Insulin Glulisine

Insulin Glulisine Brand Names- Apidra | Apidra SoloStar

What is Insulin Glulisine

Insulin glulisine is a rapid-acting insulin analog; the amino acid asparagine at position B3 in regular insulin is replaced by lysine, and the amino acid lysine at position B29 is replaced by glutamic acid.

Insulin glulisine is used in adult and pediatric patients 4 years and older with type 1 diabetes mellitus (DM) and in adults with type 2 DM.

Regular insulin and the rapid-acting insulin analogs (insulin aspart, insulin glulisine, and insulin lispro) are often given as prandial insulin due to their pharmacokinetic profiles.

All of the rapid-acting analogs have a quicker onset of action when compared to regular insulin, reach maximal concentrations faster, have less absorption variation, and have a shorter duration of action.

Regular insulin and the rapid-acting analogs are considered equipotent.

In clinical trials comparing regular insulin to the rapid-acting insulin analogs, improvements in overall glycemic control have been similar; however, the rapid-acting insulin analogs may be superior to regular insulin in improving overall glycemic control when they are used via continuous subcutaneous insulin infusion (CSII).

Also, the rapid-acting insulin analogs may offer greater patient satisfaction and flexibility in dosing as these insulins can be taken from 15 minutes before to 15 minutes after meal initiation versus 30 minutes plus before meals with regular insulin.

Because of their quicker onset and shorter duration of action, the rapid-acting analogs more closely mimic endogenous human insulin secretion after meals providing improvements in postprandial glucose control (a decrease of glucose concentrations postprandially of 21% to 57% when compared to regular insulin) and a lesser need for snacks between meals.

Finally, the rapid-acting analogs decrease the incidence of hypoglycemia including nighttime and severe hypoglycemia, even when hemoglobin A1C concentrations are lower.

Direct comparisons of insulin glulisine, insulin aspart, and insulin lispro have found them to be equally effective in patients with type 1 DM. In the treatment of type 1 DM, insulin therapy may be initiated with a basal-bolus regimen and then further individualized to achieve treatment goals.

In the treatment of type 2 DM, insulin is generally reserved for patients who continue to have an A1C above target despite dual/triple therapy with metformin and other antidiabetic agents.

In patients who need the greater glucose-lowering effect of an injectable medication, GLP-1 receptor agonists (GLP-1 RA) are the preferred choice to insulin.

Evidence from trials comparing GLP-1 RAs and insulin (basal, premixed, or basal-bolus) shows similar or even better efficacy in A1C reduction; GLP-1 RAs have a lower risk of hypoglycemia and are associated with reductions in body weight compared to weight gain with insulin.

In patients who cannot tolerate a GLP-1 RA, or who fail to meet glycemic targets with dual/triple therapy, insulin therapy with basal insulin should be initiated and titrated to target. If the A1C remains above target, prandial insulin, such as insulin glulisine should be added.

Consider initial injectable combination (i.e., GLP-1 RA plus basal insulin or prandial/basal insulin) if A1C is greater than 10% and 2% above target.

Consider the early introduction of insulin if there is evidence of ongoing catabolism, if symptoms of hyperglycemia are present, or when A1C levels (greater than 10%) or blood glucose levels (300 mg/dL or more) are very high.

In patients who are starting on insulin therapy and are taking a thiazolidinedione or sulfonylurea, discontinue or reduce the dose of the oral medication.

Indications

  • type 1 diabetes mellitus
  • type 2 diabetes mellitus

For the treatment of type 1 diabetes mellitus

Side Effects

  1. anaphylactoid reactions
  2. antibody formation
  3. arthralgia
  4. cutaneous amyloidosis
  5. diaphoresis
  6. erythema
  7. headache
  8. hyperinsulinemia
  9. hypertension
  10. hypoglycemia
  11. hypokalemia
  12. infection
  13. influenza
  14. infusion-related reactions
  15. injection site reaction
  16. insulin resistance
  17. insulin shock
  18. lipodystrophy
  19. myalgia
  20. peripheral edema
  21. pharyngitis
  22. pruritus
  23. rash
  24. sinus tachycardia
  25. Somogyi effect
  26. urticaria
  27. weight gain
  28. wheezing

Monitoring Parameters

  • blood glucose
  • glycosylated hemoglobin A1c (HbA1c)

Contraindications

  • breast-feeding
  • coma
  • continuous subcutaneous insulin infusion (CSII) administration
  • cresol hypersensitivity
  • diabetic ketoacidosis
  • diarrhea
  • fever
  • geriatric
  • hepatic disease
  • hyperosmolar hyperglycemic state (HHS)
  • hypoglycemia
  • hypokalemia
  • infection
  • intravenous administration
  • neonates
  • pregnancy
  • renal failure
  • renal impairment
  • surgery
  • thyroid disease
  • tobacco smoking
  • trauma
  • visual impairment
  • vomiting

Interactions

  • Acebutolol
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