Quiz 4: Pharmacotherapy - Insulin

When was insulin first isolated and when was it first used in humans?

Isolated in 1921 from animal sources, used therapeutically in 1922

What was significant about insulin production in 1978?

insulin became the first human protein made via biotechnology (Humulin®, regular insulin

What was the first rapid-acting analog insulin approved in 1996?

Humalog® (insulin lispro)

What is Semglee® (2021) and why is it significant?

The first interchangeable biosimilar insulin product approved by the FDA for diabetes

What is the goal of insulin therapy?

To mimic natural insulin release

Define basal insulin.

A small, continuous amount of insulin always present in the body

Define bolus insulin.

Mealtime insulin given to cover carbohydrate intake

When are rapid and short-acting (bolus) insulins taken?

Before meals; skipped if the meal is skipped

How often is intermediate-acting insulin usually dosed?

Twice daily (BID)

How often is long-acting basal insulin dosed?

Once daily (QD); glargine and detemir may be dosed BID

How are combination insulin products usually dosed?

Twice daily before meals

What is the onset, peak, and duration of lispro (Humalog®)?

Onset: 15-30 min

Peak: 30 min-2.5 hrs

Duration: 3-6.5 hrs

What are the onset, peak, and duration of aspart (Novolog, Fiasp)?

Onset: 10-20 min (Fiasp: 2.5 min; can inject at time of meal)

Peak: 40-50 min

Duration: 3-5 hrs

What are the onset, peak, and duration of glulisine (Apidra)?

Onset: 25 min

Peak: 45-48 min

Duration: 4-5.3 hrs

What are the onset, peak, and duration of inhaled insulin (Afrezza)?

Onset: 12 min

Peak: 35-55 min

Duration: 1.5-4.5 hrs

What are the onset, peak, and duration of regular insulin (Humulin R, Novolin R)?

Onset: 30-60 min (inject 30 min before eating)

Peak: U100 = 2.5-5 hrs; U500 = 4-8 hrs

Duration: 6-8 hrs

Why is regular insulin less convenient than rapid-acting analogs?

Longer onset (30-60 min); must be injected ~30 min before meals

What are the onset, peak, and duration of NPH insulin (Humulin N, Novolin N)?

Onset: 1-2 hrs

Peak: 4-12 hrs

Duration: 14-24 hrs (usually BID dosing)

What are the onset, peak, and duration of detemir (Levemir)?

Onset: 3-4 hrs

Peak: 3-9 hrs

Duration: 6-23 hrs

What are the onset, peak, and duration of glargine (Basaglar, Lantus, Toujeo)?

Onset: U100 = 3-4 hrs; U300 = 6 hrs

Peak: None (flat profile, sometimes mild at 12-16 hrs)

Duration: U100 = 22-24+ hrs; U300 = 36 hrs (more concentrated → longer action)

What are the onset, peak, and duration of degludec (Tresiba)?

Onset: ~1 hr

Peak: None

Duration: ~42 hrs

What is Afrezza®?

rapid-acting inhaled insulin powder available in 4, 8, and 12 unit cartridges

What are contraindications to Afrezza?

Chronic lung diseases (asthma, COPD)

What are common adverse effects of Afrezza?

Hypoglycemia, acute bronchospasm, cough

What is the intermediate-acting basal insulin?

NPH (Humulin N, Novolin N)

What are the long-acting basal insulins?

Detemir (Levemir), Glargine (Lantus, Basaglar, Toujeo), Degludec (Tresiba)

Which basal insulin has the longest duration?

Degludec (up to 42 hours)

What is a biosimilar?

A biologic product highly similar to an FDA-approved biologic with no meaningful differences

What makes an "interchangeable biosimilar" different?

It meets additional standards allowing substitution without a new prescription

ex. semglee

What does U100 mean?

100 units of insulin per mL (the standard concentration)

What safety concern comes with U500 insulin?

It's 5x stronger than U100; requires quadruple checking and special syringes

What are the advantages of concentrated insulins?

Smaller injection volume, more consistent absorption, longer duration, fewer injections

What are examples of intermediate/rapid insulin combos?

Humalog 75/25, Humalog 50/50, Novolog 70/30

What are examples of intermediate/regular insulin combos?

Humulin 70/30, Novolin 70/30

What is an example of a long-acting/rapid combo?

Ryzodeg® (degludec/aspart)

What are pros of intermediate/regular or rapid regimens?

Only 2 injections/day, cheapest insulins, fixed combo products provide basal + bolus

What are cons of intermediate/regular or rapid regimens?

Less flexible, dangerous if meals skipped, doesn't mimic physiologic insulin, more hypoglycemia risk

What are pros of basal/bolus regimens?

Mimics natural insulin release, flexible meals/doses, ideal for carb counting

What are cons of basal/bolus regimens?

More expensive, ~4 injections/day

What is the main goal of basal insulin?

Provide flat profile, long duration, and lower glucose throughout the day

What is the main goal of bolus insulin?

Rapid action to mimic physiologic post-meal spikes and lower glucose after meals