Insulin used in diabetes

Question 1

insulin sources

Answer 1

recombinant human insulin could be produced in large quantities using cDNA found in E. Coli, humulin (Lilly), and in transformed yeast, novolin (Novo Nordisk)

Question 1

standard unit of insulin

Answer 1

100 units/mL

Question 2

how many units/mg of insulin?

Answer 2

28 units/mg

Question 3

unitage of humulin R

Answer 3

500 units/mL

Question 4

onset/duration of lispro (humalog)

Answer 4

15 minutes / 6-8 hours

Question 5

onset/duration of aspart (novolog)

Answer 5

15 minutes / 3-5 hours

Question 6

onset/duration of glulisine

Answer 6

15 minutes / 3 to 5 hours

Question 7

onset/duration of regular insulin (R)

Answer 7

30 minutes to 1 hour / 8 to 12 hours

Question 8

onset/duration of NPH insulin (N)

Answer 8

1 to 1.5 hours / 24 hours

Question 9

onset/duration of glargine (lantus)

Answer 9

1 to 1.5 hours / over 24 hours

Question 10

onset/duration of detemir (levemir)

Answer 10

1 to 2 hours / over 24 hours

Question 11

onset/duration of degludac (tresiba)

Answer 11

1 hour / over 24 hours

Question 12

mimicking natural insulin secretion pattern

Answer 12

modifies insulin to alter the availability and absorption from subcutaneous injection sites
delayed absorption - prolong onset and duration
increase absorption - decrease time to onset and duration

Question 13

purpose of modified insulins

Answer 13

provide flexibility/convenience in dosing
be able to mimic basal levels (2nd phase) and preprandial dose levels (1st phase)

Question 14

NPH (Neutral Protamine Hagedorn) insulin (N)

Answer 14

The insulin is complexed with protamine, tissue proteases have to break down protamine to be able to release the insulin, slows absorption time

Question 15

lispro insulin

Answer 15

reverse positions of P28 and K29 on insulin B chain. Interferes with the ability to form a dimer. Monomers are absorbed much more readily from the site of injection, fast absorption time.

Question 16

ultra fast onset/very short action insulin place in therapy

Answer 16

injected immediately before meals

Question 17

insulin aspart

Answer 17

proline 28 in B chain is switched to aspart
interferes with ability to dimerize
monomer is absorbed much quicker from site of injection, rapid onset

Question 18

insulin glulisine

Answer 18

Asn 3 and Lys 29 in B chain are switched to Lys and Glu
Interferes with ability to dimerize
Monomer is absorbed much quicker from site of injection, rapid onset

Question 19

insulin glargine

Answer 19

Ask 21 of a chain is changed to Gly and 2 Arg residues are added to the end of the B chain (30 and 31)
insulin solubility can change at different pH (Clear solution at pH=4, when introduced to physiological pH it precipitates). Slowly and steadily released from injection site over 24 hours

Question 20

basal insulins place in therapy

Answer 20

inject once daily

Question 21

insulin detemir

Answer 21

discontinued
the 30 of B chain is deleted and Lys 29 is myristylated
binds to serum albumin extensively

Question 22

insulin degludec

Answer 22

Thr 30 of B chain is replaced by y-Glu/C16 fatty acid. Binds to serum albumin extensively. insulin will hang out in blood stream for a long time, gradually little amounts will come off albumin and is absorbed very slowly

Question 23

multi-dose insulin regimens

Answer 23

fast onset, short acting is taken before meals and long, or intermediate acting is taken at bedtime or at bedtime and after breakfast

Question 24

Afrezza

Answer 24

regular human insulin in a dry powder that can be inhaled

Question 25

Afrezza onset/duration

Answer 25

rapid onset/shorter duration of action than SC injection

Question 26

Afrezza place in therapy

Answer 26

used as pre-prandial insulin

Question 27

Afrezza contraindications

Answer 27

patients with asthma and COPD, may reduce lung function (decreased FEV)

Question 28

Afrezza mechanism

Answer 28

molecules aggregate and for a large surface area for insulin to bind

Question 29

IV insulin place in therapy

Answer 29

regular human insulin for severe hypoglycemia or ketoacidosis

Question 30

mode of action of insulin

Answer 30

decreased liver glucose output
increase fat storage
increase glucose uptake

Question 31

adverse reaction to insulin

Answer 31

hypoglycemia
lipodystrophy
lipohypertrophy
lipoatrophy

Question 32

hypoglycemia

Answer 32

blood glucose <70 mg/dL; caused by too much insulin and/or not enough food (glucose)

Question 33

symptoms of hypoglycemia

Answer 33

weakness, sweating, hunger, tachycardia, increase irritability, tremor, blurred vision, seizures, coma, increased sympathetic output

Question 34

treatment of hypoglycemia

Answer 34

glucose if awake and alert
glucagon if unconscious or can’t swallow

Question 35

agents that increased blood glucose

Answer 35

catecholamines
thyroid hormone
isoniazid
glucocorticoids
calcitonin
phenothiazines
oral contraceptives
somatropin
morphine

Question 36

agents that may increase the risk of insulin hypoglycemia

Answer 36

ethanol
ACE inhibitors
Fluoxetine
somatostatin
anabolic steroids
MAO inhibitors
B-adrenergic blockers
Vigorous, unaccustomed exercise

Question 37

ethanol’s role in increase risk of hypoglycemia

Answer 37

inhibits gluconeogenesis so glucose is not brought back into the blood

Question 38

B blocker’s role in increase risk of hypoglycemia

Answer 38

counteract catecholamines and mask symptoms of hypoglycemia

Question 39

exercise’s role in increase risk of hypoglycemia

Answer 39

skeletal muscle muscle contraction stimulates glucose uptake

Question 40

lipodystrophy

Answer 40

changes in fat (i.e. on upper leg) at over used injection site

Question 41

lipohypertrophy

Answer 41

accumulation of fat in subcutaneous tissue

Question 42

lipoatrophy

Answer 42

loss of fat in subcutaneous tissue; less common with recombinant insulin

Question 43

treatment of T1DM

Answer 43

insulin + diet + exercise