Insulin Administration Methods Quiz

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Questions and Answers

When should intermittent SC injections be administered in relation to starting a meal?

Within 15 minutes before to 20 minutes after starting the meal (correct)

After 1 hour of finishing the meal

30 minutes after finishing the meal

At least 1 hour before the meal

What is the onset timing following an SC injection of Regular insulin?

4 hours

2 hours

30 minutes (correct)

5 minutes

What is the duration of action of Regular insulin?

5 to 7 hours (correct)

10 to 16 hours

1 to 3 hours

2 to 4 hours

Why is Neutral Protamine Hagedorn (NPH) insulin not suitable for IV use?

The complex with protamine decreases its solubility and delays absorption Signup and view all the answers

In what clinical situation is Regular insulin typically used intravenously?

In emergency situations like ketoacidosis Signup and view all the answers

What is the clinical use of Neutral Protamine Hagedorn (NPH) insulin?

Maintaining fasting blood glucose levels Signup and view all the answers

What is metformin primarily known for in the treatment of diabetes?

Suppressing glucose production in the liver Signup and view all the answers

How is metformin absorbed into hepatocytes when taken orally?

By interaction with organic cation transporter 1 (OCT1) Signup and view all the answers

Which is a common misconception about the efficacy of metformin compared to sulfonylureas?

Metformin is less comparable to sulfonylureas in terms of efficacy Signup and view all the answers

Which mechanism of action is attributed to metformin's ability to lower hepatic glucose production?

Inhibition of mitochondrial complex 1 Signup and view all the answers

What term describes metformin as an agent that works against high blood sugar levels?

Anti-hypoglycemic Signup and view all the answers

What is the primary target organ of metformin's glucose-lowering effects?

Liver Signup and view all the answers

What is the purpose of continuous subcutaneous insulin pumps?

To deliver a constant 24-hour basal rate of insulin Signup and view all the answers

What are the advantages of using portable pen-sized injectors for insulin administration?

They facilitate subcutaneous injections Signup and view all the answers

What is a notable side effect associated with the rapid-acting inhaled formulation of insulin (Afrezza®)?

Cough and bronchospasm Signup and view all the answers

What makes the standard therapy for insulin treatment different from intensive treatment?

The number of s.c. insulin injections per day Signup and view all the answers

Why is the inhaled formulation of insulin contraindicated in patients with lung disease?

It may cause bronchospasm Signup and view all the answers

How does the inhaled formulation of insulin (Afrezza®) benefit patients in terms of mealtime insulin coverage?

It is effective and convenient for covering mealtime insulin requirements Signup and view all the answers

What contributes to the lowering of glucose production when AMP levels are increased?

Phosphorylation of CBP & CRTC2 Signup and view all the answers

How does increased AMPK activation affect mitochondrial glycerol-3-phosphate dehydrogenase (mGPD)?

Inhibits the enzyme Signup and view all the answers

Why can an accumulation of lactate to dangerous levels occur in some patients taking metformin?

As a result of liver disease Signup and view all the answers

How is metformin eliminated from the body?

Excreted in the urine unchanged Signup and view all the answers

In patients with kidney disease, what indication suggests the risk of lactic acidosis when taking metformin?

Elevated creatinine levels Signup and view all the answers

What role does Adenosine Monophosphate-Activated Protein Kinase (AMPK) play in glucose production?

Inhibits production of gluconeogenic genes Signup and view all the answers

What is the main outcome of thiazolidinediones (TZD)-mediated effects on gene expression?

Increase in the storage of fatty acids as triglycerides in adipocytes Signup and view all the answers

What is the function of GLUT-4 transporter mentioned in the text?

Facilitated transport of glucose into adipocytes and skeletal muscle Signup and view all the answers

Which compound is NOT listed as an enzyme whose expression is increased by thiazolidinediones (TZDs)?

Glycogen phosphorylase Signup and view all the answers

What led to the removal of troglitazone (Rezulin®) from the market?

Severe hepatotoxicity cases Signup and view all the answers

What is the recommended frequency of liver function tests when treating a patient with TZD agents according to the text?

Every 2-3 months for the first year Signup and view all the answers

What is emphasized regarding rosiglitazone (Avandia®) and pioglitazone (Actos®) in the text?

Their serious hepatotoxicity risks are unknown, and caution is advised Signup and view all the answers

Study Notes

Insulin Administration and Pharmacokinetics

Intermittent subcutaneous (SC) injections should be administered approximately 15-30 minutes before a meal.
The onset of action for regular insulin following an SC injection is about 30 minutes.
The duration of action for regular insulin lasts approximately 6 to 8 hours.
Neutral Protamine Hagedorn (NPH) insulin is not suitable for intravenous (IV) use due to its prolonged duration and potential for unpredictable absorption.
Regular insulin is typically used intravenously in critical situations like diabetic ketoacidosis or during surgeries when tight glycemic control is required.

Metformin and Its Mechanisms

Metformin is primarily known for its ability to lower blood glucose levels in type 2 diabetes.
It is absorbed into hepatocytes through facilitated diffusion, mainly using the organic cation transporters.
A common misconception is that metformin is less effective than sulfonylureas in lowering blood sugar when, in fact, it has distinct advantages, including a lower risk of hypoglycemia.
The mechanism by which metformin lowers hepatic glucose production is through the activation of AMP-activated protein kinase (AMPK).
Metformin is classified as an antihyperglycemic agent; it works against elevated blood glucose levels.
The primary target organ for metformin's glucose-lowering effects is the liver.

Insulin Delivery Systems

Continuous subcutaneous insulin pumps aim to provide a steady delivery of insulin, improving overall glycemic control.
Portable pen-sized injectors offer advantages in convenience, precision, and dosing flexibility for insulin administration.
A notable side effect associated with the rapid-acting inhaled formulation of insulin (Afrezza®) is potential lung-related adverse effects, including cough and reduced lung function.
Standard therapy for insulin treatment typically involves fewer injections and less intensive monitoring, contrasting with intensive treatment protocols requiring more frequent dosing and checks.

Considerations for Inhaled Insulin

The inhaled formulation of insulin is contraindicated in patients with any lung disease due to risks of respiratory complications.
Afrezza® provides rapid mealtime insulin coverage, mimicking physiological insulin release and effectively addressing postprandial glucose spikes.
Increased AMP levels contribute to a reduction in glucose production, promoting better glycemic control when AMPK is activated.

Metformin Metabolism and Risks

Metformin is eliminated primarily through the kidneys.
In patients with kidney disease, a reduced glomerular filtration rate (GFR) suggests an increased risk of lactic acidosis, a potentially serious side effect of metformin.

Thiazolidinediones (TZDs) Impact

Adenosine Monophosphate-Activated Protein Kinase (AMPK) plays a critical role in reducing hepatic glucose production through modulation of metabolic pathways.
Thiazolidinediones (TZDs) mediate effects on gene expression, enhancing insulin sensitivity and improving lipid metabolism.
The GLUT-4 transporter facilitates glucose uptake in muscle and fat tissues, playing a key role in overall glucose homeostasis.
Enzymes not included as expressed by TZDs include those related to gluconeogenesis inhibition.
Troglitazone (Rezulin®) was removed from the market due to severe liver toxicity and associated complications.
Regular liver function tests are recommended every 3 to 6 months for patients treated with TZD agents to monitor for potential hepatotoxicity.
Rosiglitazone (Avandia®) and pioglitazone (Actos®) have been emphasized for their efficacy in improving insulin sensitivity, with caution against cardiovascular risks associated with their use.

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Test your knowledge on the administration of insulin, including the timing for intermittent SC injections and the types of insulins that can be administered via external SC infusion pump. Explore questions related to the onset, duration of action, and recombinant human insulin preparations.