Insulin Therapy

Question 1

Where is proinsulin normally stored?

Answer 1

Gogli apparatus of Beta cell

Question 2

Products of proteolytic cleavage of proinsulin

Answer 2

C-peptide + insulin

Question 3

Regulation of Insulin: Stimulatory (3)

Answer 3

Nutrient load: glucose>fat/protein
Autonomic nervous system: vagal stimulation and cephalic phase
Hormonal: incretins (GLP-1, GIP)

Question 4

Regulation of Insulin: Inhibitory (3)

Answer 4

Starvation
Hypoglycemia
Hormonal: glucagon, epinephrine, GH, cortisol

Question 5

Insulin Metabolism: Endogenous

___% Hepatic and ____% Renal

Answer 5

60% immediate hepatic via first pass effect

40% degradation in kidneys

Question 6

Insulin Metabolism: Exogenous

Answer 6

Subcutaenous tissue–>bloodstream–> renal (60%)–>liver (40%)

Question 7

Indications for Inuslin (2)

Answer 7

T1DM

Inadequately controlled T2DM

Question 8

Indications for Temporary use of insulin (5)

Answer 8

Hospitalization/surgery
Pregnancy
Renal disease
Initial glycemic control for T2DM
To overcome glucose toxicity and re-regulate decompensated patients

Question 9

Bolus Insulin: Purpose

Answer 9

Coverage of food intake or correction of hyperglycemia

Question 10

Types of Bolus Insulin

Answer 10

Short Acting: regular

Rapid Acting: aspart, lispro, glulisine

Question 11

Pharamcodynamics: Regular insulin vs. short-acting

Answer 11

Onset: 30-60min vs. 5-15min
Peak: 2-4hr vs. 1-2hr
Duration: 6-10hr vs. 4-6hr

Question 12

Short-Acting insulin structures

Answer 12

Umm

Question 13

Rapid Analogues vs. Regular: Similarities (4)

Answer 13

Glucose lower effects
Affinity of insulin receptor
Induction of receptor mediated cellular signals
Bioavailability

Question 14

Rapid Analogues vs. Regular: Differences (4)

Answer 14

Faster absorption
Higher peak concentration
Faster onset of action
Shorter duration of action

Question 15

Basal insulin: Purpose

Answer 15

Maintain euglycemia in fasting state

Question 16

Types of Basal Insulin

Answer 16

Intermediate: NPH

Long acting: Glargine, detemir

Question 17

NPH: Structure and Duration

Answer 17

Suspension of Zn-insulin with positively charged protamine

Intermediate duration of action (10-20hr)–>Must be admin 2x daily

Question 18

NPH: Pros/Cons

Answer 18

Pros: can be combined with other insulins
Cons: peak in action increases risk of hypoglycemia

Question 19

Glargine Physical Characteristics: structure/pH

Answer 19

Substitution of glycine on A and addition of two arginines on B

pH=4
Flat peak

Question 20

Deter Physical Characteristics

Answer 20

Acylation
Neural pH
Flat peak

Question 21

Insulin Administration Types:

Answer 21

IV, SubQ, inhaled

Question 22

When do you use IV insulin?

Answer 22

Hospitalized patients or metabolic crisis (due to rapid onset/decay)

Question 23

Conventional Insulin Administration

Answer 23

Long/intermediate acting only

Twice daily mixed split: 70/30 intermediate-rapid

Question 24

Issues with Twice-Daily Split-Mixed Regimen

Answer 24

Still have periods of hyperglycemia between doses

Question 25

Intensive Basal/Bolus Therapy

Answer 25

Injections of rapid-acting insulin before each meal + long acting insulin once daily

Question 26

Inhaled Insulin Administration

Answer 26

Rapid acting insulin in increments for mealtime coverage

Question 27

Advantages of Insulin Pump (4)

Answer 27

Uses only regular/rapid insulin
1 Injection site
Eliminates subcutaenous insulin depot
Simulates normal pancreatic function

Question 28

Exercise & Pump

Answer 28

Must educate people about lowering insulin dose before exercise (since it induces GLUT4)

Question 29

Insulin Complications (4)

Answer 29

Hypoglycemia (at time of peak insulin)
Insulin Lipodystrophies: lipoatrophy or lipohypertrophy at injection site
Allergy: local or systemic
Insulin resistance

Question 30

Hypoglycemia: Prevention (3), Treatment (2)

Answer 30

Prevention: awareness, plan for treatment, plan for prevention

Treatment: glucose tablets, glucagon