Insulin Types and Functions Quiz

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Questions and Answers

What is the primary purpose of basal insulin?

To cover insulin needs during meals

To regulate blood glucose levels between meals (correct)

To promote weight loss

To provide immediate glucose control

Which insulin type provides coverage for up to 24 hours?

Ultra-long acting insulin

Premixed insulin

Long-acting insulin (correct)

Short-acting insulin

Which of the following is true regarding Neutral Protamine Hagedorn (NPH) insulin?

It requires multiple daily injections due to its short duration. (correct)

It has no distinct peak and lasts more than 24 hours.

It is not typically used as a basal insulin.

It is the most ideal option for basal insulin.

How long before meals should premixed insulin typically be taken?

10 to 30 minutes Signup and view all the answers

What is a characteristic feature of ultra-long acting insulin?

It provides steady insulin coverage for up to 36 hours. Signup and view all the answers

What is a common initial presentation for individuals with inadequate insulin supply?

Ketoacidosis (DKA) Signup and view all the answers

What often triggers the onset of symptoms in individuals with diabetes?

Infection, trauma, or psychological stress Signup and view all the answers

Which of the following is an important blood test for assessing long-term blood sugar control?

Hemoglobin A1c (HbA1c) Signup and view all the answers

Which of the following groups of patients is most likely to be asymptomatic at diagnosis?

Overweight or obese individuals Signup and view all the answers

What is the primary goal of treatment for diabetes?

To prevent or delay long-term complications Signup and view all the answers

What is a disadvantage of using insulin for hyperglycemia management?

Risk of hypoglycemia and weight gain Signup and view all the answers

What is the most commonly used insulin concentration for chronic diabetes management?

100 units/mL (U-100) Signup and view all the answers

Which type of insulin should be reserved for patients with extreme insulin resistance?

U-500 Regular Insulin Signup and view all the answers

What characterizes individuals with prediabetes?

They have abnormal blood glucose but not at diabetes levels Signup and view all the answers

Which type of insulin is considered an insulin analogue?

Insulin lispro Signup and view all the answers

What defines the 'peak time' of an insulin product?

When insulin is at maximum strength Signup and view all the answers

Which type of insulin has the shortest duration of action?

Rapid Acting Insulin Signup and view all the answers

What is a key difference between longer-acting and shorter-acting insulins in terms of hypoglycemia risk?

Shorter-acting insulins pose a higher risk of hypoglycemia Signup and view all the answers

How quickly does rapid-acting insulin typically onset?

15 minutes Signup and view all the answers

What is the usual administration timing for intermediate-acting insulin?

Covers insulin needs for half a day or overnight Signup and view all the answers

What is the maximum duration of regular/short-acting insulin?

6 hours Signup and view all the answers

Which of the following best describes the primary issue in Type 1 Diabetes Mellitus?

Autoimmune destruction of pancreatic β-cells Signup and view all the answers

What percentage of diabetes cases does Type 2 Diabetes Mellitus typically account for?

90–95% Signup and view all the answers

Which of the following factors is commonly associated with the onset of Type 2 Diabetes Mellitus?

Age ≥45 years Signup and view all the answers

What role does amylin play in the context of Type 1 Diabetes Mellitus?

Inhibits glucagon secretion Signup and view all the answers

Which of the following symptoms is commonly associated with the onset of Type 1 Diabetes Mellitus?

Fatigue Signup and view all the answers

In Type 2 Diabetes Mellitus, what is primarily responsible for insulin resistance?

Excessive hepatic glucose production Signup and view all the answers

Which hormonal deficiency is associated with the progression of Type 1 Diabetes Mellitus?

Amylin Signup and view all the answers

What complication can occur if diabetes mellitus is left untreated?

Diabetic ketoacidosis (DKA) Signup and view all the answers

Study Notes

Introduction to Diabetes Mellitus (DM)

DM is a group of metabolic disorders characterized by chronically elevated blood glucose (BG), abnormal carbohydrate, fat, and protein metabolism.
It affects the body's ability to produce and/or utilize insulin.
DM has categories including Type 1 and Type 2.
Without effective treatment, DM can lead to acute complications like diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS).
Chronic hyperglycemia can cause microvascular, macrovascular, and neuropathic complications.

Pathophysiology of Type 1 DM

Type 1 DM affects 5%-10% of cases.
The pancreas does not produce insulin.
It usually results from autoimmune destruction of pancreatic ẞ-cells, leading to absolute insulin deficiency.
This condition can occur in children and adolescents but can also occur at any age.
Amylin, a hormone co-secreted with insulin from pancreatic ẞ-cells, is also deficient in type 1 DM due to ẞ-cell destruction.
Amylin suppresses inappropriate glucagon secretion, slows gastric emptying, and causes central satiety.

Pathophysiology of Type 2 DM

Type 2 DM affects 90%-95% of cases.
It usually occurs in people age 45 or older.
It is characterized by insulin resistance, manifested by excessive hepatic glucose production, decreased skeletal muscle uptake of glucose, and increased lipolysis and fatty acid production.
Over time, impaired insulin secretion occurs, with reduced ẞ-cell mass and function.
The failure and decline in ẞ-cells is progressive.
Incretin effects are also reduced in Type 2 DM; gut incretin hormones are reduced or are not secreted as effectively, decreasing insulin secretion and increasing glucagon release in response to a meal.

Clinical Presentation of Type 1 DM

Patients often have symptoms in the days or weeks before diagnosis.
Common initial symptoms include polyuria, polydipsia, polyphagia, weight loss, fatigue, and lethargy.
Individuals with type 1 DM are often thin and prone to develop DKA in the absence of adequate insulin supply; many patients initially present with DKA.
Symptom onset can be triggered by infection, trauma, or psychological stress.

Clinical Presentation of Type 2 DM

Most patients are asymptomatic or have only mild fatigue at diagnosis.
Many are incidentally diagnosed after routine lab testing (plasma glucose or A1C) or developing complications like myocardial infarction or stroke.
Hemoglobin A1C (HbA1c) is an important blood test that provides an average of blood sugar (glucose) control over the past 2-3 months.
Because mild hyperglycemia can exist for years before diagnosis, microvascular and macrovascular complications are often present at the time of diagnosis.
Most patients are overweight or obese with an elevated waist-to-hip ratio.

Diagnosis of Diabetes Mellitus

Diagnosis is based on criteria for A1C, fasting plasma glucose, and/or two-hour post-load plasma glucose.

Goals of Treatment

The primary goal is to prevent or delay progression of long-term microvascular and macrovascular complications.
Additional goals are alleviating symptoms of hyperglycemia, minimizing hypoglycemia, minimizing treatment burden, and maintaining quality of life.
General glycemic targets for most nonpregnant adults with DM are listed in Table 19-1.

Treatments: Insulin

Endogenous insulin moves glucose from blood into cells.
Two main types exist: regular insulin and insulin analogues such as insulin aspart, lispro, glulisine, detemir.
Advantages: can achieve various glucose targets and allows individualized dosage based on glucose levels.
Disadvantages: potential hypoglycemia, need for injections, weight gain, and treatment burden.
Insulin products are typically administered through subcutaneous injections or inhaled products (except inhaled human insulin).

Treatments: Insulin (Specifics)

Most insulin products are administered (SC) for chronic diabetes management.
Different types of insulin have varying onset, peak, and duration of action.
This includes rapid-acting insulins, short-acting insulins, intermediate-acting insulins, long-acting insulins, ultra-long-acting insulins, and mixed insulins.
Insulin doses, mixtures, type, and administration are tailored to the needs of individual patients.

Treatments: Biguanides

Metformin is an oral medicine for type 2 diabetes.
It decreases hepatic glucose production, enhances insulin sensitivity in peripheral tissues, and allows for increased glucose uptake into muscle cells.
Metformin is generally recommended as first-line pharmacotherapy for patients with DM, unless contraindicated.

Treatments: Sulfonylureas

Sulfonylureas are oral medicines for type 2 diabetes.
They enhance or stimulate insulin secretion by binding to the sulfonylurea receptor on pancreatic ẞ-cells.
Sulfonylureas are used as monotherapy or in combination with other oral or injectable medications (e.g., Glimepiride and Glyburide).

Treatments: Thiazolidinediones (TZDs)

TZDs reduce insulin resistance and improve glycemic control in patients with type 2.
They improve insulin sensitivity in muscle, liver, and fat tissues.
Common TZDs include pioglitazone and rosiglitazone.

Treatments: Alpha-glucosidase Inhibitors

Alpha-glucosidase inhibitors (e.g., acarbose and miglitol) are used to delay carbohydrate absorption after a meal to lower postprandial glucose levels.

Treatments: Amylin Analogs

Pramlintide (Symlin) is a synthetic amylin analog reducing glucagon secretion, slowing gastric emptying, and increasing satiety.
It is used as an adjunctive therapy to improve postprandial glucose levels and A1C in patients with type 1 or type 2 DM.

Treatments: Glucagon-like Peptide-1 Receptor Agonists (GLP-1 RAs)

GLP-1 RAs are incretin hormones, stimulating insulin secretion, reducing postprandial glucagon secretion, and decreasing hepatic glucose output.
Common GLP-1 RAs include dulaglutide, exenatide, exenatide XR, lixisenatide, liraglutide, and semaglutide.
Short acting agents predominately lower postprandial glucose, whereas long acting agents lower both fasting and postprandial glucose.

Adverse Effects

Common adverse effects of medications for diabetes management are reviewed, including hypoglycemia, weight gain, injection site reactions, and respiratory issues.

Storage

Diabetic medications, including insulin, should be stored appropriately.

Other important considerations

The information presented is a brief summary, and individuals should consult a healthcare professional for any health concerns or medical advice.
It is crucial to note that the suggested doses, administration techniques, and other recommendations are not exhaustive and should be tailored based on individual patient's needs and medical conditions.

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Description

Test your knowledge on the different types of insulin, their purposes, and how they are administered. This quiz covers basal insulin, NPH insulin, and premixed insulin timing. Ideal for students studying diabetes management or healthcare professionals.