Insulins Flashcards by Kimmi Gem

Name the 3 rapid acting insulins

Can you think of their brand names?

Insulin Glulisine Apidra®

Insulin Aspart Novorapid®

Insulin Lispro Humalog®

That GAL is RAPID!

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What type of insulin is Novorapid?

Insulin Aspart

Rapid-acting

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When should the rapid acting insulins be injected?

Immediately before eating

0- 15 mins before food

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How long does it generally take rapid acting insulins to start working?

~10 - 20 minutes

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How long is the duration of action of rapid acting insulins?

around 2 - 5 hours

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How many units of insulin do the Flexpen, Flextouch, Kwikpen and Solostar (all pre-filled disposable pens) tend to contain?

300 units

3ml pens containing 100 units/ ml

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Are patients more or less at risk of hypoglyceamia when using rapid-acting insulins compared to other insulins?

Less at risk of hypoglyceamia as it is only in body for a few hours and is used with meals

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What type of insulin are short acting insulins?

Short acting insulin= Soluble insulin (S S)

Can get different types of soluble insulins:

Soluble human

Soluble bovine (‘neutral’) Beef

Soluble porcine (‘neutral’) Pig

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What kind of insulin is Actrapid?

Insulin soluble (human)

Short- acting

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When should short acting insulins be injected?

15 - 30 mins before food

Must eat food within 30 mins of injecting to avoid hypoglyceamia

They start working after 30 mins

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How long do short acting insulins work for and when is their peak activity?

Duration of action: 4 - 8 hours

Peak activity: 2 - 4 hours

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What type of insulin is intermediate acting?

Intermediate acting = Isophane insulin (i,i)

Human isophane insulin usually used

Isophane insulin is a suspension of Insulin with protamine: bovine porcine or human insulin in the form of a complex obtained by the addition of protamine

Usually found in biphasic preparations

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Can you think of any brands of Intermediate acting insulins?

Isophane insulins:

Insulatard®

Humulin I®

(all of the i’s!)

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When should intermediate acting (isophane) insulins be injected?

They usually need to be injected twice daily, sometime once daily in eldery

No need to inject with meals

They have a peak action at 4 - 12 hour and last for around 21 hours

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What are the three types of long- acting insulins? Do you know their brand names?

Insulin Detemir Levemir®

Insulin Glargine Lantus ®

Insulin Degludec Tresiba®

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How long do the long-acting insulins usually work for?

Which one works for up to 42 hours?

around 18 - 24 hours

42 hours: Degludec (tresiba)

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Which type of insulin is used in medical emergencies such as diabetic ketoacidosis and before surgery?

…

What is the rational behind biphasic insulin preparations?

These are basically pre-mixed preparations of a rapid or short acting insulin plus a intermediate acting insulin (either the protamine [longer chain version of the short/ rapid acting one] or isophane insulin).

They are to be injected twice daily, and are good for patients who don’t like multiple injecting regimens ( also called basal bolus- where people have to inject short acting with meals plus a long acting insulin)

Disadvantages of these are that there may be less control as proportions are fixed- if unwell and need to boost their insulin they cannot use these and would need a rapid or short acting insulin for this.

NovoMix is a Biphasic insulin (intermediate acting). It contains a mixture of which insulins?

Insulin aspart (rapid acting)
Insulin aspart protamine (long acting)

Together it becomes intermediate acting- injected twice daily

What do Biphasic insulins look like in appearance?

Cloudy

Need to be resuspended before use- tell patient this- by rolling in their hands (not shaking)

Can you name 4 brands of Biphasic insulins, and their ingredients?

Novomix 30 (insulin aspart+ aspart protamine)

Humalog Mix 25 / Humalog Mix 50 (Insulin Lispro + lispro protamine)

Humulin M3 (soluble insulin + isophane insulin)

Insuman Comb 50 (soluble insulin + isophane insulin)

What electrolyte disturbance can insulins cause?

…

When should Biphasic insulins be injected?

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Think about what each one contains: short or rapid acting?

The ones containing rapid acting (NovoMix 30, Humalog Mix) should be injected 0-15 mins before a meal

Containing short acting (Humulin M3, Insuman Comb) inject 15 - 30 mins before a meal

What substance in some insulins can cause injection site reactions and therefore is important to make patients aware the importance of rotating the site of action?

Protamine

The fridge on one of your wards is broken, therefore the not-in-use pens are having to be stored at room temperature. What should inform staff/ label these with?

These will now have a 28 day expiry, as not-in-use pens need to be in the fridge to be used by their original expiry date (i.e. now follow the same rules that In-use pens have)

To diagnose diabetes, a random venous plasma glucose concentration would need to read > __ mmol/L

Over 11 mmol/L

To diagnose diabetes, a fasting plasma glucose concentration would need to read over __ mmol/L

Fasting= over 7 mmol/L

To diagnose diabetes, a two hour plasma glucose concentration (two hours after eating/ two hours after 75g glucose in a glucose tolerance test) would need to read over __ mmol/L

Two hour post food/ glucose: Over 11 mmol/L

a HbA1c of __ mmol/mol or __% is needed to diagnose diabetes

HbA1c of over 48 mmol/mol or 6.5%

What situations would a HbA1c test be inappropriate to diagnose diabetes? (try and think of around 5)

``` Children/ young adults Suspected Type 1 diabetes Symptoms less than 2 months Medication related glucose effects e.g. steroids, antipsychotics Pancreas damage Pregnancy Acutely unwell/ in hospital ```

Which insulins are cloudy in appearance?

Intermediate acting (Isophane) Biphasic preparations- Novomix, Humulin M3, Humalog Mix, Insuman Comb

For a driver of a car/ motorbike, who has been deemed fit to drive due to the presence of only 1 episode of severe hypoglyceamia in the last year, how often should you advise them to check their BG levels?

Within 2 hours of starting their journey Every 2 hours whilst driving If a hypo occurs: stop, pull over, get out of drivers seat, eat sugar, wait 45 mins after BG has returned to normal to continue driving

How many months worth of BG readings must Lorry drivers provide to the DVLA if they are to drive?

3 months

How often should Lorry/ Bus drivers test their blood glucose whilst driving, and on days when theyre not driving?

Within 2 hours of starting to drive every 2 hours whilst driving at least twice daily when not

What are the side effects of insulin?

Fat hypertrophy at injection site Local reactions at injection site Transient oedema

What are the insulin sick day rules?

Just because the patient is ill and not eating does not mean they should stop injecting their insulin ill/ infection= stress hormones/ steroids released steroids increase blood glucose stay well hydrated to avoid DKA patient should monitor their BG and urine ketones more frequently and be prepared to inject accordingly

When should insulin be resuspended before use?

For all insulin preparations, except rapid- and short-acting insulin and insulin glargine (Lantus), the vial or pen should be gently rolled in the palms of the hands (or shaken gently) to resuspend the insulin.

First line insulin used in Type 2 diabetes? NB: Insulin chosen if persons BG inadequately controlled by metformin + sulfonylurea or triple therapy: 3 oral antidiabetic drugs together has failed

Intermediate acting: Human isophane insulin

Novomix is a biphasic insulin with an onset of action of _____ mins and peak activity of ______ hours.

Onset of action of 10-20 mins Peak acivity of 1-4 hours

What is it that makes Insulin Degludec (tresiba) different from all the other insulins licensed in the UK?

It is the first insulin to be available in two different strengths: 100 units/ml 200 units/ml