pc5 1.3 pharmacology of injectables for DM

glucose uptake, glycolysis, glycogen synthesis, protein synthesis, uptake of K ions

what does insulin stimulate

gluconeogenesis, glycogenolysis, lipolysis, etogenesis, proteolysis

what does insulin inhibit

units

unit for insulin

U-100

(100 units per 1 mL)

what concentration does insulin usually come in

10 mL

(1000 units per vial)

most vials of insulin contain __ mL

rapid, short acting

bolus insulin includes what kinds of insulins

intermediate, long acting

basal insulin includes what kinds of insulins

insulin aspart, insulin lispro, insulin gllisine, inhaled insulin

rapid acting insulins include what products

regular insulin (humulin R, novolin R, myxredlin)

short acting insulins include what products

insulin NPD(humulin N, novolin N), regular insulin U-500

intermediate insulins include what products

insulin glargine, insulin degludec

long acting insulin include what products

novolog mix 70/30, humalog mix 75/25, humalog mix 50/50, ryzodeg

what mixed insulins have aspart/lispro with rapid acting insulin

humulin 70/30, novolin 70/30

what mixed insulin have regular insulin

novolog mix 70/30, humalog mix 75/25, humalog mix 50/50, ryzodeg

what mixed insulins should be delivered 15 minutes before meals

humulin 70/30, novolin 70/30

what mixed insulins should be delivered 30 minutes before meals

amino acid sequence, addition of protamine/zinc to make slowly absorbed, acidic pH that stabilizes insulin hexamer(glargine)

what is manipulated in insulin development to change onset/peak/duration

15 to 20 minutes

onset of rapid acting insulin

30 minutes

onset of short acting insulin

1.5 to 2 hours

onset of intermediate acting insulin

1 hour

onset of insulin glargine

over 6 hours

onset of insulin glargine U-300

30 to 90 minutes

onset of insulin degludec

45 to 2 hours

peak of rapid acting insulin

2 to 3 hours

peak of short acting insulin

4 to 12 hours

peak of intermediate acting insulin (NPH Regular U-500)

3 to 5 hours

duration of rapid acting insulin

6 to 8 hours

duration of short acting insulin

16 to 24 hours

duration of intermediate-acting insulin

10.8-24 hours

duration of insulin glargine

over 24 hours

duration of insulin glargine U-300

42 hours

duration of insulin degludec

15 minutes before meal or elevated BG

when should rapid acting insulin be taken

yes, up to 20 min

after a meal can rapid acting insulin be administered

no

if you skip a meal should you still take rapid or regular insulin

30 minutes before meals or elevated BG

when should regular insulin be take

once or twice daily

(breakfast and dinner or bedtime)

when should intermediate acting insulin (NPH) and mixed insulin be taken

once daily, consistent times

when should long acting insulin be taken

tresiba

what insulin can be dosed any time of day

e. coli

insulin is produced by recombinant DNA technology using strains of what ___

IV, inhaled, pump

alternative routes for insulin

dose, injection site, blood supply, temperature, physical activity

what an the onset and duration of insulin be affected by

abdomen, arm, buttock, thigh

rank what sites have the fastest insulin absorption

liver

how is insulin metabolized

kidney

how isi insulin excreted

insulin sensitivity

what may increase in severe renal impairment

hypoglycemia, weight gain, skin reactions(lipohypertrophy, lipoatrophy)

AE of insulin

rotate injection sites

how to reduce lipohypertrophy and lipoatrophy in insulin use

increased hypoglycemia

insulin use with other antidiabetic could have what interaction

mask symptoms

insulin use with beta blockers could have what interaction

thiazide diuretics, corticosteroids

insulin use with what drugs could increase glucose

unopened vials/pens

what insulin should be stored in the fridge

in use products

(stability depends on product and device)

what insulin should be stored room temp

long acting insulin

what insulin can not be mixed with other products in the same syringe

regular/rapid acting + NPH

what insulin products can be mixed

NPH

what insulin can be cloudy

dose, timing, when to skip dose, what to do if missed dose, injection technique, storage, recognizing and managing hypoglycemia

what do patients need to be counseled on with insulin use

dry powder

what formulation is inhaled insulin (Afrezza)

cough, hypoglycemia

common side effects of inhaled insulin(afrezza)

spirometry at baseline, 6 months then annually

monitoring in use of inhaled insulin (Afrezza)

how to use inhaler, dose, AE, storage, monitoring/spirometry, recognize and manage hypoglycemia

counseling for Afrezza/inhaled insulin

amylin

what is a peptide produced in pancreatic B cell and secreted with insulin

inhibits glucagon release, delays gastric emptying, improves satiety

effects of binding to amylin receptor

pramlintide

synthetic analog of amylin that has several amino acids altered to improve bioavailability

adjunct therapy to insulin users

(lowers A1c, lowers insulin requirements, weight loss)

what is pramlintide used for

renally

how is pramlintide metabolized

15 mcg SQ before main meal

how is pramlintide dosed for T1DM

60 mcg SQ before main meal

how is pramlintide dosed for T2DM

hypoglycemia, n/v

AE of pramlintide

don't titrate more than every 3-7 days, reduce dose

how to reduce n/v with pramlintide

gastroparesis, other slowing GI motility disorders

pramlintide CI

agents that decrease GI motility, could cause hypoglycemia

pramlintide drug interactions

dose and titration, risk/management of hypoglycemia, educate they take reduced mealtime insulin before starting, n/v will improve with time, titrate q3-7 days

pramlintide counseling points

stimulate insulin with glucose, inhibit gastric emptying, decrease food intake, inhibit glucagon secretion, slow glucose production, protect beta cells from apoptosis, stimulate beta cell proliferation

functions of GLP-1

oral glucose

___ is required for GLP-1 response because GLP-1 works through GI track stimulation

exenatide BID, liraglutide daily, lixisenatide daily

short acting GLP-1 RA agents

exenatide, dulaglutidee, semaglutide, tirzepatidee

long acting GLP-1 RA agents

weekly

how often are long acting GLP-1 RA agents administered

weight loss

beneficial GLP-1 RA AE

n/v, injection site reactions, pancreatitis, pancreatic cancer, thyroid c cell tumor

AE of GLP-1 RA

liraglutide, semaglutide, dulaglutide

what GLP-1 RAs have CV benefits

liraglutide

what GLP-1 RAs have a significant reduction in CVD outcome

- including non fatal MI, non fatal stroke, and CV death

dulaglutide

what GLP-1 RAs have a significant reduction in CVD outcome

- including non fatal stroke, and CV death

semaglutide

what GLP-1 RAs have a significant reduction in lowering non fatal stroke

lixisenatide, ER exenatide

what GLP-1 RAs have no CV benefits

exenatide

what GLP-1 RAs need renal dose adjustment

under 30

what is the crcl cut off for exenatide

FPG

Long acting GLP-1 Ras have a better ___ reduction

PPG

Short acting GLP-1 Ras have a better ___ reduction

lixisenatide + insulin glargine, liraglutide + insulin degludec

what combos exist with GLP-1RAs and basal insulin

insulin

dose adjustments of GLP-1 RA combos with basal insulin are based on what

60 min of AM and PM meal

when is exenatide BID dosed within

consistent time each week, mealtime doesn't matter

besides exenatide BID, when are the other GLP-1 Ras doses

yes

do GLP-1s have similar injection sites to insulin injection

how product works, admin technqiue, storage, AE, recognition/management of hypoglecemia

patient counseling for GLP-1 RAs

if taking other anti diabetic med at the same time

(not likely as monotherapy)

when is hypoglycemia likely when taking a GLP-1 RA