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Flashcards in Insulin Options Deck (30)
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1

What chemical was added to insulin in 1950 that is still used today to increase the half life of insulin?

Protamine

2

Purified pork insulin 7 then recombinant human insulin virtually eliminated what diabetic complication?

Insulin allergy & immune-mediated lipoatrophy

3

What are older insulins more commonly associated with?

hypoglycemia

4

Weight gain while on insulin is due to what 4 things?

-anabolic effects of insulin
-increased appetite
-defensive eating from hypoglycemia
-Caloric retention r/t decreased glycosuria

5

Insulin is a very common offender in causing ER visits due to hypoglycemia. What is a common reason for this?

Inability to draw up an accurate dose

6

Prandial insulins (Bolus)

Fast acting: Regular

Faster acting: Lispro, aspart, glulisine, human (inhaled)

7

Basal insulins

Intermediate acting: NPH

Long acting: Glargine, determir, degludec

8

Biphasic combination that is commonly used

70% NPH/30% regular

9

What is a pearl about insulin metabolism

Insulin is broken down in the kidney

If CKD, decrease dose to compensate

10

Prandial Insulin MOA

-Act on specific membrane-bound receptors on target tissues to regulate metabolism of carbohydrates, protein, and fats

***Also increases cellular permeability to several ions (K, Mg, phos)

11

Regular insulin pearls

-Cheap
-Good for DM gastroparesis (later onset when gastric emptying occurs)
-less physiologic and causes more hypoglycemia

Take 30 min before meal

12

"Faster" insulin pearls

-superior to regular insulin in reducing postprandial hyperglycemia
-More rapid pharmacodynamics make post-absorptive hypoglycemia less common than in regular insulin
-$$$$ (expensive)

Take right before first bite

13

Faster insulin and exercise

Patients who exercise 1--3 hrs after a meal require dose reduction

14

Inhaled insulin (human)

-expensive
-Not used much
-Pax daddy fatty bong rips

15

Prandial insulin interactions/ADRs

-All agents have longer half life with CKD
-Hypoglycemia
-weight gain

16

NPH pearls

-cheap and familiarity
-Less physiologic, causes more hypoglycemia (nocturnal)
-Erratic pharmacokinetics

17

Glargine: onset, peak, duration, meal timing

-Onset: 1 hr
-Peak: none
-Duration: 24 hrs
-Meal timing: take at same time of the day

18

Detemir: onset, peak, duration, meal timing

-Onset: 1-2 hrs (dose dependent)
-Peak: flat
-Duration: dose dependent, low = 12hrs, high =20-24hrs
-Meal timing: qday = PM meal or hs, BID 12 hrs pAM dose

19

Degludec: onset, peak, duration, meal timing

-Onset: 30-90min
-Peak: none
-Duration: 42 hrs
-Meal timing: no requirements

20

Advantages of Basal Insulin Analogues

-Long duration of actions (qday)
-No peak
-Less nocturnal hypoglycemia

21

Disadvantages of Basal Insulin Analogues

-Generally cannot be mixed with other insulins*
-Slower onset of action
-If OD, prolonged risk of hypoglycemia

22

CI with Basal Insulin Analogues

All agents have a longer half life with CKD*

23

ADRs of Basal Insulin Analogues

Hypoglycemia, weight gain

24

Biphasic Insulins (include onset, peak, duration, admin, timing, color)

70% NPH, 30% regular
-Onset: 30 to 60min
-Peak: 2-12 hrs
-Duration: effective 10-15 hrs
-Admin: SC bid
-Meal timing: 30 min before meal
-Color cloudy

25

Clinical use of biphasic insulins

-For patient unwilling to do >2 injections per day*
-Minimal use overall (duration of action longer in CKD, less flexibility, $$$)

26

Where does insulin rank in comparison to metformin/other oral drugs? Is it first line, second line, etc?

Consider insulin second line after metformin IF A1c is >/= 9%, especially if asymptomatic

27

Rundown of initiating insulin therapy - where do you start, and what are the next three options?

-Start with longer-acting, "basal" insulin once daily
THEN
-Option 1: add GLP-1 agonist, can help limit weight gain due to insulin
-Option 2: add "prandial" insulin at largest meal
-Option 3: switch to premixed insulin BID (less cost)

28

Pearl about sliding scale insulin, w

This chases glucose, doesn't control it

29

Sliding scale insulin options

-Option 1: basal insulin
-Option 2: basal plus short/rapid acting
-Option 3: basal bolus (basal qday or BID plus short-acting before each meal)

30

Options for pregnancy

-Diet/nutritional counseling and exercise
-Oral agents (metformin = B)
-Insulin = gold standard/drug of choice if not controlled with diet/exercise (NPH and regular have the most safety data)