Podcast
Questions and Answers
What is the main characteristic that distinguishes rapid-acting insulins?
What is the main characteristic that distinguishes rapid-acting insulins?
- Rapid onset and short duration of action (correct)
- Moderate onset and moderate duration of action
- Slow onset and long duration of action
- Variable onset and variable duration of action
What is the primary difference between insulin lispro and regular (short-acting) human insulin?
What is the primary difference between insulin lispro and regular (short-acting) human insulin?
- Amino acid sequence
- Synthesis process
- Absorption rate and half-life after subcutaneous injection (correct)
- Duration of action
What distinguishes insulin lispro from human insulin at the molecular level?
What distinguishes insulin lispro from human insulin at the molecular level?
- Removal of two amino acids
- No difference at the molecular level
- Reversal of two amino acids (correct)
- Addition of two amino acids
Which rapid-acting insulin has the shortest onset of action?
Which rapid-acting insulin has the shortest onset of action?
What is the duration of action for rapid-acting insulins?
What is the duration of action for rapid-acting insulins?
What is the primary benefit of insulin lispro over regular (short-acting) human insulin?
What is the primary benefit of insulin lispro over regular (short-acting) human insulin?
What is the primary advantage of injecting insulin lispro just before a meal?
What is the primary advantage of injecting insulin lispro just before a meal?
Which insulin analog was the first to be marketed?
Which insulin analog was the first to be marketed?
What is the primary advantage of insulin aspart over insulin lispro?
What is the primary advantage of insulin aspart over insulin lispro?
What is the primary benefit of insulin glulisine's rapid onset of action?
What is the primary benefit of insulin glulisine's rapid onset of action?
What is the approximate onset of action for rapid-acting insulins?
What is the approximate onset of action for rapid-acting insulins?
What is the primary reason for insulin lispro's similarity to physiologic insulin secretion after a meal?
What is the primary reason for insulin lispro's similarity to physiologic insulin secretion after a meal?
What is the main reason for the U.S. Food and Drug Administration issuing a BLACK BOX WARNING for Afrezza?
What is the main reason for the U.S. Food and Drug Administration issuing a BLACK BOX WARNING for Afrezza?
Which insulin is contraindicated in patients with asthma and chronic obstructive pulmonary disease?
Which insulin is contraindicated in patients with asthma and chronic obstructive pulmonary disease?
What is the primary purpose of evaluating the patient’s spirometry before prescribing Afrezza?
What is the primary purpose of evaluating the patient’s spirometry before prescribing Afrezza?
Where is insulin absorbed most rapidly after subcutaneous injection?
Where is insulin absorbed most rapidly after subcutaneous injection?
Which insulin is of choice during acute situations such as diabetic ketoacidosis (DKA) or severe infection?
Which insulin is of choice during acute situations such as diabetic ketoacidosis (DKA) or severe infection?
Which insulin is often used for long-term insulin therapy?
Which insulin is often used for long-term insulin therapy?
What is the main characteristic of insulin lispro, aspart, or glulisine?
What is the main characteristic of insulin lispro, aspart, or glulisine?
For what purpose are all rapid-acting insulins approved?
For what purpose are all rapid-acting insulins approved?
Which insulin may be used to provide a basal amount of insulin over 24 hours?
Which insulin may be used to provide a basal amount of insulin over 24 hours?
What distinguishes regular insulin from isophane insulin (NPH)?
What distinguishes regular insulin from isophane insulin (NPH)?
What is the insulin of choice for a mixture administered before the morning and evening meals?
What is the insulin of choice for a mixture administered before the morning and evening meals?
Which insulin may be used instead of regular subcutaneous insulin in most situations?
Which insulin may be used instead of regular subcutaneous insulin in most situations?
Which insulin has a rapid onset of action and can be given intravenously?
Which insulin has a rapid onset of action and can be given intravenously?
What is the main insulin concentration in the United States?
What is the main insulin concentration in the United States?
Which insulin is administered at the beginning of every meal?
Which insulin is administered at the beginning of every meal?
Which insulin is used to provide a basal amount of insulin through 24 hours, similar to normal, endogenous insulin secretion?
Which insulin is used to provide a basal amount of insulin through 24 hours, similar to normal, endogenous insulin secretion?
Which insulin is contraindicated in patients with asthma and chronic obstructive pulmonary disease who need insulin?
Which insulin is contraindicated in patients with asthma and chronic obstructive pulmonary disease who need insulin?
Which insulin has been modified by protamine in a neural buffer to slow the absorption and prolong the duration of action?
Which insulin has been modified by protamine in a neural buffer to slow the absorption and prolong the duration of action?
Which insulin is absorbed most rapidly from the abdomen after subcutaneous injection?
Which insulin is absorbed most rapidly from the abdomen after subcutaneous injection?
Which insulin is often used for long-term insulin therapy and can be combined with short-acting insulin for more consistent control of blood glucose levels?
Which insulin is often used for long-term insulin therapy and can be combined with short-acting insulin for more consistent control of blood glucose levels?
Which insulin has a mixture available that is more convenient and probably more accurate than a mixture prepared by a patient or caregiver?
Which insulin has a mixture available that is more convenient and probably more accurate than a mixture prepared by a patient or caregiver?
Which insulin is approved for use in external insulin pumps that administer a continuous subcutaneous infusion?
Which insulin is approved for use in external insulin pumps that administer a continuous subcutaneous infusion?
Which insulin is used to provide a basal amount of insulin over 24 hours, with a short-acting or rapid-acting insulin at meal times?
Which insulin is used to provide a basal amount of insulin over 24 hours, with a short-acting or rapid-acting insulin at meal times?
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Study Notes
Rapid-Acting Insulins
- Characterized by a quick onset of action, allowing for flexibility around meal times.
- Typical onset of action is approximately 15 minutes after injection.
Insulin Lispro vs. Regular Human Insulin
- Insulin lispro differs from regular insulin primarily in its structure, where two amino acids are reversed, leading to rapid absorption.
- Primary benefit of insulin lispro is its rapid action and the ability to align more closely with physiological insulin secretion.
Molecular Distinctions
- Insulin lispro has a unique amino acid sequence compared to human insulin, impacting its absorption and activity profile.
Onset and Duration of Action
- Insulin aspart has the shortest onset of action among rapid-acting insulins, typically around 10-20 minutes.
- The duration of action for rapid-acting insulins is approximately 3-5 hours.
Benefits of Insulin Lispro
- Injecting insulin lispro just before a meal allows patients to better manage postprandial blood glucose levels.
Historical Context
- The first marketed insulin analog was insulin lispro.
Advantages of Insulin Analogues
- Insulin aspart offers a faster absorption rate than insulin lispro, enhancing post-meal glucose control.
- Rapid onset of action in insulin glulisine allows for effective management of blood glucose spikes after meals.
FDA Black Box Warning
- The U.S. FDA issued a BLACK BOX WARNING for Afrezza due to potential risks in patients with respiratory conditions.
Respiratory Considerations
- Afrezza is contraindicated in patients with asthma and chronic obstructive pulmonary disease (COPD).
- Spirometry evaluations are crucial before prescribing Afrezza to assess lung function.
Absorption Sites
- Insulin is absorbed most rapidly from the abdomen following subcutaneous injection.
Insulin Use in Critical Situations
- Regular human insulin is the preferred choice during acute events such as diabetic ketoacidosis (DKA) or severe infections.
Long-Term and Basal Insulin Therapy
- NPH (isophane insulin) is often used for long-term therapy and provides a basal insulin over 24 hours.
- Insulin lispro, aspart, and glulisine share a common feature of rapid action and are approved for mealtime glucose management.
Insulin Comparisons
- Regular insulin differs from NPH insulin in its kinetics; NPH has a delayed onset and prolonged action due to protamine modification.
- Rapid-acting insulins are generally administered at the beginning of every meal for optimal glucose control.
- Insulin glargine is used to maintain a steady baseline insulin level over 24 hours.
Delivery Devices
- Insulin mixtures, such as those preferred before meals, offer convenience and accuracy in managing blood glucose levels.
- Insulin is approved for use in external pumps for continuous subcutaneous infusion, typically utilizing rapid-acting formulations.
Insulin Mixtures and Patient Convenience
- Premixed insulins provide a more accurate and convenient alternative to patient-prepared mixtures, facilitating compliance.
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