D. Pharm Of Insulin

Front 1

What are the 2 types of insulin to know?

Back 1

-Regular insulin
-NPH

Front 2

What type of insulin did we used to give?

Back 2

From beef and pork

Front 3

What type of insulin do we give now?

Back 3

Insulin analogs

Front 4

What is Regular insulin?

Back 4

A clear solution of insulin

Front 5

What is the most important thing to remember about Regular Insulin?

Back 5

It is the ONLY insulin suitable for IV use

Front 6

How are all of the other insulins administered?

Back 6

By subQ injection

Front 7

What is NPH insulin?

Back 7

CLOUDY insulin SUSPENSION

Front 8

Why is NPH insulin a cloudy suspension?

Back 8

Because Insulin is aggregated with protamine and zinc.

Front 9

Why would you want to take NPH insulin?

Back 9

Because the aggregates take longer to break down, so you don't have to take as many shots so often.

Front 10

What is the onset/duration of action of regular vs NPH insulin?

Back 10

Reg: 30min onset, 6hr duration
NPH: 1hr onset, 18-26hr durtn

Front 11

What are Regular vs NPH insulin doses given for?

Back 11

Regular: for meals

NPH: for basal control

Front 12

What is 'Pre-mixed' insulin?

Back 12

A mixture of NPH and regular insulin

Front 13

What does the term "Insulin analogs" refer to in general?

Back 13

Synthetic insulins in which one or more AA's has been changed to yield insulin with very short or long durations.

Front 14

What are the 2 very short acting insulin analogs?

Back 14

-Insulin aspart
-Lispro insulin

Front 15

Why would you want to decrease the onset of effects of regular insulin injections?

Back 15

Bc Regular insulin subQ injections take longer to work than native insulin from pancreas.

Front 16

Why does Regular insulin take longer to work than pancreatic insulin?

Back 16

It tends to form hexamers in solution, which take time to break down.

Front 17

How do lispro insulin and Insulin aspart have shorter onsets than Regular insulin?

Back 17

They more readily form monomers in solution.

Front 18

In addition to quicker onset, what else is quicker with the short-acting insulin analogs?

Back 18

Their duration of effects is also shorter.

Front 19

What is the onset and duration of effects for Insulin aspart and Lispro insulin?

Back 19

Onset = 10 min
Duration = 2 hrs

Front 20

What is the time course of the short-acting insulins similar to?

Back 20

That of the normal meal-induced peak of pancreatic insulin

Front 21

What is the AA change in Lispro insulin?

Back 21

The Pro/Lys at B28 and B29 are switched

Front 22

What is the AA change in Insulin aspart?

Back 22

B28 Proline is replaced by an Aspartic acid residue

Front 23

And what do these AA changes allow for?

Back 23

More ready formation of MONOMERS instead of hexamers in solution.

Front 24

What is the LONGER acting Insulin?

Back 24

Insulin glargine

Front 25

What are the AA changes in Insulin glargine?

Back 25

-Normal Asparagine at A21 is replaced by Glycine
-2 arginines are added onto the C-term of the B-chain

Front 26

What effect do the AA changes in Insulin glargine have?

Back 26

They make it SOLUBLE at ph=4, but LESS soluble at ph=7

Front 27

So what happens when Insulin glargine is injected?

Back 27

It forms a fine precipitant in the interstitial fluids.

Front 28

How long does it take for onset of effects for Insulin glargine? What is its duration?

Back 28

Onset = 4 hrs
Duration = 24-36 hrs

Front 29

What type of pancreatic insulin secretion is Insulin glargine meant to mimic?

Back 29

Basal

Front 30

So the short-acting insulins are:

Back 30

-Regular Insulin
-Lispro insulin
-Insulin aspart

Front 31

The intermediate acting insulin is:

Back 31

NPH

Front 32

The long-acting insulin is:

Back 32

Insulin glargine

Front 33

Which one is Peakless?

Back 33

Insulin glargine

Front 34

What is the GOAL in developing insulin regimens?

Back 34

To keep glucose levels as close to normal, but avoid causing severe insulin reactions (hypoglycemia)

Front 35

Why do we want to keep the blood sugar levels so low?

Back 35

To prevent long term complications of diabetes.

Front 36

What do normal insulin regimens generally consist of?

Back 36

Multiple shots of combined short and intermed or long acting insulins.

Front 37

Why do insulin shots contain mixtures of the different time course insulins?

Back 37

To mimic profiles of insulin levels found in NON diabetic, normal people.

Front 38

What are the intermed/long acting insulins meant to mimic?

Back 38

24hr BASAL insulin secretion

Front 39

What are the short-acting insulins meant to mimic?

Back 39

Nutrient-stimulated insulin secretion

Front 40

When do short-acting insulin shots need to be given to mimic nutrient stim'd secretion?

Back 40

Prior to eating - preprandially

Front 41

What is the classic, Old-Fashioned regimen of insulin therapy?

Back 41

The Split-Mixed regimen - 2 shots, 2 times daily at breakfast and dinner

Front 42

What do the shots contain in the Split-Mixed regimen? What type of Diab is this for?

Back 42

NPH and Regular insulin; for type II dm

Front 43

What is a 3-shot variation of the split-mixed regimen?

Back 43

Still take a shot at bkfst and dinner, but move the NPH at dinner to bedtime so it peaks at 3-7AM.

Front 44

What does the "Basal-Bolus" Regimen of insulin therapy consist of?

Back 44

-Short acting analog shots before each meal
-1 daily shot of longacting Insulin glargine

Front 45

What can't you do when giving the short and long acting shot in the morning though?

Back 45

Can't mix - bc the pH in the vial of Insulin glargine is only 4!

Front 46

For which type of Diabetes is the Basal Bolus regimen typically used?

Back 46

Type I DM

Front 47

What other insulin regimen is typically given for Type I DM?

Back 47

Insulin Pump therapy - continuous subcut insulin

Front 48

Why don't you like insulin side effects?

Back 48

EW it's a HALL

Front 49

What are 6 side effects of insulin?

Back 49

Hypoglycemia
Insulin Allergy
Lipoatrophy
Lipohypertrophy
Edema
Weight gain