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- 4 short acting insulin
- 1. regular insulin 2. Lispro 3. Aspart 4. Glulisine
- 1 intermediate actiing insulin
- NPH
- 3 long acting insulin
- 1. protamine zinc 2. insulin glargine 3. insulin detemir
- What does NPH consist of
- 2 parts regular insulin and 1 part protamine zinc solution
- Onset and diration of short acting insulins
- 5-15min onset; 4-6hrs duration
- Which insulins are ideal in controling post-prandial glucose excursions and why?
- Lispro, aspart and glulisine because they have rapid onset and short duration
- What is the basal-bolus insulin concept?
- to combine basal insulin strategies to control basal insulin needs throughout day and bolus insulin strategy to control post-prandial excursion glucose
- 3 basal insulin strategies and which one is ideal?
- 1. NPH 2. Detemir 3. Glargine (Ideal)
- What is the problem with NPH?
- It has variable absorption and must be admin BID
- What is the problem of bolus insulin strategy with regular insulin?
- It's inconveniet with slow onset (30-45min)
- Why is it ideal for bolus insulin strategy to have fast onset and short duration?
- Good in controling post-prandial so since onset short, then don't have to wait as long to begin meal. Short duration decreases risk of hypoglycemia 3+ hours after meal
- Modifications of Lispro (Humalog)
- Lysine and proline switched
- Modifications of Aspart (Novolog)
- Aspartate replaces proline at position 28
- Modifications of Glulisine (Apidra)
- Lysine and Glutamate added to B chain
- Modification of Glargine (Lantus)
- Glycine added to A chaine and 2 argenine added to B chain
- Modification of Detemir (Levemir)
- Threonine removed and myristic added to C-terminus of B chain
- What effects do modifications of Lispro, Aspart and Glulisine do?
- They increase pharmakinetics because the modifications won't bind in hexamer as tightly, this allows for dissociation into monomer faster
- MOA of normal insulin
- Insulin complexed with Zn w/hexamer bound to it. First appears as hexamer when injected, then dissociates to dimers then monomers so it can be absorbed in bloodstream (takes a lont time)
- MOA of lispro
- Once injected, it does not self form to hexamers and dimers; if hexamers are present it rapidly dissocitaes into monomers to be absorbed. This creates a faster duration and onset
- MOA of glargine
- Soluble at pH<4. Once injected, it forms microprecipitates at neutral pH to be dissolved and absorbed over a constant rate over 24hours
- Why can't glargine be mixed with other insulin?
- Because of it's low pH 4, it will mess up the other preparations
- 4 adverse rxn of insulin therapy
- 1. insulin reaction 2. insulin resistance 3. allergy 4. weight gain
- What can cause an insulin reaction (hypoglycemic rxn) -4
- 1. overdose of insulin 2. failure to eat 3. low glucose production (ex: from alcohol) 4. lower insulin requirement (ex: from exercise)
- 5 new methods for insulin delivery
- 1. pancreas transplant 2. islet transplant 3. insulin pump 4. inhalation 5. needless injectors
- What is the problem with pancreas transplantation
- Although high success for DMI pts, after transplant, must take immunosuppressant for rest of life
- 4 types of drug interactions w/insulin and their causes
- 1. Drugs can increase/decrease glu levels 2. nicotine can decrease absorption of insulin 3. Bblockers can mask hypoglycemic symptoms 4. Drug abuse-MJ can cause the munchies and impair judgement