L39 Insulins for optimal therapy

The goal of all insulin treatment is to mimic the healthy pancreas’ way of secreting insulin to the blood stream.

Which of these is not a limitation of regular human insulin?

Insulins are first injected as hexamers, but become dimers and monomers which can enter the blood.

Insulins are categorized first by length of action. 1. Rapid-Fast acting Insulin: begins to work approximately [blank_start]15[blank_end] min after injection, peaks in about 1 hour, and continues to work for 2 to 4 hour. This is usually taken directly prior to a [blank_start]meal[blank_end] and in addition to a [blank_start]long[blank_end]-acting insulin. 2. Short-Regular acting Insulin: reaches the bloodstream [blank_start]30[blank_end]min to an hour after injection, peaks anywhere from 2 to 3 hours after Injection, and is effective for approximately 6-8 hours. It is usually given before a meal and in addition to a long-acting insulin. 3. Intermediate acting Insulin: generally reaches the bloodstream about [blank_start]2 to 4[blank_end] hours after injection, peaks 4 to 8 hours later and is effective for about 12 to 18 hours. It is usually taken [blank_start]twice[blank_end] a day and in addition to a [blank_start]rapid- or short[blank_end] acting insulin. 4. Long acting Insulin: starts working several hours after injection and works for approximately [blank_start]24[blank_end] hours. If necessary, it is often used in combination with rapid- or short acting insulin.

Choose the incorrect statement.

Rapid insulins are lispro, aspart, and glulisine. • Lispro - a human analogue which works [blank_start]more[blank_end] quickly than soluble human insulin because the insulin molecule has been changed slightly. Through [blank_start]recombinant[blank_end] DNA technology, the final lysine and proline residues on the C-terminal end of the [blank_start]B[blank_end]-chain are reversed. This modification does not alter receptor binding, but blocks the re-formation of insulin [blank_start]dimer and hexamers[blank_end]. It is sold under the brand name [blank_start]Humalog[blank_end]. • Aspart - a human analogue which also works [blank_start]faster[blank_end] than soluble human insulin because of a substitution which reduces the tendency of the insulin to form [blank_start]hexamers[blank_end]. Sold under the brand name [blank_start]Novolog[blank_end].

Which of these is not a short acting regular human insulin brand?

Humulin N and Novolin N are the most common brands of NPH insulin, which is intermediate acting.

The delayed release of insulin from protamine complexes causes NPH insulin to last longer than soluble human insulin.

Insulin glargine, marketed under the brand name [blank_start]Lantus[blank_end], is a human insulin analogue. After injection, micro-[blank_start]crystals[blank_end] slowly release insulin for about 24 hours. It uses pH reactions to form micro-precipitates under the skin, which create the time-release action. Insulin glargine differs from human insulin by replacing asparagine with [blank_start]glycine[blank_end] in position 21 of the [blank_start]A[blank_end]-chain, and by carboxy-terminal extension of [blank_start]B[blank_end]-chain by 2 [blank_start]arginine[blank_end] residues. The arginine amino acids shift the isoelectric point from a pH of 5.4 to 6.7, making the molecule more soluble at an [blank_start]acidic[blank_end] pH and less soluble at [blank_start]physiological[blank_end] pH. This allows for the subcutaneous injection of a [blank_start]clear[blank_end] solution with [blank_start]peakless[blank_end] dissolution and absorption for at least 24 hours.

Pre-mix insulin analogues mimic physiological insulin secretion.

Pre-mix insulin analogues are a mixture of short or fast acting insulin and long acting insulins.