Insulins Flashcards
How can insulin be administrated?
- Subcutaneous: home setting (most insulins)
- IV: emergencies, hospital setting (only for regular insulin, short-acting)
- IM: cannot
- Nasal: inhale to lungs => only avail in rapid onset medicines (cuz lungs r very vascularised) (new tech)
What is the function of basal insulin?
- for body to suppress hepatic glucose production overnight & btw meals
What is the function of prandial insulin?
- body needs the insulin to dispose glucose after meals
What are the factors influencing the PK of insulin?
Pharmacokinetics refers to the movement of drugs through the body, aka what the body does to the drugs.
- Site of injection
- Depth of injection (generally, deeper=> faster absorption)
- Larger volumes (slows rate of ab)
- Exercise before injection (increases rate of ab)
- Application of heat/massaging at injection site (increases rate of ab)
Which sites of injection leads to higher rate of absorption of insulin?
Abdomen=> faster rate of absorption + more reproducible than arms/buttocks/thighs
- due to diff in blood flow
How does the depth of injection affect the rate of absorption of insulin?
Too deep=> delivers into muscles, greater vascularisation than in subcutaneous tissue => faster absorption
Too shallow=> superficial injection in derma => slow & incomplete absorption
- conflict w predicted onset/peak time/duration of action
What are the 2 main needs to be satisfied via insulin therapy?
- Basal insulin
- Prandial insulin
Name the 3 rapid-acting insulin analogues
- Lispro
- Aspart
- Glusinine
Which type of insulin can be injected intravenously?
Regular insulin (short-acting insulin)
What are the 2 types of long-acting insulins?
- Glargine
- Detemir
What are long-acting insulin analogues useful for?
- takes care of basal insulin needs
Why can’t long-acting insulins be mixed in the same syringe with other insulins?
- it’ll change how the insulins work
- prolly cuz of the association into hexamers blahblah (go read the detemir part) & cuz of incompatible pH (for glargine)
Name an ultra long-acting insulin and what is its duration of action?
Degludec, DOA>24h
Name an advantage and disadvantage of Degludec:
Advantage: it can be mixed in a syringe (unlike long-acting insulins, glargine & detemir)
Disadvantage: inability to tweak day to day levels due as it is ultra long-acting
Which insulin drug comes w the highest risk of hypoglycemia?
Intermediate-acting: Neutral Protamine Hagedorn (NPH)
Due to:
- high intra & inter patient variation
- long peak
Rank the different types of insulin drugs in decreasing risk of hypoglycemia.
3. Intermediate > 2. Short > 1. Rapid > 4. Long > 5. Ultra-Long
Why?
Intermediate has highest risk cuz of long peak + high intra & inter patient variation
Short has higher risk than Rapid cuz the longer the DOA, the greater the risk of **hypoglycemia **
BUT
For long n ultra-long, each has lower intra-px variation n PD variation, thus, lower risk of hypoglycemia
Name the common adverse effects of insulin drugs.
- Hypoglycemia
- Lipodystrophy
- lipoatrophy &/or lipohypertrophy
What are the 2 types of lipodystrophy and what causes them?
- Lipoatrophy
- loss of fat at site of injection
- occured in past due to usage of animal insulin, when recombinant insulin didnt exist - Lipohypertrophy
- accumulation of fat, due to repeated injection at same site
- due to lipogenic action of insulin
- that’s why site of injection needs to be rotated to prevent lipohypertrophy at only one site.
Compare the duration of action and adverse effects of rapid-acting vs short-acting insulins:
DOA: rapid<short
Thus, short has a greater risk of hypoglycemai than rapid
Which insulin has a unique appearance from the rest?
Intermediate acting- Neutral Protamine Hagedorn(NPH) insulin
- cloudy appearance
- the rest of the insulins are clear
