Insulins

Question 1

Describe rapid-acting insulins and give examples of them

Answer 1

Used when required
Faster onset
Short duration of action
Should be used before or after eating

Examples:
Aspart (Novorapid)
Glulisine (Apidra)
Lispro (Humalog)

Question 2

Describe short-acting insulin (neutral or soluble) and give examples of them

Answer 2

Used when required
Longer duration of action
Injected 30 mins before eating

Examples:
Actrapid
Humulin S
Insuman Rapid

Question 3

Describe intermediate-acting insulin and give examples

Answer 3

Usually used TWICE daily
up to 16 hours of duration
Resuspend zinc insulin particulate before injecting
Never use via IV

Examples:
Isophane/NPH (insulatard, Humulin I, Insuman basal)

Question 4

Describe long-acting insulin and give examples

Answer 4

For 24 hour cover, usually used at the same time each day

Examples:
Detemir (levemir)
Glargine (Absaglar, Lantus)
Deglubec (Tresiba)

Question 5

Describe biphasic insulin and give examples

Answer 5

Combination of shorter and longer-acting insulins
More convenient but less control
Need to resuspend before injection

Examples:
Novomix 30
Humalog Mix 25
Humulin M3

Question 6

What are the warning signs of insulin use

Answer 6

Recurring episodes of hypoglycaemia (sweating, palpitations, confusion, drowsiness)

Signs of diabetic ketoacidosis (nausea, vomiting, drowsiness)

Any symptoms of liver toxicity, heart failure or pancreatitis (jaundice, abdominal pain)

Ulceration of foot tissue

Question 7

What are the interactions you can have with insulin use

Answer 7

Substances that may enhance blood glucose lowering activity (reducing insulin requirements that may lead to hypoglycaemia) such as: 
ACE inhibitors
MAOIs
Salicylates
Sulphonamide antibiotics 

Substances that may reduce blood glucose lowering activity (increase insulin requirements)
Corticosteroids
Diuretics
Sympathomimetics (epinephrine, salbutamol, terbutaline)
Thyroid hormones
Oral contraceptives (oestrogens, progestogens)

Beta blockers or alcohol may potentiate or weaken the blood glucose lowering activity of insulin