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DEMS Unit 2 > Insulin therapy for Type 1 and 2 DM > Flashcards

Insulin therapy for Type 1 and 2 DM Flashcards

1
Q

How much insulin is secreted in pancreas/day?

A

30 units from the beta cells

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2
Q

What closes the ATP-sensitive K+ channel?

A

Increased ATP/ADP ratio

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3
Q

When did recombinant human insulin become available for general use? When were analogs introduced?

A

1982 and 1996

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4
Q

Who needs insulin therapy?

A
  1. Anyone with Type 1 DM

2. Some patients with Type 2 DM - those who can’t achieve glucose control

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5
Q

How many units of insulin within each 10mL vial?

A

1000 units; with pens don’t need to store in fridge

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6
Q

How are the A and B chains connected? and where do the insulin analogs act?

A

A and B are attached by disulfide bonds.

  1. Lispro - proline and lysine reversed
  2. Lysine at B3 and glutamate at B29 substituted
  3. Aspartae substitued instead of Proline
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7
Q

Activity of rapid-acting insulins

A
  • onset 5-15 mins
  • peak 1-1.5 hrs
  • duration 3-5 hrs

can do as injection or insulin pump that you can bolus right before meals; dissociates into monomers after injection

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8
Q

Inhaled insulin

A

Afrezza - came out last year

  • very very quick 5 min onset
  • done by 2 hrs
  • set-dose cartridges for inhalation device (risk of under or over dosing because just available in 4 unit increments)
  • administered just prior to meal
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9
Q

Short-actin insulin

A

Regular human insulin

  • Onset: 30-60 min
  • peak: 2 hr
  • duration: 6-8 hr
  • inject 30 mins before food
  • knowing when to inject was hard because who knows when food is early
  • risk for stacking and hypoclycemia
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10
Q

Intermediate-acting

A

NPH

  • onset 1-3 hrs
  • peak 6-8 hr
  • duration 12-16 hr
  • injection only (BID for basal coverage - issue for ppl who play sports etc. because it won’t be enough)
  • CLOUDY solution
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11
Q

Long-actin

A

About 24 hrs

  • onset 1-1.5 hrs
  • no pronounced peak
  • duration is 24 hrs (glargine) or 12-20 hrs (detemir)
  • SQ injection only
  • CANNOT be mixed in same syringe with any other insulins… this is frustrating for people
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12
Q

Premixed insuins

A

Biphasic, usually 70/30 of NPH/regular

  • Used twice a day before AM and PM meals
  • Not a lot of control, you better have a set schedule
  • SQ injection only
  • Mixture of intermediate and short or rapid acting (rapid start working faster)
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13
Q

Caveats to insulin pharmacokinetics

A
  1. Volume
  2. Concentration (U500 - 5x more concentrated)
  3. Body site of injection - how much body fat
  4. How much fat… presence of lipodystrophy (scarring at injection site)
  5. Intradermal vs. subcutaneous vs. intramuscular
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14
Q

Explain bolus therapy

A
  1. Use long-acting

2. Bolus with rapid or short so that you can adjust for carb content in meals

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15
Q

Correction-dose insulin

A
  1. Insulin taken to correct pre-meal hyperglycemia
    - often added to meal/prandial dose
    - can be taken between meals alone
    - CAUTION: do not stack corrections
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16
Q

Pros and cons of insulin pump therapy

A

Pros:

  • eliminates multiple injections
  • different basal rate settings (great for week vs. weekend)
  • Small increment boluses possible
  • Different bolus types (square vs. dual wave)

Cons:

  • Upfront cost
  • Significant training
  • Motivation
  • Ability to troubleshoot
  • Interruption of infusion or “bad site” can lead to DKA within hours
17
Q

What affects patient regimen?

A
  1. Age
  2. Duration of diabetes
  3. Complications? Retinopathy?
  4. Motivation
  5. Self-management skills
  6. Daily schedule - skipped meals? activity?
18
Q

Insulin with T2DM

A

ALWAYS IF:

  • Insulin deficiency on presentation (weight loss, fasting >250, random >300, A1c >10)
  • Hospital admission for diabetic emergency
19
Q

How to start insulin in T2DM

A

Most flexibility = most complicated, most injections
Regimented = least injections, better have a good set schedule

  1. Start with NPH glarginine/detemir 10 units and check A1c in 3 months…
  2. If not at target, add more dosage or rapid-acting injections
  3. If too low, reduce dose
20
Q

Odd inpatient hyperglycemia risks

A
  1. Glucocorticoid meds
  2. Enteral or parenteral nutrition therapy
  3. Renal disease
  4. CF related diabetes

DEMS Unit 2 (19 decks)

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