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Insulin Types & Glycemic Excursions – Diabetes Medications

by Pravin Shukle, MD
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    00:01 Let's take a look at the profiles, of the different types of insulins that are on the market today.

    00:07 So the rapid acting insulins, sometimes called the ultra rapid acting insulins, are usually given at meal time.

    00:14 There is three different major groups of rapid acting insulins. There is the aspart insulin that peaks at 10 to 20 minutes, there is lispro insulin that peaks at 15 to 30 minutes, and there is glulisine insulin that will peak, a little bit later at about 20 to 30 minutes time.

    00:30 The short acting insulins take a little bit longer but they are still considered short acting.

    00:35 These are the oldest of the insulins, and we call them regular insulins. Trade names include Humulin and Novolin.

    00:43 They peak at around 30 minutes to 60 minutes and they last up to 4 to 12 hours.

    00:52 The intermediate insulins lasts generally in the 12 hour range. They peak at about 1 to 2 hours. We call them intermediate insulins, NPH insulins.

    01:04 The long acting insulins, are the newest insulins out there and they're really starting to become a mainstay of insulin therapy.

    01:12 Detemir insulin peaks around 60 to 90 minutes, and lasts about 24 hours. Glargine insulin doesn't really have a peak time, or at least that's what the marketing information says. There is a bit of a spike at around 3 or 4 hours, but it's not really a clinically relevant spike, it's only relevant on a pharmacology chart, but from a practical point of view, it doesn't really have a peak time and it also lasts about 24 hours. There are actually new insulins out there, that are super long acting insulins that now lasts about 36 to 48 hours, and we will briefly mention them today. As time goes on, they are going to become more and more important.

    01:54 Let's talk about the concept of glycemic excursion. So glycemic excursion really means the difference, between the level at the start of a meal, and at the end of a meal. So if you take a look at your breakfast excursion, that is the largest excursion of the day. Even though lunch and dinner may be larger meals, there is not as much of an excursion.

    02:18 This is going to be really important when we start prescribing insulin.

    02:24 I mentioned to you before that we do have some novel insulins out there. The ultralong-acting insulins have just come on to the market in the last, probably 8 months. Glargine modified insulin has a very very long duration of action probably around 36 hours.

    02:43 Now I also want to talk about inhalational insulins. These very first products were very unsuccessful unfortunately.

    02:50 You can see the first puffer, was really more like a huge beer can than really a puffer. It was quite inconvenient.

    02:57 It had the spacer built into the device. And it wasn't as successful and it ended up getting pulled off the market because of various reasons. There are new insulins out there that are much smaller and perhaps a little bit more palatable, and we'll see if they pick up and take off.

    03:17 Now let's just review the actions of insulin. The actions of insulin does not include.

    03:25 Decreased protein catabolism in myocytes? Decreased protein catabolism in hepatocytes? Decreased protein catabolism in adipocytes, and increased triglyceride storage in adipocytes. Which of these does insulin not include? Well, increased triglyceride storage in adipocytes. That's not a correct answer because we know insulin increases triglyceride.

    03:53 Decreased protein catabolism in adipocytes. That's not correct. Decreased protein catabolism in hepatocytes.

    04:02 And decreased protein catabolism in myocytes. So there you have the correct answer.


    About the Lecture

    The lecture Insulin Types & Glycemic Excursions – Diabetes Medications by Pravin Shukle, MD is from the course Endocrine Pharmacology. It contains the following chapters:

    • Activity Profiles of Different Types of Insulins
    • Glycemic Excursions
    • Question: Drugs in Diabetes

    Included Quiz Questions

    1. Glargine
    2. Lispro
    3. Aspart
    4. Regular
    5. Glulisine
    1. Does not have a peak time.
    2. Lasts 12 hours.
    3. Specially designed to prevent allergic reaction.
    4. Due to its formulation, glargine has multiple concentration peaks throughout the day.
    5. Lasts 48-72 hours.
    1. The change in your blood glucose when measured just before the start of a meal and just after a meal is finished.
    2. The change in blood triglycerides when measured just before the start of a meal and just after a meal is finished.
    3. The change in blood cholesterol when measured just before the start of a meal and just after a meal is finished.
    4. The amount of insulin required to maintain blood sugar a certain level. This is value is calculated over the course of care and adjusted annually.
    5. The distance aerosolized insulin must travel in the formulations of inhaled insulins.

    Author of lecture Insulin Types & Glycemic Excursions – Diabetes Medications

     Pravin Shukle, MD

    Pravin Shukle, MD


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