[PHARMA] INSULIN Flashcards by Aseel Maher

Insulin counter-regulatory hormones (5)

1-Glucagon
2-GH
3-Cortisol
4-Catecholamines
5-Thyroxine

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Drugs inducing diabetes (4)

1-Cortisol
2-OC
3-Thiazide diuretics
4-BB

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thiazides induce DM via

↓ insulin release

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BB induce DM via

glucose intolerance

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ultra rapid ultra short (URUS) insulin

1-Lispro
2-Aspart
3-Glulisine

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intermediate acting insulin

NPH (isophane)

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Long acting insulin

Glargine
Detemir
Degludec

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prandial preparations

1-URUS
2-Regular insulin
3-long acting
4-afrezza

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basal preparation

NPH

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lispro/aspart/glulisine
route?
time of administration?

SC
15 minutes before meal

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Regular acting insulin
route?
time of administration

SC
30-45min before meal

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NPH
route?
dosage?

SC
T1DM= 2-4times/d
T2DM= once/day

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Glargine/Detemir/Degludec
route?
dosage?

SC
once or twice/day

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preparation w/ variable absorption>50%

NPH

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preparation w/ broad conc plateau

Glargine/Detemir/Degludec

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lispro/aspart/glulisine advantages

rapid onset,duration,action & absorption—>
1-better postprandial glycemic control
2-↓risk of hypoglycemia

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lispro/aspart/glulisine advantages

rapid onset & absorption—>
1-better postprandial glycemic control
2-↓risk of hypoglycemia

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Regular insulin advantages

rapid onset, short duration–>
useful in emergencies & ketoacidosis (IV/IM)

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NPH advantages

1-can be mixed w/ regular insulin
2-useful in ALL DM types (except DKA)

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Glargine advantages

effect= 24h
so better compliance

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Glargine disadvantage

cant be mixed

long acting preparation that CAN be mixed

Degludec

NPH can be mixed w/

-regular insulin
-lispro
-aspart

Degludec has very long duration due to

formation of multihexamers

URUS duration

3-5h

Regular insulin duration

5-8h

NPH duration

4-12 hours (great variability)

Glargine duration

≥ 24h

Degludec duration

24-42h

Detemir duration

>12 h (~20h)

inhaled insulin

afrezza

afrezza cc

1-inhaled powder 2-rapid acting 3-covers prandial requirements

T1 diabetics on afrezza must use

SC long acting insulin

afrezza CI

chronic lung disease

afrezza disadvantages

1-no fine dose adjustments 2-cant be used in smokers & pt w/ lung disease

insulin is first-line therapy in T2 diabetics in case of (4)

A1c>10% FPG>250mg/dL random glucose>300 mg/dl ketonuria

insulin is indicated to T2 diabetics if

metformin, exercise,diet regulations fail to treat hyperglycemia

insulin indications (6)

1- T1DM 2-T2DM 3-DM w/ pregnancy & lactation 4-DM w/ stress & emergencies 5-DM w/ renal/liver disease 6-Hyperkalemia

insulin is indicated in pregnancy & lactation to

avoid sulfonyl-urea induced hypoglycemia in baby

temporary indications of insulin (4)

1-pregnancy 2-lactation 3-stress & emergency 4-hyperkalemia

insulin adv effects (6)

1-HYPOGLYCEMIA 2-↑ weight 3-insulin resistance 4-urticaria (rare) 5-Lipodystrophy 6-hypokalemia

insulin resistance w/ insulin therapy occurs due to? requirements?

anti-insulin Ab insulin requirements >120 units/d

most frequent & serious adv effect

HYPOGLYCEMIA

Lipohypertrophy occurs due to? avoided by?

repeated injection at same site changing site

lipoatrophy used to occur w/

animal insulin=forms IC @ site of injection

causes of insulin-induced hypoglycemia (3)

1-insulin overdose 2-↓food intake 3-physical effort

warning signs of insulin-induced hypoglycemia

1-adrenergic (+)= ↑HR, sweating, tremors 2-neurological= dizziness, convulsions, coma

adrenergic warning signs are masked by

TTT of insulin-induced hypoglycemia

1-rapid oral glucose administration 2-1mg IV/IM glucose or glucagon

to avoid hypoglycemia patient should be

aware of warning signs carry candy/sugar