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Product Modules > Insulin Therapy > Flashcards

Insulin Therapy Flashcards

1
Q

Does human insulin for medical use have the same amino acid sequence as endogenous human insulin?

A

Yes

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2
Q

What technique is used to produce human insulin and insulin analogs?

A

recombinant DNA technology genetically alters bacteria or yeast

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3
Q

Describe the broad steps to create human insulin and analog insulin through rDNA technology.

A
  • DNA is inserted into host cell
  • host cell is placed in conditions favorable for growth and division
  • proinsulin is released by host cell (yeast) or is formed and retained inside host cell (bacteria)
  • proinsulin is removed and purified
  • c-peptide is enzymatically removed
  • further purified and commercially prepared
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4
Q

What part per million is proinsulin considered pure? What ppm is rDNA made insulin?

A
  • <10 ppm
  • <1 ppm
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5
Q

The presence of _____ helps insulin readily crystallize.

A

zinc

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6
Q

What is one of the biggest factors that influences the absorption of insulin?

A

its tendency to self-associate and form hexamers

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7
Q

True or False: IV injected regular human insulin has a more rapid onset, peak, and duration when compared to SC injected regular human insulin.

A

True, because it is already in the bloodstream it more closely resembles endogenous insulin. Its hexamers also do not have to break apart to get absorbed when already in the bloodstream.

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8
Q

What is the time action profile of regular human insulin (onset, peak, duration)?

A
  • Onset: 30 minutes
  • Peak: 80-120 minutes
  • Duration: up to 8 hours
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9
Q

When should regular human insulin be dosed?

A

30 minutes before meals subcutaneously

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10
Q

What is the primary disadvantage to using regular human insulin?

A

its nonphysiologic time action profile makes it difficult to match its peak to the blood glucose peak after a meal.

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11
Q

What is added to regular insulin to make NPH?

A

protamine

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12
Q

What is the time action profile of NPH (onset, peak, duration)?

A
  • Onset: 1.6 hours
  • Peak: 4-12 hours
  • Duration: up to 24 hours after SC injection
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13
Q

What is a major risk/disadvantage to using NPH?

A

the risk of hypoglycemia - especially nocturnal - due to its pronounced peak

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14
Q

Describe the time action profile of Novolog. When should it be dosed?

A
  • Onset: 10-20 minutes
  • Peak: 40-50 minutes
  • Duration: 3-5 hours
  • 5-10 minutes before the start of meal
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15
Q

What is the time action profile of Humalog? When should it be dosed?

A
  • Onset: 15-30 minutes
  • Peak: 30-90 minutes
  • Duration: 3-6 hours
  • within 15 minutes before or immediately after starting meal
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16
Q

Describe the time action profile of Apidra and when it should be dosed.

A
  • Onset: 25 minutes
  • Peak: 100 minutes
  • Duration: 4-5 hours
  • within 15 minutes before a meal, or within 20 minutes after starting a meal
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17
Q

What amino acid substitutions give Novolog its unique characteristics?

A

Aspartic acid replaces proline at position 28 of the B chain

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18
Q

What populations is Novolog indicated for?

A
  • Type 1 and Type 2 adults
  • Type 1 children 2 years and older
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19
Q

What year was Novolog launched?

20
Q

What amino acid changes are made in Humalog?

A

Proline and Lysine have been reversed at positions 28 and 29 on the B chain

21
Q

What age children can use Humalog?

A

3 years and older

22
Q

What amino acid change has been made with Apidra?

A
  • Lysine replaced asparagine at B3
  • Glutamic acid replaced lysine at B29
23
Q

What pediatric patients are approved to use Apidra?

A

Type 1 patients 4 years or older

24
Q

What is an advantage of rapid-acting insulin analogs over regular human insulin?

A
  • significantly fewer episodes of severe hypoglycemia, probably due to its predictable time action profile
25
Q

What amino acid changes are made to produce Levemir?

A
  • Threonine has been omitted at B30
  • C-14 fatty acid chain (myristic acid) has been added at B29
26
Q

What is the recommended starting dose of Levemir in patients with type 2 diabetes?

A

10 units (or 0.1-0.2 units/kg) given once daily in the evening or divided into a twice-daily regimen

27
Q

True or False: some patients may require a higher dose of Levemir than NPH.

28
Q

What amino acid change is made to produce Lantus?

A
  • Glycine replaces asparagine at A21
  • 2 arginines are added to the C-terminus of the B chain
29
Q

Is Lantus more acidic or more basic than most insulin preparations? How does this impact its absorption?

A
  • Acidic
  • When more acidic Lantus is injected in the neutral pH of SC tissue fluid, it forms microprecipitates, which slows absorption
30
Q

What is the recommendd starting dose of Lantus?

A

10 units (or 0.2 units/kg)

31
Q

How does one convert from NPH twice daily dosing to Lantus dosing?

A

dose of Lantus is reduced by 20% of the total daily dose

32
Q

True or False: Insulin analog mixes must be resuspended before injection.

33
Q

Describe the Garber 1-2-3 study.

A
  • Purpose: to see if poorly controlled type 2 patients could reach 6.5% or 7% when treated with NovoLog Mix 70/30 once daily, twice daily, or three times daily
  • Results: more intensive mix therapy led to greater percentage of patients achieving A1c goals
34
Q

Is insulin analog mixes associated with less nocturnal hypoglycemia than NPH/regular human insulin?

A

Yes, insulin analog mixes provide similar glycemic control, improved postprandial glucose control, along with less nocturnal hypoglycemia.

35
Q

According to the Heller study, what is an advantage of using an analog insulin with NPH over regular human insulin?

A
  • significant reduction in major nocturnal hypoglycemia (over 70%)
  • better PPG levels after breakfast and dinner
36
Q

Adults and children with type 1 diabetes need between ____ and ____ of insulin per day.

A

0.5, 1 units/kg

37
Q

In an intensive insulin regimen, what percentage of the total daily dose (TDD) of insulin can be provided by Novolog?

A

50-70%, with the remainder provided by the basal insulin

38
Q

What percentage of insulin-treated patients experience nocturnal hypoglycemia?

A

approximately 50%

39
Q

Describe the Dawn phenomenon.

A
  • is an increase in morning blood glucose due to natural insulin resistance and hepatic glucose production during the night
  • usually means the night time insulin dose is too low
40
Q

Describe the Somogyi effect.

A
  • morning high blood glucose due to a rebounding effect from night time hypoglycemia
  • is often the result of too much evening insulin
  • night time hypoglycemia leads to glucose secretion in the liver
41
Q

How can patients distinguish between the Dawn phenomenon and the Somogyi effect?

A
  • measure blood glucose at 3am
  • If low at 3AM, the evening insulin dose was too high (Somogyi)
  • If high at 3AM, the evening insulin dose was too low (Dawn)
42
Q

Does illness generally increase or decrease insulin resistance?

A

increases - so most patients need higher doses of insulin during period of illness.

43
Q

Which insulin formulations should appear clear?

A
  • Regular human insulin
  • Rapid- and Long-acting insulin analogs

because they are in solution

44
Q

Which insulin formulations should appear cloudy?

A
  • NPH
  • human insulin premix
  • analog insulin premixes

because they are in suspensions

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