Type I DM & Insulin Flashcards
Traditional Insulin Preps
Regular and NPH
Regular Insulin PK
Rapidly absorbed & short acting
Onset: 30-60mins
Peak: 2-4 hours
Duration: 5-8 hours
Regular Insulin Use
~30 mins before meal
critical to March dose w/ glucose load
Regular Insulin Admin
IV (clear solution)
NPH Insulin PK
Slower absorption and longer DOA (than regular insulin), neutral pH
Onset: 1-2 hours
Peak: 6-12 hours
Duration: 18-24 hours
NPH Insulin Admin
Cloudy suspension, NOT IV
NPH Insulin use
Between meals
Synthetic Modified Insulin Analogs
Lispro
Aspart
Glulisine
Insulin Lispro PK
Faster onset and shorter DOA (than regular insulin)
Peak: 30-60mins
Duration: 3-4hours
Insulin Lispro Use
Immediately before meals
Insulin Aspart PK
Longer DOA than Lispro
Insulin Aspart Use
Injected @ mealtime
Insulin Glulisine use
Injected before OR after meals
Synthetic Modified Insulin Analog dose/admin
Must have Rx and given IV
Isophane form of rapid insulin analogs
NPA
NPL
NPA/NPL purpose
Combined with protamine to slow action b/w meals
What is the dosing for synthetic ultra-long + rapid analog?
Basal + bolus
Insulin Glargine MOA
Enhanced hexamer formation (to slow absorption and low, constant DOA)
Insulin Glargine vial vs. tissue pH
Vial - 4
Tissue - 7.4
Insulin Glargine PK
Slow absorption, slow and constant DOA
Insulin Glargine Dose
1x/day; usually @ bedtime
Insulin Determir MOA
Myristic acid attached to hind to albumin (prolongs DOA)
Insulin Detemir pH
Neutral
Insulin Detemir Dose
2x/day; somewhat shorter DOA than Glargine
Insulin Detemir
Shorter DOA than Glargine, but still longer than regular
Insulin Degludec MOA
FA chain to promote aggregation & slow release
Insulin Degludec PK
Longer lasting than Glargine & Detemir
DOA: 42 hours
Insulin Degludec Dose
1x/day; anytime of day
PK from rapid/short to slow/long for insulin
Lispro/Aspart/Glulisine —> regular —> NPH (& NP analogs) —> Detemir/Glargine/Degludec
Best method to reduce long term complications of DM? Inherent risk of this approach?
Tight control of Glucose
Hypoglycemia
Type of insulin used by pumps for continuous SC insulin infusion?
Synthetic analogs
Side effects of insulin
Hypoglycemia
Lipodystrophy
Weight gain
Treatment of mild hypoglycemia
Juice, candy, honey, syrup
Treatment of severe hypoglycemia
Glucose prep (tablets, gels, IV)
Counter regulatory hormone of insulin
Glucagon (IM or SC)
Drug that is analog of amylin
Pramlintide
What is amylin?
Peptide hormone released from beta cells with insulin
Pramlintide MOA
Decrease glucagon —> decrease liver glucose —> limit glucose fluctuation
Pramlintide Use
Decrease post-prandial glucose and decrease need for short acting insulin
Pramlintide PK
Slows gastric emptying to improve satiety
Pramlintide dose
3x/day; SC before meals w/ insulin
Why is Pramlintide not frequently used?
Not very powerful and requires lots of injections
Pramlintide contraindications
Decreased GI motility/absorption Renal disease (drug is excreted here)
