Insulin Therapy

Question 1

what type of hormone is insulin? b/c it is this type of hormone it has the capacity to affect what?

Answer 1

anabolic hormone
reduces degradation of glycogen, lipids and proteins
also has several mitogenic fxns including initiation of DNA synthesis in certain cells and stimulation of their growth and differentation

Question 2

what usu stimulates endogenous insulin production?

Answer 2

a rise in serum glucose levels

Question 3

precursor to insulin? where does it come from?

Answer 3

pre-proinsulin to proinsulin - a protein hormone produced in the beta cells of the pancreas

Question 4

definition of metabolic syndrome?

Answer 4

abd obesity defined as waist circumference 40 inches or greater in males and 35 inches or greater in females
hypertension of 130/85 or greater
serum glucose of 110 or greater
serum TGs of 150 or greater
serum HDL of 40 or less in males or 50 or less in females

Question 5

MOA of insulin?

Answer 5

lowers blood sugar level by facilitating transport of glucose from bloodstream into cells of tissues that would otherwise be impermeable to glucose
promote glycogen synthesis and FA synthesis in the liver and peripheral tissues and inhibits glycogenolysis, ketogenesis and gluconeogenesis

Question 6

what happens in the absence of insulin in regards to glycogen?

Answer 6

in the absence of insulin, glycogen synthesis in the liver ceases and enzymes responsible for breakdown of glycogen become active

Question 7

ways to stimulate breakdown of glycogen?

Answer 7

absence of insulin or presence of glucagon which is secreted when blood glucose levels fall below normal level

Question 8

insulins effects on adipose tissue?

Answer 8

inhibits its breakdown by inhibiting intracellular lipase w/in adipocytes
insulin promotes TG storage
glucose in adipocytes is used to synthesize glycerol which is used to make TGs

Question 9

insulin replacement is required in what population?

Answer 9

type 1 DM pts
can be given IM, SQ, IV (including in a pump) and a new nasal delivery form
may become required in type 2 DM pts when diet, exercise or oral meds have failed to control blood glucose or reduce HgbA1c

Question 10

first inhaled diabetes medication?

Answer 10

exubera

Question 11

4 major categories insulin therapies are divided into?

Answer 11

rapid acting
short acting
intermediate
long acting

Question 12

how was human insulin produced so as to be used a as a tx for DM?

Answer 12

recombinant DNA technology

Question 13

1 IU of insulin’s effect on blood glucose?

Answer 13

1 IU is the amount required to reduce the blood glucose concentration in a fasting rabbit to 45 mg/dL

Question 14

typical, initial dosing requirement of insulin?

Answer 14

0.4-0.6 IU of regular insulin per kg per day in divided doses (so as to approximate the normal postprandial insulin peaks and basal insulin release)

Question 15

common insulin dual dosing regiment?

Answer 15

NPH and Regular insulin administered before breakfast and before dinner

Question 16

insulin now available for immediate dosing 15 mins before each meal?

Answer 16

lispro

Question 17

what 2 insulins allow for coverage during sleep?

Answer 17

UltraLente and Lantus

Question 18

what factors can affect the absorption of insulin from an injection site?

Answer 18

blood flow of the area as well as fibrosis in sites that may be frequently used

Question 19

SEs of insulin use?

Answer 19

SEs: wt gain; hypoglycemia (can lead to seizures, coma, death), hypokalemia, injection sites may become fibrotic, injection sites may also exhibit muscle or fat atrophy