WorksheetsInsulin Therapy
Total questions: 10
Worksheet time: 7mins
According to UKPDS, 1% HbA1c reduction, reduces complications by
14% Heart attack
21% death related to diabetes
37% microvascular complications
43% Amputations
Prolonged elevation of blood glucose causes:
Oxidative stress
Impaired cardiovascular regulation
Insulin resistance
Structural changes to vessels
Benefits of Insulin therapy
Reduces glucose toxicity
Increases lipotoxicity
Increases insulin resistance
Deteriorate lipid profile
According to ADA guidelines 2020; If injectable therapy is needed to reduce A1C
Consider GLP-1 RA in most prior to insulin
Start basal insulin as first choice
Add prandial therapy to GLP-1 RA
Step wise addition of basal and prandial therapy
Native insulin has A and B chains
A chain has 21 Amino Acids
B chain has 34 Amino Acids
A chain has 20 Amino Acids
B chain has 30 Amino Acids
The short acting human insulins have
Onset of action in 30-60 mins
Duration of action of 10-12 hours
Onset of action in 60-90 mins
Duration of action of 7-8 hours
The premixed insulin analogues include:
NovoMix 30
Novomix 50
Humulog Mix 25
Humulog Mix 50
The structural changes of insulin degludec includes:
Deletion of proline
Addition of glutamic acid spacer
Addition of hexadecandiol acid
Deletion of threonine
Regarding Ryzodeg;
It is the first co-formulation of ultralong acting and short acting insulin
It has Insulin Aspart 70% and Insulin Degludec 30%
Half life of Degludec is 12.1 hours
Steady state reaches in 2-3 days
Structural changes in Insulin Detemir;
Removal of Proline at B30
Removal of Threonine at B30
Addition of Hexadecandiol at B29
Addition of Myristic acid at B29
