Insulins Flashcards
Different types of insulins:
- Short-acting insulins are used shortly before meals, they include NovoRapid and Humalog
- Intermediate insulins are usually given twice daily, they include Humulin I, Levemir + Detemir
- Long-acting insulins are usually given just once daily, they include Lantus
- Biphasic insulins combine more than one of the above, they include NovoMix30, Humalog Mix25 and Humulin M3
1st line in type 1 diabetes:
Patients are usually started on a short-acting insulin before meals, PLUS an intermediate or long acting insulin to use once or twice a day (Insulin detemir).
If 1st line not practical in type 1 diabetes:
If this is not practical, they are switched to a biphasic insulin preparation to be used once or twice a day before meal.
Alternatively, an insulin pump containing short-acting or rapid acting insulin can be used. The pump infuses the insulin into the patient s/c slowly, this provides basal control. When patient is about to eat, they press the button and get bolus dose of soluble insulin as well. NOTE: This is only used for adults who suffer disabling hypoglycaemia or have high HbA1C concentrations. Not in Type 2.
Insulin requirements may increase if the patient is affected by
infection, stress, trauma, puberty + pregnancy (2nd + 3rd trimester). In contrast, they may decrease in certain endocrine disorders (e.g. Addison’s disease, hypopituitarism), hepatic impairment and renal impairment, coeliac disease.
Insulin should be injected into
- a body area with plenty of SC fat usually the abdomen (fastest absorption rate) or outer thighs/buttocks (slower absorption rate).
Lipohypertrophy
- Lipohypertrophy can occur due to repeatedly injecting the same area and can cause erratic absorption of insulin resulting in poor glycaemic control.
- Lipohypertrophy can be minimised by using different injection sites in rotation.
Insulins should be prescribed by BRAND NAME
as patient familiarity and ease of use are important
Rapid Acting
- Insulin Soluble Examples: Actrapid, Humulin R, Humulin S, Bovine, Porcine
- Insulin Aspart Examples: Novorapid
- Insulin Glulisine Examples: Apidra
- Insulin Lispro Examples: Humalog KwikPen
Intermediate Acting
- Biphasic Isophane Insulin Examples: Humulin M3, Humulin M3 KwikPen, Hypurin Porcine, Insuman Comb 15/25/50
- Isophane (NPH) Insulin Examples: Humulin I, Humulin I KwikPen, Hypurin Porcine Isophane, Insulatard. Never give Isophane IV due to thrombosis.
Insulin storage
Store insulin in fridge between 2 to 8c
Once opened store at room temp + use by 28 days
If left outside fridge at 15-30 c >48h then discard
If frozen discard
Intermediate Acting COMBINED WITH Rapid Acting
- Biphasic Insulin Aspart Examples: NovoMix 30
* Biphasic Insulin Lispro Examples: Humalog Mix
Long Acting
- Insulin Degludec Examples: Tresiba
- Insulin Detemir Examples: Levemir
- Insulin Glargine (Biological med - Must be prescribed by brand name) Examples: Abasaglar, Lantus, Toujeo
- Insulin Zinc suspension Examples: Hypurin Bovine Lente
- Protamine Zinc Insulin Examples: Hypurin Bovine Protamine Zinc. Never give IV due to thrombosis. Protamine causes allergic reactions. Don’t mix with soluble – binds in syringe.
Side effects of Insulin:
Hypoglycaemia Do not miss meals. Right insulin, Right dose, Right time, Right route.
Lipodystrophy rotate injection site (can be administered to buttocks, upper arm, abdomen + thigh)
Local injection site reactions check injection technique
Interactions:
Enhanced hypoglycaemic effect of insulin -> ACEi (hyperkalemia +hypoglycaemia linked), B-Blockers (mask symptoms of hypoglycaemia), Alcohol
Antagonised hypoglycaemic effect of insulin -> Corticosteroids, Oral Contraceptives, Loop/Thiazide diuretics
