Pharm2 2 Insulins pt1 Flashcards
UKPDS: The lower A1C gets, for every 1% reduction, there’s a 37% decrease in microvascular complications, 14% in macrovascular complications.
But:
But, If you were to push down a patient with dangerous numbers & other risk factors (cv) very fast, it’s a U-shaped curve. Hazard ratio decreases, but then increases again since they’re being pushed down too quickly.
How has Diabetes control in the US changed between 1988 and 2002?
We haven’t seen huge improvements despite better medications.
5 barriers as to why patients are unwilling to use insulin
Fear of injection Permanence of having to take insulin Personal failure in managing diabetes Inconvenience of monitoring Fear of the demands of insulin therapy
Metabolic Staging of Type 2 Diabetes (based on insulin levels)
Impaired glucose tolerance (high insulin lvls) Early Diabetes (failing insulin production) Late Diabetes (no insulin production)
If a patient asks why it’s so bad to have high blood glucose, what’s your response to them?
too much glucose is like ground glass running through your blood vessels. Imagine the damage it would do to your eyes, kidneys, (for men, penis)
Losing weight to reverse your T2DM (as soon as they’re diagnosed to DM from Prediabetes)
Losing _% of your bodyweight
A 200 lbs patient should lose how many pounds?
Lose 7% of your bodyweight
If they weigh 200 lbs try and lose 14 pounds (down to 186)
Biphasic (Fixed Split Mixed) Insulins
Tell me about Novolog 70/30
What does the ratio mean? What does each part stand for?
The first number (70 in this case) is always ___ acting
The following number (30 in this case) is always ___ acting.
note that these #’s always add to 100.
70/30: 70% insulin protamine ; 30% is insulin aspart. These ratios are what prof herman is talking about in my notes on slide 19. Those 2/3 (66.7%), 1/3 (33.3%) ratios are very close to 70% and 30%
The first part is always the basal/long-acting part
The second part is the short-acting
How does the body handle meals with insulin?
When you eat, there’s a spike in glucose. So you need a short acting insulin to take care of this. The pancreas only makes one type of insulin.
4 shots/day method (undesirable)
When is each one? How many finger-sticks/when?
A long acting will last 24 hours, take care of the parts of the day when you’re not eating.
But then you’d need 3 shots for the major meals of the day with short-acting.
5 fingersticks per day: 1 for every shot, and 1 more post-prandial (dinner)
A split-mixed regimen (2 shots/day)
How does it work? When’s each shot?
a combo of a long & short acting insulin. 2 shots at the two biggest meals of the day (usually breakfast and dinner). The combo of long & short acting will often be adequate to get you through lunch as well.
Insulin Aspart
Onset, peak, duration, route of admin (2)
Onset: <15 minutes (Rapid & short acting insulin)
Peak: 1-3 hours
Duration: 3-5 hours
Route of admin: SC, Pump
some insulins are made from recombinant DNA, some are made from ___
Pork. Some people won’t take the this one for religious reasons.
The route of admin depends on the patient.
If you need to give a bolus of insulin to lower their glucose instantly, use:
the IV insulin. (regular insulin)
Insulin Lispro
Onset, peak, duration, route of admin (2)
Onset: <15 minutes (Rapid & short acting insulin)
Peak: 1 hour
Duration: 3.5-4.5 hours
Route of admin: SC, Pump
Insulin Injection Regular ® (regular insulin)
Onset, peak, duration, route of admin (3)
Onset: 30 min
Peak: 2-4 horus
Duration: 6-8 hours
Route of admin: SC, IM, IV
What are the 2 Basal insulins?
How many injections per day/how long do they last?
Insulin Detemir
Insulin Glargine
Basal insulins are started as 1x day injections given before bed & they last 24 hours.
these are the simplest of all insulins to start on patients with the typical T2DM insulin resistance process:
Basal insulins (Detemir or Glargine)
Insulin Detemir or Insulin Glargine
Onset, Peak, Duration, Route of admin
Onset: 1 hour
Peak: NONE
Duration: 24 hours
Route: SC
4 common insulin regimens in primary care
Basal + Oral Agents
Basal + Bolus (meal time insulin) Therapy
Fixed Split Mixed (Biphasic) +/- Oral Agents
Pumps
Rapid acting insulin = __-time insulin
meal time insulin
given literally as the patient is served their meal. They can discretely pull up their shirt & inject their # in units (depends on # of carbs in your meal) – Carb counting
what class of insulins Work over a narrow, more predictable range of time?
Rapid-acting insulins
What class of insulin acts most like insulin produced by the human pancreas
Rapid-acting insulin
It quickly drops the blood sugar level and works for a short time
Intermediate- and long-acting insulins contain added substances (____) that make them work over a long time
buffers
some Intermediate- and Long-acting Insulins appear ___. Is this normal? Why?
Milky-white. This is normal.
When these types of insulin sit for even a few minutes, some types of the buffered insulin settles to the bottom of the vial
Glargine is a ___-colored solution.
clear solution, not milky-white
When is Glargine given?
What’s its pregnancy info?
Lantus is given as ONE dose daily given at bedtime
Lantus is not approved for use in pregnant women
