M15 - Insulin for Diabetes Pharm Flashcards
Synthesis of Insulin
-Made by pancreatic beta cells
-Precursor (proinsulin) cleaved proteolytically into mature insulin
-Both mature insulin and C-peptide are released into the circulation
-Insulin and C-peptide are produced in ____ amounts
-C-peptide has a ____ half-life and is an ideal marker of endogenous insulin production and secretion
-Equimolar
-Long
Regulation of insulin secretion
- Glucose is the major regulator of insulin release
- Increase Glucose = Increase Insulin
Other Insulin Indication
- Acute Hyperkalemia
– Drip containing regular insulin and a solution of glucose
Insulin Adverse Effects
-Hypoglycemia
-Lipodystrophy at inj. site
-Weight gain
-Hypokalemia
Insulin Administration
-SubQ (vial+syringe or pen)
-IV infusion
-Insulin delivery pumps
-Inhaled insulin
Rapid-acting Insulin
Aspart, Lispro, Glulisine
-breaks down quickly after injection
Onset: 15 min
Peak: 1 hr
Duration: 2-4 hr
Short-acting Insulin
Regular Insulin
Onset: 30 min
Peak: 2-4 hr
Duration: 5-8 hr
Intermediate-acting Insulin
NPH (Neutral Protamine Hagedorn)
-NPH co-crystallizes with protamine, slowing absorption and action
Onset: 2 hr
Peak: 6 hr
Duration: 12-16 hr
Long-acting Insulin
Detemir, Glargine
-forms compact aggregate at injection site = slows abs.
Onset: 2 hr
Peak: none
Duration: 20-26 hr
Basal Insulin Dosing
-Once daily
-Covers body for 24 hrs
-LOW risk of hypoglycemia
Bolus Insulin Dosing
-Given with meal
-Nutritional: reduce glucose rise of meals
-Correctional: correct hyperglycemia
-HIGH risk of hypoglycemia
Bolus Insulin: Nutritional dosing
- Take set amount of insulin with each meal
- Take insulin according to amount of carbs eaten (1 unit per 15g)
Bolus Insulin: Correctional dosing
Pt given scale (sliding/correctional scale)
Pre-mixed Insulin
Basal and rapid-acting insulin combined
70/30 = ratio of basal/bolus so 70 basal and 30 bolus
-Given twice daily before meals
-ADV: reduces # of inj, simple reg
-DIS: less physiologic
When T2 DM needs Insulin
- Severe hyperglycemia (A1c
> 9-10%) despite oral/GLP1
medications - Hyperglycemia with medical
contraindications to several oral medications (i.e. Stage 4 CKD)
Type 1 DM Units
Basal and Bolus
0.4-0.7 units/kg/day
Type 2 DM Units
Basal and Bolus
= 0.5-2.0 units/kg/day
Basal Only
= 10 units a day or 0.2 units/kg/day
BASAL
* If fasting glucose is high, ____ basal insulin
* If fasting hypoglycemia, ____ basal insulin
-INCREASE
-DECREASE
BOLUS
-Adjust based on glucose levels 2 hours after meal or glucose before next meal (goal ___ mg/dL)
goal <180 mg/dL
