Lecture 8: Insulin Therapy

Question 1

What does insulin bind to?

Answer 1

Binds to IGF-1 receptors and gets GLUT 4 to come to the membrane
Tyrosine kinase
Broken down in liver

Question 2

What kind of hormone is insulin?

Answer 2

An ANABOLIC one

1. adipose tissue build up
2. muscle tissue build up
3. glycogen build up and FA synthesis in the liver

Question 3

What are the indications for insulin?

Answer 3

1. Type 1 diabetes
2. Inadequately controlled Type 2 diabetes
3. Temporary use
   
   • hospitalization/surgery
   • surgery
   • renal disease
   • to initially attain glycemic control in patients with severe type 2 diabetes
   • to overcome glucose toxicity and re-regulate decompensated patients

Question 4

What are the types of insulin analogues?

Answer 4

Modification of synthetic insulin molecules allow for unique pharmacodynamics profiles

i. rapid-acting: lispro aspart, glulisine
ii. short-acting: regular
iii. intermediate: NPH
iv. long acting: glargine, detemir

Question 5

What are examples of RAPIDLY acting human analogs of insulin?

Answer 5

1. Aspart (aspartic acid for proline)
2. lispro (lysine for proline)
3. Glulisine (glutamic acid for lysine)
   Homologous with regular human insulin
   Single substitution

Question 6

What is bolus insulin?

Answer 6

Used for coverage of food intake or correction of hyperglycemia
Comes in short acting and rapid acting forms
Short acting = regular insulin
Rapid acting = apart, lispro, glulisine

Question 7

What types of insulin are used for bolus insulin?

Answer 7

Rapid acting 
	Aspart (aspartic acid for proline)
	Lispro
	Glulisine
Short acting
	Regular insulin

Question 8

What is the structure of lispro?

Answer 8

Exchanged a lysine (lis) for a proline (pro) in the insulin structure
Otherwise all the same
Dirsupts monomer-monomer interactions and leads to more rapid absorption

Question 9

When do you take aspart, lispro, glulisine?

Answer 9

Take them 5-15 minutes before meal

Question 10

What is the difference between regular and rapid acting insulin?

Answer 10

Rapid = 2x faster absorption
2x higher peak concentration
10-20 minutes post injection

Question 11

What is basal insulin?

Answer 11

Maintain euglycemia in the fasting state

Two types: intermediate and longacting

Question 12

What is intermediate types of basal insulin?

Answer 12

NPH

Neutral protamine Hagedorn

Question 13

What is NPH?

Answer 13

Intermediate type of insulin
Used for basal insulin
Insulin + protamine, a positively charged polypeptide

Question 14

What is glargine and detemir?

Answer 14

Long acting insulin
Used for basal insulin
Several substitutions and addtions
Forms microprecipitate of insulin (Glargine) and is broken down slowly in body
Detemir binds to albumin and slowly dissociates (long-acting)

Question 15

What are the long acting basal insulins?

Answer 15

Glargine

Detemir

Question 16

What does NPH stand for?

Answer 16

Neutral protamine hagedorn

Question 17

What basal insulin is used more commonly used?

Answer 17

Glarginea and detemire = 24 hours

NPH = 10-20 hours (not as good) so is less commonly used

Question 18

What are the conventional ways to administer insulin?

Answer 18

Long or intermediate acting only, twice daily

Question 19

What are the intensive ways to administer insulin?

Answer 19

Multiple injections

-rapid acting insulin after each meal

Question 20

Why is conventional insulin administration not as effective?

Answer 20

Because you get hyperglycemia at certain point

Insulin is NOT matching the glucose coming in

Question 21

What are insulin complications?

Answer 21

1. Hypoglycemia
2. Insulin lipodystrophies
3. Allergy
4. Insulin Resistance

Question 22

What are the key characteristics of hypoglycemia?

Answer 22

1. low blood glucose common in well controlled patients
2. Decrease episodes through
   
   • improving awareness
   • plan for treatment
   • plan for prevention
3. Treatment
   
   • glucose tablets
   • glucagon

Question 23

What is the key characteristic of basal bolus regiment? Method of entry?

Answer 23

Basal bolus regiment via subcutaneous injections or continuous insulin infusion most closely simulate normal insulin physiology