Endogenous hormone

Mechanism of action
  • Acts on ligand-regulated tyrosine kinase receptor
  • Promotes uptake of glucose from blood into tissues, especially fat, liver, skeletal muscle
  • Promotes glycogen synthesis
  • IV or SC administration
  • Rapid and short acting:
    • Clear solution, neutral pH
    • Rapid onset, short duration
    • e.g. insulin lispro
    • Short-acting regular soluble insulin is used for IV infusion, as it immediately dissociates on dilution and thus is able to be more precisely delivered
  • Intermediate acting:
    • Turbid solution, neutral pH
    • Protamine in phosphate buffer (NPH) to prolong action
    • e.g. insulin aspart protamine
  • Long-acting:
    • Clear solution
    • Slow onset, prolonged action
    • Daily administration mimics basal insulin secretion
    • e.g. insulin glargine
Clinical uses
  • Regulation of blood glucose:
    • Combinations of insulins with different durations of actions (see below) aim to replace basal insulin requirement (50%) and meal requirement (50%) to achieve optimal glycaemic control
  • Hyperkalaemia
  • Calcium channel blocker overdose
Adverse effects
  • Hypoglycaemia
  • Hypoglycaemia unawareness
  • Allergy (usually due to non-insulin contaminants)
  • Immune insulin resistance
  • Lipodystrophy at injection sites

Pharmacology 101

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MBBS (UWA) CCPU (RCE, Biliary, DVT, E-FAST, AAA) Adult/Paediatric Emergency Medicine Advanced Trainee in Melbourne, Australia. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Editor-in-chief of the LITFL ECG Library. Twitter: @rob_buttner

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