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BNF Chapter 6 - Endocrinology > Insulins > Flashcards

Insulins Flashcards

1
Q

Name the rapid acting insulins.

A

Aspart, glulisine, lispro.

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2
Q

Name some brands of rapid acting insulins.

A

NoveRapid, Apidra, Humalog.

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3
Q

For whom are rapid acting insulins particularly useful?

A

For patients susceptible to hypos before lunch and during the evening.

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4
Q

How long does it take for rapid acting insulins to have an effect?

A

5-10 minutes.

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5
Q

How long does the therapeutic effect of the fast acting insulins last for?

A

2-4 hours.

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6
Q

Describe the pre-prandial blood glucose concentrations of patients on rapid acting insulins.

A

Higher pre-prandial blood glucose levels, reduced risk of hypos.

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7
Q

When should patients be advised to administer their rapid acting insulin?

A

15 minutes before food or after a meal.

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8
Q

Give examples of animal derived short acting insulins.

A

Hypurin porcine neutral.

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9
Q

Give examples of human derived short acting insulins.

A

Actrapid, Humulin S, Insuman Rapid.

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10
Q

Which form of insulin is the most appropriate for use in diabetic emergencies such as DKA and prior to surgery?

A

Soluble insulins, short acting.

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11
Q

How long does it take for short acting insulins to have an effect?

A

30 minutes.

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12
Q

How long does the therapeutic effect of short acting insulins last for?

A

4-6 hours.

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13
Q

Give examples of intermediate acting insulins - both animal and human derived.

A

Isophane insulin (NPH), Hypurin Porcine, Isophane, Insulatard, Humulin I, Insuman Basal.

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14
Q

How long does it take for intermediate acting insulins to have an effect?

A

2 hours.

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15
Q

How long does the therapeutic effect of intermediate acting insulins last for?

A

18-24 hours.

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16
Q

Why should non-soluble insulins never be given IV?

A

The particulate matter in the suspension may lodge in the capillary beds of the lungs and the brain, leading to thrombus formation.

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17
Q

Which ingredient in some intermediate acting insulins may cause allergic reactions?

A

Protamine.

18
Q

Give examples of long-acting insulins.

A

Insulin detemir, insulin glargine, insulin degludec.

19
Q

Give examples of brands of long-acting insulins.

A

Levemir, Lantus, Abasaglar, Tresiba.

20
Q

How long does the therapeutic effect of insulin degludec (tresiba) last for?

A

42 hours.

21
Q

For whome is insulin detemir or insulin glargine recommended?

A

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.

22
Q

Long-acting insulins may be confused with which other insulins and why?

A

Quick-acting insulins because they are both clear liquids.

23
Q

In order to provide 24 hour cover, how should long-acting insulins be administered?

A

At roughly the same time every day.

24
Q

Give examples of brands of biphasic insulins.

A

NovoMix 30, Humalog Mix 25, Humulin M3, Insuman Comb 50.

25
Q

What is the insulin makeup of NovoMix 30?

A

30% insulin aspart and 70% insulin aspart protamine.

26
Q

What is the insulin makeup of Humalog Mix 25?

A

25% insulin lispro and 75% insulin lispro protamine.

27
Q

What is the insulin makeup of Humulin M3?

A

30% soluble human insulin and 70% isophane human insulin.

28
Q

What is the insulin makeup of Insuman Comb 50?

A

50% soluble human insulin and 50% isophane human insulin.

29
Q

Describe biphasic insulin preparations.

A

Combinations of shorter- and longer-acting insulins within one vial or device.

30
Q

In which patients is the use of biphasic insulin preparations beneficial?

A

Patients with poor dexterity. Patients with trouble measuring the required quantity of insulins. Patients with poor compliance with multiple insulin preparations.

31
Q

What is one drawback of using biphasic insulin preparations?

A

Proportions are fixed so there is less control of dose for specific insulin components.

32
Q

Describe the management of acutly ill patients who use biphasic insulin preparations.

A

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.

33
Q

What component in some biphasic insulin preparations may cause an allergic reaction?

A

Protamine.

34
Q

What important counselling point should patients be aware of before using their biphasic insulin?

A

The insulins must be resuspended before use.

35
Q

Give the equation used to determine the dose of insulin given as a bolus dose in a basal-bolus regimen.

A

Dose of bolus = amount of carbs eaten (g) / insulin to carb ratio.

36
Q

What does the acronym DAFNE stand for and what does it relate to?

A

Dose Adjustment for Normal Eating. It is an education framework for diabetic patients.

37
Q

Why should intermediate insulins never be administered IV?

A

Because it comes as a zinc-insulin particulate which may block a capillary.

38
Q

When a patient is using insulin, what warning signs should one be aware of and make the doctor aware of?

A

Recurrent episodes of hypoglycaemia, signs of DKA, any symptom of liver toxicity, heart failure or pancreatitis, ulceration of foot tissue.

39
Q

Give examples of substances which may enhance blood-glucose lowering activity of insulins, and increase the risk of hypoglycaemia.

A

Oral antidiabetics, ACE inhibitors, MAOis, salicylates, sulphonamide antibiotics.

40
Q

Give some examples of substances which may reduce blood-glucose lowering activity of insulins, and increase the risk of hyperglycaemia.

A

Corticosteroids, diuretics, sympathomimetics (e.g. salbutamol, terbutaline, epinephrine), thyroid hormones, oral contraceptives (progesterone, oestrogens).

41
Q

Which substances may potentiate and/or weaken the blood-glucose lowering activity of insulins?

A

Beta-blockers, alcohol.

BNF Chapter 6 - Endocrinology (16 decks)

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