Insulin. That's the big one, right?
Here's the medication that we have to use for type 1 diabetics.
It's what tells the body to uptake glucose, amino acids, nucleotides, and potassium.
Would you do me a favor and just circle potassium there? Just as a side note.
I want you to keep in mind that we can use insulin for potassium that's too high.
So sometimes this is used as a treatment for people who have hyperkalemia.
We give them insulin.
Now, clearly we're gonna have to help keep their blood sugar up too
but we can use insulin for nondiabetic patients to treat hyperkalemia.
Now, we'll also promote the synthesis of these organic molecules that you know.
Glycogen and proteins and triglycerides.
So insulin is a pretty complex impact on the whole body.
Have you ever wondered where they come from?
Well, there's sources of insulin.
Recombinant DNA, that's all the insulins that are now manufactured in the United States.
So I wanna talk about human insulin versus human insulin analogs.
Okay, so underline human insulin and then analogs
because I wanna kinda point this out so you can understand and remember the drug names easier.
So both of these categories have the same actions but different time courses.
Okay, so same actions but different time courses.
That's important that you remember that between human insulin and human insulin analogs.
Now, old school, we used to have beef and pork pancreas.
So that's what's used to be available but it's no longer available.
I just want to tell you about it so if someone ask you, you don't look at them like, what?
Yeah, no, it used to happen but we don't offer that in the United States anymore.
We stopped using the beef in the date there and we stopped using the pork in 2006.
So it's been a very long time since we used this but your patients may have some really old information.
Let's talk about where the insulin that we do use and where it comes from.
Now, here's the difference between human insulin and insulin analog.
Human insulin is manufactured when they take a DNA code for making human insulin
and they put it into a bacteria or yeast cells.
Then they purify it and it's sold as human insulin.
So we're not taking it from a donor.
It's not like blood where you can have a blood donor and then you give it.
We're taking the DNA code, we're putting it inside, bacteria or yeast,
then what's produced is purified and sold as human insulin.
Now, insulin analog is an altered form of insulin.
It's different from natural insulin but it's still usable by the human body.
See if you recognize some of these names: Humalog, NovoLog, or Apidra.
That one's not as fun but that's why these drugs have their names of Humalog and NovoLog.
That will help you remember it.
So it's not exactly the same as human insulin but it's able to be used by the body
and do the similar things of insulin.
That's the difference between human insulin and insulin analog, right?
So neither one is coming from a human donor.
They're made in different ways but they both have their uses with diabetic patients.
Now, here's how I recommend you really zeroing in on this slide
and learning these categories for insulin.
You see across the top, we have short duration rapid-acting.
Now, what that means is it doesn't last very long, short duration, and it kicks in really quick.
So rapid-acting means that'll feel the -- they'll feel the effect pretty quickly
but it's not gonna last a long time. Now, how many drug names do we have there?
Good, you can still count at this point. I'm impressed.
So you've got 3: insulin lispro, insulin aspart, and insulin glulisine.
You've got those 3 there.
This slide is worth making copies because this is critically important that you understand that.
I'm not as interested in you memorizing minutes of peak onset and duration.
Maybe you had that in your faculty
but here, this is great information in a way that you can remember it for a long time.
You can remember that these 3 insulins don't last very long but they kick in really quickly.
You can remember that regular insulin doesn't last very long
but it's slower acting than -- right, the category before it.
The third category, intermediate duration.
So that's like NPH or Humulin N or insulin determir.
So I've got short duration rapid-acting, short duration slower-acting, intermediate duration, and long duration.
So really, it's only 3 categories. Short duration, intermediate duration, long duration.
Start there, make sure you have those, then you can break down short duration to rapid-acting and slower-acting.
Make sure that's solid then review the intermediate duration category
and the long duration category.
Okay, this is the way I recommend you putting the information in your brain about insulins.
You honestly can't remember onset peak and duration for 1, 2, 3, 4, 5, 6, 7 -- it's not gonna stick with you.
So do the work of memorizing this information as chunked information
and it'll stick with you much, much longer.
So now, your chance. I know, I know, but do it without looking at your notes.
Ready? Here's your question.
I titled this one 'keeping up appearances'.
See, used to be that all clear insulins were short-acting because regular was the only clear one
but now, there are 4 clear short-acting ones.
We've got them listed there for you and 2 more are clear but they're prolonged-acting.
So that's pretty important that you know that especially
when we talk about the order of insulin being drawn up.
Now, which ones can go IV? What do you think?
Alright, there's the group that can be given IV and the group that cannot be given IV
so make sure you know that when you're reviewing the IV medications for diabetes.
Now, the concentrations of insulin in the US, that's the key, usually is 100 units/mL or U-100.
Now, it does exist 500 units/mL but only Humulin R.
This would be used for very, very severe diabetics.
It's not normally kept on any unit because you obviously can see their risk to patients.
If we had 500 units and 100 units/mL on the same unit,
there's a strong risk for somebody to get 5 times the dose that was ordered.
So we do use it in very special occasions but it's labeled separately, kept separately.
We're really careful with it so we don't overdose our other patients.
You'll predominantly see the 100 units/mL in practice.
Now, mixing insulins, we talked about that.
Why it's important that you remember which one is clear.
We've got a single shot advantage where we mix them
because we can just give it all in one shot
but only NPH is appropriate for mixing with short-acting insulins.
Regular, lispro, aspart, and glulisine. So you draw the short-acting up first.
Good. The short-acting up first. Excellent slide reading there by you.
Now, the mixtures are stable for usually about 28 days
but keep that in mind, you always draw the short-acting one up first.
Now, the temperature of insulin.
If the vial hasn't been opened, it's usually stored under refrigeration as needed
but once the vial has been opened,
we can use it for up to one month without significant impact.
So keep that in mind. How long is insulin good for after it's opened?
Up to one month. Otherwise, watch the expiration date that's stamped right on the label.
Now, it's better if you inject room temperature insulin. Not the super cold insulin.
It's less pain for the patient and they'll cause less lipodystrophy.
So what does that mean?
'Lipo' is referring to fat and 'dystrophy' is like where you have that side effect of injected insulin.
Sometimes diabetics have that so by teaching them to give themselves room temperature insulin,
there's less risk for pain and the longer term effect of lipodystrophy.
Now, we're doing subcutaneous injection.
Those are our options there that you have available for it.
In subcutaneous infusion, it would involve a portable insulin pump
or an implantable insulin pump.
Even patients that are compliant, when they start using a pump,
they have much better glucose control. Problem is, they're a little pricey.
They can be kind of expensive but they're fantastic for maintaining a lower blood sugar control.
So we're talking about sub-q administration, these are the options.
The subcutaneous injections on the left are the single time we give it
but the subcutaneous options on the right involve pumps
and can have continuous administration.