Medications in Diabetes Mellitus

Question 1

What are classifications of Insulin?

Answer 1

• Porcine: extracted and purified from pig pancreas
• Human sequence insulin: either produced by enzyme modification of porcine insulin (emp) or biosynthetically by recombinant DNA using bacteria (crb, prb) or yeast (pyr)
• Analogues

Question 2

What are the different durations of Insulin?

Answer 2

• Rapid-acting insulin analogues (O=5m, P=1hr, D=3-5hr)
o the rapid-acting human insulin analogues act faster and have a shorter duration of action than soluble insulin
 insulin aspart: NovoRapid
 insulin lispro: Humalog
• Short-acting insulins (O=30m, P=3hr, D=6-8hr)
o soluble insulin examples: Actrapid (human, pyr), Humulin S (human, prb)
o may be used as the bolus dose in ‘basal-bolus’ regimens
• Intermediate-acting insulin (O=2hr, P=5-8hr, D=12-18hr)
o isophane insulin
• Long-acting insulins (O=1-2hrsm, P=n/a, D=24hr)
o insulin determir (Levemir): given once or twice daily
o insulin glargine (Lantus): given once daily

Question 3

How are premixed solutions made?

Answer 3

• combine intermediate acting insulin with either a rapid-acting insulin analogue or soluble insulin
o Novomix 30: 30% insulin aspart (rapid-acting), 70% insulin aspart protamine (intermediate-acting)
o Humalog Mix25: 25% insulin lispro (rapid-acting), 75% insulin lispro protamine (intermediate-acting); Humalog Mix50: 50% insulin lispro, 50% insulin lispro protamine
o Humulin M3: biphasic isophane insulin (human, prb) - 30% soluble (short-acting), 70% isophane (intermediate-acting)
o Insuman Comb 15: biphasic isophane insulin 9human, prb) - 30% soluble (short-acting), 70% isophane (intermediate-acting)

Question 4

Describe insulin regimens prescribed to patients?

Answer 4

• Offer multiple daily injection basal–bolus insulin regimens, rather than twice daily mixed insulin regimens, as the insulin injection regimen of choice for all adults
o Twice daily insulin detemir is the regime of choice. Once-daily insulin glargine or insulin detemir is an alternative
• Offer rapid acting insulin analogues injected before meals, rather than rapid acting soluble human or animal insulins, for mealtime insulin replacement for adults with type 1 diabetes

Question 5

When is Metformin recommended to be added to insulin?

Answer 5

Metformin

• Recommend considering adding metformin if the BMI >= 25 kg/m²

Question 6

How is Insulin administered and why?

Answer 6

• IV preferred to subcutaneous insulin regimens for adults with T1 diabetes if:
o The person is unable to eat or is predicted to miss more than 1 meal or
o Acute situation is expected to result in unpredictable blood glucose levels for examples major surgery, high-dose steroid treatment, inotrope treatment or sepsis
• Important to rotate injection site to prevent lipodystrophy