Insulins Flashcards
Name the rapid acting insulins.
Aspart, glulisine, lispro.
Name some brands of rapid acting insulins.
NoveRapid, Apidra, Humalog.
For whom are rapid acting insulins particularly useful?
For patients susceptible to hypos before lunch and during the evening.
How long does it take for rapid acting insulins to have an effect?
5-10 minutes.
How long does the therapeutic effect of the fast acting insulins last for?
2-4 hours.
Describe the pre-prandial blood glucose concentrations of patients on rapid acting insulins.
Higher pre-prandial blood glucose levels, reduced risk of hypos.
When should patients be advised to administer their rapid acting insulin?
15 minutes before food or after a meal.
Give examples of animal derived short acting insulins.
Hypurin porcine neutral.
Give examples of human derived short acting insulins.
Actrapid, Humulin S, Insuman Rapid.
Which form of insulin is the most appropriate for use in diabetic emergencies such as DKA and prior to surgery?
Soluble insulins, short acting.
How long does it take for short acting insulins to have an effect?
30 minutes.
How long does the therapeutic effect of short acting insulins last for?
4-6 hours.
Give examples of intermediate acting insulins - both animal and human derived.
Isophane insulin (NPH), Hypurin Porcine, Isophane, Insulatard, Humulin I, Insuman Basal.
How long does it take for intermediate acting insulins to have an effect?
2 hours.
How long does the therapeutic effect of intermediate acting insulins last for?
18-24 hours.
Why should non-soluble insulins never be given IV?
The particulate matter in the suspension may lodge in the capillary beds of the lungs and the brain, leading to thrombus formation.
Which ingredient in some intermediate acting insulins may cause allergic reactions?
Protamine.
Give examples of long-acting insulins.
Insulin detemir, insulin glargine, insulin degludec.
Give examples of brands of long-acting insulins.
Levemir, Lantus, Abasaglar, Tresiba.
How long does the therapeutic effect of insulin degludec (tresiba) last for?
42 hours.
For whome is insulin detemir or insulin glargine recommended?
Those who require assistace injecting insulin. Those whos lifestyle is significantly restricted by recurrent symptomating hypos. Those who would otherwise require twice-daily basal insulin injections in combination with oral antidiabetic drugs. Those who cannot use the device needed to inject isophane insulin.
Long-acting insulins may be confused with which other insulins and why?
Quick-acting insulins because they are both clear liquids.
In order to provide 24 hour cover, how should long-acting insulins be administered?
At roughly the same time every day.
Give examples of brands of biphasic insulins.
NovoMix 30, Humalog Mix 25, Humulin M3, Insuman Comb 50.
What is the insulin makeup of NovoMix 30?
30% insulin aspart and 70% insulin aspart protamine.
What is the insulin makeup of Humalog Mix 25?
25% insulin lispro and 75% insulin lispro protamine.
What is the insulin makeup of Humulin M3?
30% soluble human insulin and 70% isophane human insulin.
What is the insulin makeup of Insuman Comb 50?
50% soluble human insulin and 50% isophane human insulin.
Describe biphasic insulin preparations.
Combinations of shorter- and longer-acting insulins within one vial or device.
In which patients is the use of biphasic insulin preparations beneficial?
Patients with poor dexterity. Patients with trouble measuring the required quantity of insulins. Patients with poor compliance with multiple insulin preparations.
What is one drawback of using biphasic insulin preparations?
Proportions are fixed so there is less control of dose for specific insulin components.
Describe the management of acutly ill patients who use biphasic insulin preparations.
They cannot use their biphasic insulin preparations to boost their insulin levels so should ideally have a short- or rapid-acting insulin to se to manage their insulin requirement when ill.
What component in some biphasic insulin preparations may cause an allergic reaction?
Protamine.
What important counselling point should patients be aware of before using their biphasic insulin?
The insulins must be resuspended before use.
Give the equation used to determine the dose of insulin given as a bolus dose in a basal-bolus regimen.
Dose of bolus = amount of carbs eaten (g) / insulin to carb ratio.
What does the acronym DAFNE stand for and what does it relate to?
Dose Adjustment for Normal Eating. It is an education framework for diabetic patients.
Why should intermediate insulins never be administered IV?
Because it comes as a zinc-insulin particulate which may block a capillary.
When a patient is using insulin, what warning signs should one be aware of and make the doctor aware of?
Recurrent episodes of hypoglycaemia, signs of DKA, any symptom of liver toxicity, heart failure or pancreatitis, ulceration of foot tissue.
Give examples of substances which may enhance blood-glucose lowering activity of insulins, and increase the risk of hypoglycaemia.
Oral antidiabetics, ACE inhibitors, MAOis, salicylates, sulphonamide antibiotics.
Give some examples of substances which may reduce blood-glucose lowering activity of insulins, and increase the risk of hyperglycaemia.
Corticosteroids, diuretics, sympathomimetics (e.g. salbutamol, terbutaline, epinephrine), thyroid hormones, oral contraceptives (progesterone, oestrogens).
Which substances may potentiate and/or weaken the blood-glucose lowering activity of insulins?
Beta-blockers, alcohol.
