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Flashcards in Insulin Options Deck (30)
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1
Q

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

A

Protamine

2
Q

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

A

Insulin allergy & immune-mediated lipoatrophy

3
Q

What are older insulins more commonly associated with?

A

hypoglycemia

4
Q

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

A
  • anabolic effects of insulin
  • increased appetite
  • defensive eating from hypoglycemia
  • Caloric retention r/t decreased glycosuria
5
Q

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

A

Inability to draw up an accurate dose

6
Q

Prandial insulins (Bolus)

A

Fast acting: Regular

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

7
Q

Basal insulins

A

Intermediate acting: NPH

Long acting: Glargine, determir, degludec

8
Q

Biphasic combination that is commonly used

A

70% NPH/30% regular

9
Q

What is a pearl about insulin metabolism

A

Insulin is broken down in the kidney

If CKD, decrease dose to compensate

10
Q

Prandial Insulin MOA

A

-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
Q

Regular insulin pearls

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

Take 30 min before meal

12
Q

“Faster” insulin pearls

A
  • 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
Q

Faster insulin and exercise

A

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

14
Q

Inhaled insulin (human)

A
  • expensive
  • Not used much
  • Pax daddy fatty bong rips
15
Q

Prandial insulin interactions/ADRs

A
  • All agents have longer half life with CKD
  • Hypoglycemia
  • weight gain
16
Q

NPH pearls

A
  • cheap and familiarity
  • Less physiologic, causes more hypoglycemia (nocturnal)
  • Erratic pharmacokinetics
17
Q

Glargine: onset, peak, duration, meal timing

A
  • Onset: 1 hr
  • Peak: none
  • Duration: 24 hrs
  • Meal timing: take at same time of the day
18
Q

Detemir: onset, peak, duration, meal timing

A
  • 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
Q

Degludec: onset, peak, duration, meal timing

A
  • Onset: 30-90min
  • Peak: none
  • Duration: 42 hrs
  • Meal timing: no requirements
20
Q

Advantages of Basal Insulin Analogues

A
  • Long duration of actions (qday)
  • No peak
  • Less nocturnal hypoglycemia
21
Q

Disadvantages of Basal Insulin Analogues

A
  • Generally cannot be mixed with other insulins*
  • Slower onset of action
  • If OD, prolonged risk of hypoglycemia
22
Q

CI with Basal Insulin Analogues

A

All agents have a longer half life with CKD*

23
Q

ADRs of Basal Insulin Analogues

A

Hypoglycemia, weight gain

24
Q

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

A

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
Q

Clinical use of biphasic insulins

A
  • For patient unwilling to do >2 injections per day*

- Minimal use overall (duration of action longer in CKD, less flexibility, $$$)

26
Q

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

A

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

27
Q

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

A

-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
Q

Pearl about sliding scale insulin, w

A

This chases glucose, doesn’t control it

29
Q

Sliding scale insulin options

A
  • 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
Q

Options for pregnancy

A
  • 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)