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34 Cards in this Set
- Front
- Back
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In solution, how does insulin tend to aggregate?
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into hexamers around a zinc molecule
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What two drugs are in the modified human insulin class?
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Regular insulin (hexamers in a Zn2+ buffer) --> solution
Neutral Protamine Hagedorn (NPH) --> Medium-sized crystals in a protamine-Zn2+ buffer (suspension) |
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what is the duration of regular insulin?
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short acting (6-8 hrs)
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what is the duration of NPH insulin?
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intermediate acting (12-20 hrs)
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Name some rapid acting insulin analogs
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Aspart
Glulisine Lispro |
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Name some long acting insulin analogs
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Glargine
Detemir Levemir |
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what is the principle behind rapid acting insulins?
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amino acid changes cause the molecules to repel each other and remain monomers instead of aggregating --> faster absorption
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Regular or Fast-acting: Which insulin has better postprandial BG control?
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Fast-acting (Aspart, Glulisine, Lispro)
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Explain the idea behind the long acting insulin Glargine (Lantis)
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Injection of acidic solution
precipitates in subq tissue slow dissolution of free glargine hexamers from precipitate protracted insulin |
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How long does Glargine (Lantis) last?
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24 hours
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Explain the idea behind the long acting insulin Levemir
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a fatty acid side chain binds to albumin after injection
this buffers the insulin and causes the long lasting effect |
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How long does Levemir last?
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Between NPH and Glargine
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which sites of injection are insulins most readily absorbed?
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abdomen > arm > thigh
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where should pts inject short acting insulins?
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abdomen
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where should pts inject long acting insulins?
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thigh
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what is the rationale behind the twice-daily split-mixed (regular + NPH) regimen?
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regular insulin limits postprandial hyperglycemia after breakfast and dinner
NPH before breakfast (dinner) limits glycemia in afternoon (early hours of morning) |
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What is a limitation of the twice-daily split-mixed regimen?
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attempts to increase dinnertime NPH to control the next morning's BG increases risk of nocturnal hypoglycemia
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What is the rationale behind the multiple daily injections (MDI) regimen of NPH + mealtime regular?
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more physiologic than twice-daily method
pts can adjust prandial regular insulin dose relative to the food intake |
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What are some limitations of the MDI method consisting of NPH and regular insulin?
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regular insulin should be injected 30 minutes before a meal
potential for mismatch if unsure of food intake regular insulin lasts 4-6hrs so it is still active long after eating --> risk of low BG |
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What is another MDI combination that mitigates the limitations of using NPH and regular insulin?
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Inject Lispro (rapid) at mealtime and Glargine (Lantis) at bedtime.
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What is the basal/bolus dose regemin?
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It's the same as MDI
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What is the average daily insulin requirement for T1DM?
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0.6U/kg/day
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Using the basal/bolus method, how much is long acting and how much is short acting?
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50-50
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For pts on the split-mixed regimen, what determines fasting glucose levels (in the am)?
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prior evenings intermediate dose (NPH at dinner)
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For pts on the split-mixed regimen, what determines pre-lunch glucose levels?
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morning short-acting insulin
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For pts on the split-mixed regimen, what determines pre-dinner glucose levels?
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morning intermediate-acting insulin
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For pts on the split-mixed regimen, what determines bedtime glucose levels?
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pre-dinner short acting dose
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For pts on the basal/prandial (rapid+long acting) regimen, what determines the fasting glucose?
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prior night's long acting dose (glargine)
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For pts on the basal/prandial (rapid+long acting) regimen, what determines the pre-supper, pre-bedtime, and pre-lunch blood glucose level?
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short acting dose at the previous meal
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how do you explain a pt having fasting hyperglycemia and normal to high glucose levels at 3am?
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GH and cortisol cause blood glucose levels to rise
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If you have a pt with fasting hyperglycemia but 3am BG is low, what do you do?
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decrease the bedtime insulin dose
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What is lipoatrophy?
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immune-mediated condition in which there is a loss of fat at insulin injection sites. More common w/ cow/pig insulins
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What is lipohypertrophy?
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non-immunological SE of insulin resulting from repeated admin at the same site.
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Insulin pumps allow the pt to adjust their __ insulin levels
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basal
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