Pharmacology Of DM Insulin

Question 1

What is the MOA of Endogenous Insulin Preparations?

Answer 1

They activate insulin receptors & DECREASE plasma glucose levels (Same as endogenous)

Question 2

Insulin preparations differ in:

Answer 2

• Source
• onset and duration of action
• Concentration (100 units/ mL most common)

Question 3

What is human insulin produced by?

Answer 3

Recombinant DNA technology

Question 4

What is human pro-insulin gene inserted to?

Answer 4

E.Coli (humilin) and yeasts (Novolin)

Question 5

Human insulin is dispensed as:

Answer 5

• Regular (R) Formulations
• Neutral Protamine hagedorn (NPH) formulations

Question 6

What are insulin analogs?

Answer 6

Chemically modified (amino acid substitutions) versions of human insulin preparations to improve PK

Question 7

How is insulin given?

Answer 7

As solutions or suspensions of insulin proteins in water

Question 8

What are the rapid acting insulins?

Answer 8

GAL**
-Glulisine
-Aspart
- Lispro

Question 9

Similarities & differences of rapid acting insulin vs Regular insulin

Answer 9

• RA insulin is structurally similar to regular insulin with slight amino acid modification
• RA insulin has more rapid absorption, faster onset of action, and shorter DOA

Question 10

When should rapid acting insulin be administered?

Answer 10

Immediately before a meal

Question 11

Rapid acting insulin color?

Answer 11

Clear solution

Question 12

Short acting insulins?

Answer 12

SR
Regular (R) Insulin

Question 13

Short acting insulin administration?

Answer 13

30 minutes prior to a meal (due to onset)

Question 14

Color of Regular Insulin?

Answer 14

Clear solution

Question 15

Regular insulin is available OTC. True or False?

Answer 15

True

Question 16

Immediate acting insulins?

Answer 16

NPH (aka insulin isophane)

Question 17

NPH color?

Answer 17

Turbid whitish/cloudy suspension

Question 18

Why is NPH highly unpredictable?

Answer 18

It’s erratic absorption (50% variability)

Question 19

What must NPH often need to be taken with?

Answer 19

Short/rapid acting insulin to achieve full BG control

Question 20

What are long acting insulins?

Answer 20

DGD
-degludec
- Glargine
-detemir

Question 21

Long acting insulin is designed to…

Answer 21

Provide constant & steady insulin release to mimic basal insulin

Question 22

Long acting insulin has a _______ effect

Answer 22

Peakless or near peakless

Question 23

When is long acting insulin administered?

Answer 23

Once daily most commonly at night. Sometimes twice daily

Question 24

Long acting insulin color?

Answer 24

Clear solution

Question 25

Name ultra rapid acting insulins

Answer 25

- Fiasp (fast acting insulin aspart) - Afrezza

Question 26

What is Fiasp?

Answer 26

Insulin asaprt, just with faster absorption to blood

Question 27

Inhaled Insulin=

Answer 27

Afrezza

Question 28

Side effects of Afrezza?

Answer 28

Cough & upper respiratory infections

Question 29

What are Afrezza contraindications?

Answer 29

- chronic lung disease (asthma, COPD)

Question 30

What are insulin combinations?

Answer 30

= premixed insulin formulations of short and intermediate acting insulins for patients convenience

Question 31

Components of Novolin, Humilin 70/30?

Answer 31

70 % NPH & 30% Regular

Question 32

Components of Humalog 75/25, 50/50

Answer 32

Insulin lispro portamine + Insulin lispro

Question 33

Components of Novolog 50/50

Answer 33

Insulin Aspart protamine + Insulin Aspart

Question 34

Insulin combination color?

Answer 34

Turbid/ cloudy suspension

Question 35

Are insulin combinations available OTC?

Answer 35

YES

Question 36

What insulins cannot be mixed acutely with regular insulin or with rapid acting insulin analogs?

Answer 36

Insulin glargine & Insulin detemir

Question 37

Insulin combination onset?

Answer 37

Similar to shortest acting component

Question 38

Insulin combination peak?

Answer 38

Dual, per agents

Question 39

Insulin combinations DOA?

Answer 39

Similar to longest acting component

Question 40

What do patients on insulin usually require?

Answer 40

Both a longer (basal) and shorter (bolus/prandial) insulin for optimal control of hyperglycemia

Question 41

Why can’t insulin be given orally?

Answer 41

Because the insulin protein would degrade in stomach acid

Question 42

Insulin routes of administration?

Answer 42

-SQ: Abdomen*, upper arms, thighs - IV: Regular only - Inhalation: Afreeza only

Question 43

What does a continuous subcutaneous insulin infusion device/ Insulin pump do?

Answer 43

It is programmable to deliver individualized basal and bolus insulin replacement only using short acting insulin

Question 44

Factors affecting insulin absorption? (7)

Answer 44

1. Site of injection 2. Type of insulin 3. Subcutaneous blood flow 4. Smoking 5. Muscular activity near site of injection 6. Volume and concentration of injected insulin 7. Depth of injection (more rapid IM than SQ)

Question 45

Time to peak glucose reduction can vary by____?

Answer 45

50%. Can vary insulin to insulin, injection to injection, and person to person

Question 46

What is the most common insulin concentration?

Answer 46

100 units/mL

Question 47

What insulins are available in more concentrated doses?

Answer 47

200 Units/ mL= Dugledec and Lispro 300 units/ mL= Glargine 500 units/ mL= Regular insulin (works as LA)

Question 48

What are insulins side effects?

Answer 48

- Hypoglycemia - Weight gain - Lipodystrophy - Hypersensitivity/ Allergy

Question 49

What are signs and symptoms of hypoglycemia? (13)

Answer 49

-headache -tachycardia -palpitations -sweating -shaking -convulsions -coma -anxious -dizziness -hunger -impaired vision -weakness/ fatigue -irritable

Question 50

How can you prevent lipodystrophy?

Answer 50

Rotating site of injection

Question 51

Why do people get hypersensitivity/allergy to insulin?

Answer 51

Because of the non insulin protein component. You are not actually allergic to insulin as the body naturally produces it.