Insulin Therapy Flashcards
what type of hormone is insulin? b/c it is this type of hormone it has the capacity to affect what?
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
what usu stimulates endogenous insulin production?
a rise in serum glucose levels
precursor to insulin? where does it come from?
pre-proinsulin to proinsulin - a protein hormone produced in the beta cells of the pancreas
definition of metabolic syndrome?
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
MOA of insulin?
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
what happens in the absence of insulin in regards to glycogen?
in the absence of insulin, glycogen synthesis in the liver ceases and enzymes responsible for breakdown of glycogen become active
ways to stimulate breakdown of glycogen?
absence of insulin or presence of glucagon which is secreted when blood glucose levels fall below normal level
insulins effects on adipose tissue?
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
insulin replacement is required in what population?
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
first inhaled diabetes medication?
exubera
4 major categories insulin therapies are divided into?
rapid acting
short acting
intermediate
long acting
how was human insulin produced so as to be used a as a tx for DM?
recombinant DNA technology
1 IU of insulin’s effect on blood glucose?
1 IU is the amount required to reduce the blood glucose concentration in a fasting rabbit to 45 mg/dL
typical, initial dosing requirement of insulin?
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)
common insulin dual dosing regiment?
NPH and Regular insulin administered before breakfast and before dinner
insulin now available for immediate dosing 15 mins before each meal?
lispro
what 2 insulins allow for coverage during sleep?
UltraLente and Lantus
what factors can affect the absorption of insulin from an injection site?
blood flow of the area as well as fibrosis in sites that may be frequently used
SEs of insulin use?
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
