Insulin Types & Glycemic Excursions: Diabetes Medications – Pharmacology | Lecturio

Insulin Types & Glycemic Excursions: Diabetes Medications – Pharmacology | Lecturio

[Music] let’s take a look at the profiles of the different types of insulins that are on the market today so the rapid-acting insulins sometimes called the ultra rata rapid-acting insulins are usually given at mealtime there’s three different major groups of rapid-acting insulin there’s the aspart insulin that peaks at 10 to 20 minutes there’s Liz pro insulin that peaks at 15 to 30 minutes and there’s glue lysine insulin that will peak a little bit later at about 20 to 30 minutes time the short acting insulins take a little bit longer but they’re still considered short acting these are the oldest of the insulins and we call them regular insulins trade names include human and novel n’ they peak at around 30 minutes to 60 minutes and they last up to up to 4 to 4 to 12 hours the intermediate insulins lasts generally in the 12 hour range they peak at about one to two hours we call them intermediate insulins NPH insulin the long-acting insulins are the newest insulins out there and they’re really starting to become a mainstay of insulin therapy Dedham er insulin Peaks around sixty to ninety minute and lasts about 24 hours large E and 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’re going to become more and more important let’s talk about the concept of glycemic excursion so glycemic excursion really means the difference between the level at the start of at the start of a meal and at the end of a meal so if you take a look at your breakfast X version that is the largest excursion of the day even though lunch and dinner maybe larger meals there’s not as much of an excursion this is going to be really important when we start to prescribing insulin I’ve mentioned to you before that we do have some novel insolence out there the ultra long-acting insulins have just come onto the market in the last probably eight months glargine modified insulin has a very very long duration of action probably around 36 hours now I also want to talk about inhalational insolence the these very first products were very unsuccessful unfortunately you can see the first puffer was really more like a huge beer can than really a puffer it was quite inconvenient it had the spacer built into the 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 if they pick up and take off now let’s just review the actions of insulin the actions of insulin does not include decreased protein catabolism and myocytes decreased protein catabolism and hepatocytes decreased protein catabolism in adipocytes and increased triglyceride storage in adipocytes which of these does insulin not include well increased triglyceride storage and adipocytes that’s not a correct answer because we know insulin increases triglyceride decreased protein catabolism and adipocytes that’s not correct decreased protein catabolism in hepatocytes and decreased protein catabolism and myocytes so there you have the correct answer [Music] you


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