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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
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you