE > INSULIN REGIMENS > Flashcards

INSULIN REGIMENS Flashcards

1
Q

MOA of insulin

A
  • Secreted by b-cells
  • Increases glucose uptake by adipose tissue and muscle
  • Suppresses hepatic glucose release
  • Decreases blood glucose conc to prevent hyperglycaemia
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2
Q

How is insulin administered and why?

A
  • Administered via subcutaneous injection
  • Because insulin is inactivated by Gl enzymes
  • It should be Injected into a body area with plenty of subcutaneous fat (abdomen or inner thigh)
  • Abdomen has the fastest absorption rate
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3
Q

What can occur as a result of repeatedly injecting into the same small area?

A

LIPOHYPERTROPHY
- poor absorption of insulin = poor control
- ROTATE
- Signs of infection: swelling, bruising and lipohypertrophy

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4
Q

Types of insulin regimens

A

1.Basal-bolus insulin regimens
2.Biphasic regimen
3.Continuous subcutaneous insulin infusion (insulin pump)

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5
Q

T1DM - first line treatment

A

Basal bolus regime
- 3 bolus injections of rapid acting insulin for meals
- Once-twice daily background long acting insulin

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6
Q

What are the THREE categories of insulin preparation?

A
  1. Short-acting
    - Includes “Soluble-Insulin” and “Rapid-acting” insulin
  2. Intermediate-acting
  3. Long-acting
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7
Q

Basal

A

Long/ intermediate acting insulin
OD or BD
1. detemir BD
2. second line = glargine OD

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8
Q

List the different types of long-acting insulins?

A
  1. Insulin detemir
    - Levemir
  2. Insulin glargine
    - Abasaglar
    - Lantus
    - Toujeo
  3. Insulin degludec
    - Tresiba
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9
Q

How often are long-acting insulins administered?

A

OD
- Insulin glargine (e.g. Abasaglar, Lantus, toujeo)
- Insulin degludec (e.g. Tresiba)

OD/BD
- Insulin detemir (e.g. Levemir)

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10
Q

Long-acting insulin’s pharmacokinetics

A
  • Onset: 2-4 days to reach steady state
  • Duration: 36 hours
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11
Q

Long-acting vs
Intermediate acting

A
  • Both provide basal insulin
  • But long-acting has a longer duration of action then intermediate (up to 36 hours)
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12
Q

Intermediate acting insulin’s
pharmacokinetics

A
  • Onset: 1-2 hours
  • Peak affect of 3-12 hours
  • Duration: 11-24 hours
    Given in conjunction with short acting, can be mixed or pre-mixed (biphasic)
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13
Q

Which Insulin is
intermediate-acting?

A
  • Isophane insulin
  • It is a suspension of insulin with protamine
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14
Q

What are the brands for Isophane insulin?

A
  • Humulin I
  • Insulatard
  • Insuman
    I for Intermediate-acting!
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15
Q

Which insulins mimic endogenous basal insulin sectretion?

A
  • Intermediate-acting
  • Long-acting
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16
Q

What are the types of short acting insulin?

A

Soluble (short-acting) insulin
Rapid-acting insulin

17
Q

Describe the time-profile of short-acting insulins?

A
  • They have a short duration of action
  • And a relatively rapid onset of action
  • it is used to replicate the insulin normally produced by the body in response to glucose absorbed from a meal
18
Q

Short-acting: Soluble insulin’s
pharmacokinetics

A

Inject: 15-30 mins before meals
Onset: 30-60 mins
Peak action: 1-4 hours
Duration: up to 9 hours

If injected IV, then it has short t1/2 and onset of action instantaneous

19
Q

When is IV soluble insulin mainly used?

A
  • In diabetic emergencies e.g.
    DKA
  • It is the most appropriate insulin to use in DKA
20
Q

Give examples of Soluble insulin brands?

A
  1. Human Actrapid
  2. Humulin S
  3. Insuman Rapid
  4. Insuman Infusat
  5. Hypurin Bovine/Porcine neutral (Animal)
21
Q

Short-acting: Rapid-acting insulin’s pharmacokinetics

A

Inject: immediately before meal
Onset: < 15 mins
Duration: 2-5 hours

Lower risk of hypo than soluble (short acting)
Alternative to soluble in emergency

22
Q

What are the different types of rapid acting-insulin? Give examples of brands

A
  • Lispro (Humalog Kwikpen)
  • Aspart (NovoRapid, Fiasp)
  • Glulisine (Apidra)

LAG = doesn’t LAG

23
Q

Rapid-acting vs soluble insulin

A

Rapid:
- faster onset
- improved glucose control, reduction of HbA1c, and hypos

Soluble:
- longer duration

24
Q

When should short-acting insulin be administered?

A
  • Before meals!
  • When given during or after meals, it is associated with poorer glucose control so therefore should be avoided
25
Q

Which insulins mimic the endogenous bolus insulin secretions (meal-time insulin)?

A

Short-acting:
- Soluble insulin
- Rapid-acting analogous

26
Q

Which short-acting insulin is NOT found pre-mixed with
isophane insulin as a biphasic preparation?

A
  • Insulin Glulisine (e.g. Apidra)
27
Q

Which insulins mimic the endogenous bolus insulin secretions (meal-time insulin)?

A

Short-acting:
- Soluble insulin
- Rapid-acting analogous

28
Q

What formulations are available for insulin preparations?

A
  • Pre-filled pens (throw away whole pen when finished)
  • Cartridges (to put in a pen which you always have but change cartridge when they finish)
  • Vial (where you get a syringe and draw it out of a vial)
29
Q

Why should some insulins never be given IV

A

Particulate matter in suspension may lodge in the capillary beds of the lungs and the brain, leading to thrombus development

30
Q

Biphasic insulin

A
  • 1, 2 or 3 insulin injections per day of short acting MIXED with intermediate acting insulin
  • Preps may be mixed by pt or pre-mixed
  • More convenient
  • Less control as proportions are fixed
31
Q

Acutely ill patients on biphasic insulins

A
  • Can’t use these biphasic mixtures to boost their insulin levels
  • Should ideally have short or rapid-acting insulins to use to manage their insulin requirement whilst being ill.
32
Q

Which insulins are found pre-mixed with Isophane insulin as biphasic preparation?

A
  1. Insulin aspart
    - NovoMix 30
  2. Insulin Lispro
    - Humalog Mix25
    - Humalog Mix50
  3. Soluble insulin
    - Humulin M3
    - Insuman Comb 15
33
Q

Continuous subcutaneous insulin infusion (insulin pump)

A

Regular or continuous amount of insulin (usually rapid acting insulin analogue or soluble insulin) delivered by a programmed pump and insulin storage reservoir via SC needle or cannula

34
Q

When would you give continuous subcutaneous insulin infusion (insulin pump)

A
  • Disabling hypoglycaemia
  • Glycaemic control >8.5% despite optimised MIR
  • Children over 12 (MIR is impractical) BUT they must undergo MIR trial between 12-18
35
Q

What factors require pt to decrease insulin administration?

A
  • Physical activity
  • Reduced food intake
  • Impaired renal function
  • Certain endocrine disorders (thyroid, coeliac, Addison’s)
  • Immediately after birth
36
Q

When do insulin requirements increase?

A
  • Infections or intercurrent illness
  • Stress
  • accidental surgical trauma
  • Puberty
  • Pregnancy - 2nd/3rd trimester

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PR - ENDOCRINE (25 decks)

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