Diabetes Treatment: Insulin Types

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Questions and Answers

What is the duration of action for insulin detemir at a dose of 0.4 units/kg?

Up to 42 hours

24 to 30 hours

20 to 24 hours (correct)

12 hours

Which insulin analog is associated with effects lasting up to 42 hours?

Insulin glargine (U-100)

NPH insulin

Insulin detemir

Insulin degludec (correct)

What distinguishes U-300 insulin glargine from U-100 insulin glargine?

It has a peak effect.

It is three times concentrated, leading to a longer duration. (correct)

It requires twice-daily dosing.

It has a faster onset of action.

Why is insulin detemir not used before meals?

It is used for basal glycemic control, not postprandial control. Signup and view all the answers

How does the duration of action of insulin glargine (U-300) compare to NPH insulin?

It lasts longer than NPH insulin. Signup and view all the answers

What is a key characteristic of regular insulin when injected subcutaneously?

It forms aggregates at the injection site causing delayed absorption. Signup and view all the answers

Which type of insulin is suitable for mixing with short-acting insulins?

NPH insulin Signup and view all the answers

Why is NPH insulin not suitable for mealtime administration?

Its absorption is delayed due to protamine. Signup and view all the answers

What is the duration of action for insulin glargine (U-100)?

Up to 24 hours Signup and view all the answers

How does insulin glargine differ from natural human insulin?

It has four additional amino acids. Signup and view all the answers

What is the primary reason most users opt for rapid-acting insulin over regular insulin in pumps?

Regular insulin has a slower onset of action. Signup and view all the answers

Which type of insulin should be injected to control postprandial hyperglycemia?

Regular insulin Signup and view all the answers

What is the typical dosing schedule for NPH insulin?

Twice or three times daily Signup and view all the answers

What is the main purpose of administering short-duration insulins?

To manage postprandial blood glucose spikes Signup and view all the answers

How do insulin lispro and regular insulin differ in terms of administration timing?

Lispro can be administered immediately before or after meals, unlike regular insulin. Signup and view all the answers

Why does insulin lispro act more rapidly than regular insulin?

Two amino acids have been switched in its structure. Signup and view all the answers

What is the onset time for insulin aspart after subcutaneous injection?

10 to 20 minutes Signup and view all the answers

What distinguishes inhaled human insulin from regular insulin injections?

Inhaled insulin has a faster onset and shorter duration than injected regular insulin. Signup and view all the answers

What is the duration of action for insulin glulisine?

3 to 5 hours Signup and view all the answers

Which route of administration is NOT commonly used for regular insulin injections?

Intravenous injection Signup and view all the answers

Which of the following insulin types must be used in conjunction with another agent to provide glycemic control at night for type 1 diabetes patients?

Short-acting insulin Signup and view all the answers

What is a primary characteristic of insulin detemir compared to NPH insulin?

It has a longer duration of action. Signup and view all the answers

Which insulin analog offers effects lasting over 24 hours?

U-300 insulin glargine Signup and view all the answers

Why is insulin degludec particularly beneficial for diabetic patients?

It has effects that persist for up to 42 hours. Signup and view all the answers

What is the main indication for using U-300 insulin glargine?

Once-daily subcutaneous dosing Signup and view all the answers

Which feature is common to both insulin glargine and insulin degludec?

They provide basal glycemic control. Signup and view all the answers

What is the primary action of short-duration insulins in diabetes management?

To control the postprandial rise in blood glucose Signup and view all the answers

Insulin lispro is characterized by its action starting within how many minutes after injection?

15 to 30 minutes Signup and view all the answers

Which of the following statements about inhaled human insulin is accurate?

It alters the action profile when compared to injected regular insulin. Signup and view all the answers

How does the onset of action for insulin aspart compare to insulin lispro?

Both have similar onset times. Signup and view all the answers

What is a key distinction between regular insulin and short-acting insulin analogs like insulin lispro?

Regular insulin requires administration at least 30 minutes before meals. Signup and view all the answers

Which statement correctly describes insulin glulisine?

It is a synthetic analog with a rapid onset and short duration. Signup and view all the answers

What is the typical duration of action for insulin aspart?

3 to 5 hours Signup and view all the answers

Which of the following best describes the structural difference between insulin lispro and regular insulin?

Insulin lispro differs by the position of two amino acids. Signup and view all the answers

What is the primary reason NPH insulin is injected multiple times a day?

To achieve steady blood insulin levels Signup and view all the answers

Which characteristic of insulin glargine allows for its prolonged duration of action?

It creates microprecipitates that dissolve slowly Signup and view all the answers

How does the onset of regular insulin compare to NPH insulin?

Regular insulin has a faster onset and shorter duration Signup and view all the answers

Why might some patients require twice-daily doses of insulin glargine?

To achieve full 24-hour basal coverage Signup and view all the answers

What is a consequence of regular insulin forming aggregates at the injection site?

Slower onset of action compared to rapid-acting insulins Signup and view all the answers

What differentiates insulin detemir from insulin glargine in terms of action?

Insulin detemir causes a steady rise to a peak and fall Signup and view all the answers

For what purpose is regular insulin primarily used?

To control postprandial hyperglycemia Signup and view all the answers

What makes NPH insulin unique among the longer-acting insulins?

It can be mixed with short-acting insulins Signup and view all the answers

What is the main reason insulin detemir is not used for controlling postprandial hyperglycemia?

It is designed for basal glycemic control. Signup and view all the answers

Which statement accurately distinguishes U-300 insulin glargine from U-100 insulin glargine?

U-300 insulin glargine has a concentration three times greater than U-100. Signup and view all the answers

What is a key characteristic of insulin degludec compared to other insulin analogs?

It can last up to 42 hours. Signup and view all the answers

What does the prolonged duration of action of U-300 insulin glargine primarily enable?

It allows for once-daily subcutaneous dosing. Signup and view all the answers

In terms of effectiveness, how does insulin detemir compare with NPH insulin?

Insulin detemir has a longer duration and slower onset. Signup and view all the answers

What is the main reason for using insulin glargine once daily?

It has a prolonged duration of action up to 24 hours. Signup and view all the answers

How does the absorption of NPH insulin compare to regular insulin?

It is absorbed more slowly due to protamine. Signup and view all the answers

What differentiates U-100 insulin glargine from other long-acting insulins?

It forms microprecipitates for slow release. Signup and view all the answers

What is a potential risk associated with the use of NPH insulin?

Allergic reactions due to the presence of protamine. Signup and view all the answers

Why do most patients prefer rapid-acting insulin over regular insulin for pumps?

Rapid-acting insulin has a quicker onset and less delay. Signup and view all the answers

How long does regular insulin typically last after injection?

Up to 10 hours. Signup and view all the answers

What is an implication of injecting regular insulin subcutaneously?

Absorption may be slightly delayed due to aggregation. Signup and view all the answers

What distinguishes NPH insulin in terms of administration frequency?

It is typically injected two or three times a day. Signup and view all the answers

What is the typical onset time for insulin glulisine after subcutaneous injection?

10 to 15 minutes Signup and view all the answers

What unique structural feature distinguishes insulin lispro from regular insulin?

The positions of two amino acids are switched Signup and view all the answers

Which of the following is a characteristic of inhaled human insulin?

It can be used in both type 1 and type 2 diabetes Signup and view all the answers

What is the primary function of short-duration insulins in diabetic management?

To manage postprandial blood glucose spikes Signup and view all the answers

How does the duration of action for insulin aspart compare to insulin lispro?

Insulin aspart has a similar but not identical duration Signup and view all the answers

Which type of insulin requires administration specifically before meals to ensure effectiveness?

Insulin lispro Signup and view all the answers

What is one of the main reasons inhaled human insulin is distinct from regular insulin?

It is delivered in cartridges Signup and view all the answers

When can insulin lispro be administered in relation to meals?

At any time around meal times Signup and view all the answers

Study Notes

Regular Insulin

For diabetes treatment, regular insulin is typically injected before meals to control postprandial hyperglycemia or infused subcutaneously via insulin pump for basal glycemic control.
Subcutaneous injection of regular insulin results in slightly delayed absorption due to the formation of small aggregates at the injection site.
Regular insulin onset of action is 30 to 60 minutes, peaks in 1 to 5 hours, and persists for up to 10 hours.
Regular insulin onset is slower than rapid-acting insulins and faster than longer-acting insulins.
Most insulin pump users prefer rapid-acting insulin analogs over regular insulin due to the delayed onset of regular insulin.

NPH Insulin

NPH insulin (Humulin N, Novolin N) is an intermediate-acting insulin created by conjugating regular insulin with protamine, a large protein.
Protamine reduces the solubility of NPH insulin, delaying absorption and extending its duration of action.
The delayed onset of NPH insulin makes it unsuitable for mealtime administration to control postprandial hyperglycemia.
NPH insulin is typically injected twice or thrice daily to provide glycemic control between meals and overnight.
NPH insulin is the only long-acting insulin currently available for mixing with short-acting insulins.
Allergic reactions may occur due to protamine's foreign protein nature.

Insulin Glargine (U-100)

Insulin glargine (U-100) (Lantus, Basaglar) is a modified human insulin with a prolonged duration of action (up to 24 hours).
U-100 insulin glargine is indicated for once-daily subcutaneous dosing in adults and children with type 1 diabetes and adults with type 2 diabetes.
Some patients may require twice-daily administration to achieve the full 24 hours of basal coverage.
Dosing can be administered at any time of day but should be consistent if possible.
U-100 insulin glargine differs from natural human insulin by four amino acids, forming microprecipitates upon subcutaneous injection that slowly dissolve, releasing insulin glargine gradually.
Unlike other long-acting insulins, insulin glargine achieves relatively steady blood levels, avoiding peak-and-trough fluctuations.

Insulin Detemir

Insulin detemir (Levemir) is a human insulin analog with a slow onset and dose-dependent duration of action.
Effects persist for approximately 12 hours at low doses (0.2 units/kg) and up to 20 to 24 hours at higher doses (0.4 units/kg).
Insulin detemir is used for basal glycemic control due to its slow onset and prolonged duration.
It is not administered before meals to control postprandial hyperglycemia.
Compared to NPH insulin, insulin detemir has a slower onset and longer duration.

Insulin Glargine (U-300)

U-300 insulin glargine (Toujeo) is similar to U-100 insulin glargine but three times concentrated, extending its duration of action beyond 24 hours.
U-300 insulin glargine is indicated for once-daily subcutaneous dosing in both type 1 and type 2 diabetes.
Individuals who do not achieve a full 24 hours of effect with U-100 insulin glargine may benefit from using U-300 insulin glargine due to its extended duration of action.

Insulin Degludec

Insulin degludec (Tresiba) is the only human insulin analog with effects that persist for up to 42 hours.
Insulin degludec is used to provide basal glycemic control due to its prolonged duration.
Similar to insulin glargine, insulin degludec does not have a peak.

Insulin Lispro

Insulin lispro (Humalog) is a rapid-acting analog of regular insulin, with effects starting within 15 to 30 minutes of subcutaneous injection and lasting for 3 to 6 hours.
Insulin lispro acts faster than regular insulin but has a shorter duration.
The rapid onset of insulin lispro allows for administration immediately before or even after eating, unlike regular insulin, which is typically administered 30 to 60 minutes before meals.
Insulin lispro's structure is nearly identical to natural insulin, except for the positions of two switched amino acids.
This structural difference leads to less aggregation of insulin lispro molecules compared to regular insulin, explaining its faster action.

Insulin Aspart

Insulin aspart (NovoLog) is a human insulin analog with a rapid onset (10 to 20 minutes) and short duration (3 to 5 hours).
Insulin aspart is very similar to insulin lispro.

Insulin Glulisine

Insulin glulisine (Apidra) is a synthetic analog of natural human insulin with a rapid onset (10 to 15 minutes) and short duration (3 to 5 hours).
The rapid onset necessitates administration close to mealtime.

Inhaled Human Insulin

Inhaled regular human insulin has a faster onset and shorter duration compared to subcutaneously injected regular insulin.
Inhaled human insulin (Afrezza) is a mealtime insulin product used in people with type 1 and type 2 diabetes.
Afrezza is available in cartridges containing 4, 8, or 12 units each.

Regular Insulin Injection

Regular insulin (Humulin R, Novolin R) is unmodified human insulin.
The product has four approved routes: subcutaneous injection, subcutaneous infusion, and intramuscular injection (rarely used).

Rapid-Acting Insulin Analogs

Insulin lispro (Humalog): Rapid-acting analog of regular insulin; onset within 15-30 minutes, lasts 3-6 hours.
Insulin aspart (NovoLog): Rapid-acting analog, similar to lispro; onset 10-20 minutes, lasts 3-5 hours.
Insulin glulisine (Apidra): Synthetic analog, rapid onset (10-15 minutes), short duration (3-5 hours).
Inhaled human insulin (Afrezza): Mealtime insulin for Type 1 and Type 2 diabetes; acts faster and has shorter duration than injected regular insulin.

Short-Acting Insulin

Regular insulin (Humulin R, Novolin R): Unmodified human insulin; onset 30-60 minutes, peaks 1-5 hours, lasts up to 10 hours.
Absorption: Delayed due to small aggregates forming at the injection site.

Intermediate-Acting Insulin

Neutral protamine Hagedorn (NPH) insulin (Humulin N, Novolin N): Regular insulin conjugated with protamine, delaying absorption and extending duration.
Onset: Delayed, making it unsuitable for mealtime control.
Administration: Injected twice or thrice daily for between-meal and nighttime control.

Long-Acting Insulins

Insulin glargine (U-100) (Lantus, Basaglar): Modified human insulin, prolonged duration (up to 24 hours).
Administration: Once-daily subQ dosing, some patients require twice-daily doses for full coverage.
Mechanism: Forms microprecipitates that slowly dissolve, releasing insulin gradually.
Insulin detemir (Levemir): Human insulin analog with slow onset and dose-dependent duration (12 to 24 hours).
Use: Provides basal control, not for mealtime adjustments.

Ultralong-Acting Insulins

Insulin glargine (U-300) (Toujeo): Three times concentrated U-100 glargine, extending duration beyond 24 hours.
Insulin degludec (Tresiba): Human insulin analog with prolonged effect (up to 42 hours).
No peak: Blood levels remain relatively stable, unlike other long-acting insulins.

Rapid Acting Insulin

Insulin lispro (Humalog) is a rapid-acting analog of regular insulin, effective 15 to 30 minutes after injection with a duration of 3 to 6 hours.
Insulin lispro acts faster than regular insulin, can be administered immediately before or after a meal.
Insulin aspart (NovoLog) is another rapid-acting insulin analog, effective 10 to 20 minutes after injection with a duration of 3 to 5 hours.
Insulin glulisine (Apidra) is a synthetic analog similar to Insulin Lispro and Aspart, effective 10 to 15 minutes after injection with a duration of 3 to 5 hours.
Inhaled human insulin (Afrezza) is a mealtime insulin product for type 1 and type 2 diabetes, available in cartridges containing 4, 8, or 12 units.

Short Acting Insulin

Regular insulin (Humulin R, Novolin R) is unmodified human insulin, onset is 30 to 60 minutes with a peak at 1 to 5 hours and lasting up to 10 hours.
Regular insulin is typically administered 30 to 60 minutes before meals.

Intermediate Acting Insulin

Neutral protamine Hagedorn (NPH) insulin (Humulin N, Novolin N) is a conjugation of regular insulin with protamine, delaying absorption and extending duration.
NPH insulin is administered twice or three times daily to provide glycemic control between meals and during the night.

Long Acting Insulin

Insulin glargine (U-100) (Lantus, Basaglar) is a modified human insulin lasting up to 24 hours, administered once daily for type 1 and 2 diabetes.
Insulin detemir (Levemir) is a human insulin analog with a slow onset and dose-dependent duration, persisting for 12 hours at low doses and up to 20 to 24 hours at higher doses.

Ultralong Acting Insulin

Insulin glargine (U-300) (Toujeo) is a concentrated version of U-100 insulin glargine with a duration exceeding 24 hours, administered once daily.
Insulin degludec (Tresiba) is a human insulin analog with effects lasting up to 42 hours, providing basal glycemic control without a peak.

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Description

This quiz explores the different types of insulin used in diabetes treatment, including regular insulin and NPH insulin. It covers their mechanisms, onset of action, and common administration methods. Test your knowledge on how these insulins affect glycemic control.