Unit 5 - Diabetes 1 Flashcards
What do all patients with type 1 diabetes need treatment with?
Insulin
How is insulin used to manage type 1 diabetes?
Prevent the development of severe hyperglycaemia - ketosis - ketoacidosis - coma - death Decrease microvascular complications - retinopathy - nephropathy - neuropathy Avoid macrovascular complications in later life - cardiovascular - peripheral vascular problems
What is used to mimic the normal physiological secretion of insulin?
Exogenous insulin
What are the principle insulin types?
- rapid acting
- short acting
- intermediate acting
- long actingGIve
Give an example of an ultrarapid acting insulin
Insulin aspart
Describe the onset, timing and duration of insulin aspart
Onset - 5-10 minutes
Timing - 2 minutes before and up to 20 minutes after meals
Duration - 3-5 hours
Give three examples of rapid acting insulins
Insulin lispro
Insulin aspart
Insulin glulisine
Describe the onset, timing and duration of rapid acting insulins
Onset - 10-20 minutes
Timing - 0-15 minutes before or soon after meals
Duration - 2-5 hours
Give two examples of short acting insulins
Insulin soluble
Insulin porcine
Describe the onset, timing and duration of short acting insulins
Onset - 15-30 minutes
Timing - 15-30 minutes before meals
Duration - 6-12 hours
Give an example of an intermediate acting insulin
Isophane insulin
Describe the onset, timing and duration of intermediate acting insulins
Onset - 1-2 hours
Timing - once or twice daily
Duration - 10-12 hours
What are intermediate acting insulins complexed with?
Conventially, insoluble, cloudy suspensions of insulin complexed with either protamine (isophane or NPH insulin) or zinc (lente insulin)
Why do intermediate acting insulins take longer to work?
In order to be active, the insulin must dissociate from the protamine
What are the advantages of using intermediate acting insulins?
Do not need to be co-ordinated with meals
How are long acting insulins administered?
Basal-bolus regimes
How are long acting insulins used?
Alongside rapid-acting insulin analogues in basal-bolus
How are insulin glargine and insulin determir produced?
Using recombinant technology
What is the duration of action of long acting insulins?
Around 24 hours
- a very flat PK profile
What are the advantages of long acting insulins?
Limited peak/trough effects
Limited inter- or intra- patient variability
Describe the onset, timing and duration of insulin detemir
Timing - once or twice daily
Onset - steady state after 2-3 doses
Duration - 24 hours
Describe the onset, timing and duration of insulin glargine
Timing - once daily
Onset - 1.5-2 hours
Duration - 24 hours
Give an example of ultralong acting insulin
Insulin degludec
Describe the onset, timing and duration of insulin degludec
Timing - once daily
Onset - steady state after 2-3 hours
Duration - beyond 42 hours
