APIDRA (Insulin Glulisine)
APIDRA (Insulin Glulisine)
APIDRA (Insulin Glulisine)
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APIDRA (Insulin Glulisine)

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What is this medication?

APIDRA (Insulin Glulisine)
Rapid Acting Insulin

APIDRA (Insulin Glulisine) is officially indicated for Diabetes mellitus types 1 and 2.  It is also used off-label for diabetic ketoacidosis and hyperglycemia during critical illness.

How does this medication work? 

APIDRA (Insulin Glulisine) works on liver, muscle and adipose (fat) tissue to regulate the metabolism of carbohydrates, protein, and fats.  In the liver and muscles, it increases glycogen synthesis which is the immediate storage form of glucose.  It increases fat production by increasing fatty acid release from the liver in the form of lipoproteins which adipose tissue converts to fatty acids then to triglycerides for storage whilst also stopping the metabolism of triglycerides (fat).  Insulin also increases the cellular uptake of amino acids and some electrolytes such as potassium into the cell.  In muscle tissue protein synthesis is increased.

Normally insulin is produced by the pancreas however insulin products for pharmaceutical use have been produced via recombinant DNA technology using certain bacteria (they splice the gene for insulin production into bacterial DNA so the cell produces insulin – a gene is a portion of DNA or RNA that produces one specific protein).  Insulin Glulisine is different from human insulin as it has some modifications to make it work faster.  This is done by swapping the asparagine and lysine found at B3 and B29 in human insulin with a lysine and glutamic acid respectively (these are all names of amino acids which are the building blocks of proteins such as insulin).

How should I take this medication? 

APIDRA (Insulin Glulisine) is a rapid acting mealtime insulin.  It is injected subcutaneously in multiple daily dosages depending on the number of meals the patient consumes.  It should be given 15 minutes prior to the meal up to 20 minutes after the first bite.  In type 2 diabetes someone usually starts around 4-5 units per day or 10% of basal insulin dose prior to largest meal of the day and the dosage is slowly increased until glucose control is achieved.  In type 1 diabetes 50-60% of total daily insulin is given as fast acting mealtime insulin with the rest going to intermediate or long acting basal insulins.  If converting from another insulin the number of units given may need to be lowered as a precaution.

How to Take: Follow instructions provided by physician/pharmacy label, use consistently at same times each day unless otherwise directed. Inject subcutaneously generally into abdomen, thighs, buttocks, or arms with absorption rates varying from site to site.  Be consistent with the part of body you inject into but rotate injection site to avoid redistribution of fat and excessive irritation to the area.  For example, if you choose abdomen which is the most common, inject in circular order at least 2 inches from navel.

You Need to Avoid: Do not use if solution seems viscous (thick) or appears cloudy, only use if clear, colorless and with no visible particles.  Avoid injecting cold insulin as it may be painful.  

What should I watch for while using this medication? 

Before starting APIDRA (Insulin Glulisine), make sure your physician is aware of any allergies or medications you currently take.  Closely monitor your blood glucose levels and make changes to your insulin regimen under medical supervision.  All insulins, including Insulin Glulisine can cause hypoglycemia and hypokalemia which can be life threatening.  If you have hepatic and/or renal impairment, a reduced dose of insulin may be required.

What is the difference between a prefilled pen and a cartridge?

The prefilled pen is in a ready to use format including a fixed needle, whereas a cartridge needle is separate from the glass body.

What if I miss a dose?

Since APIDRA (Insulin Glulisine) is used before meals, you may not be on a timed dosing schedule. Whenever you use Insulin Glulisine, be sure to eat a meal within 15 minutes. Do not use two doses at the same time.

How should I store this medication?

Refrigerate product not in use (36-46°F, 2-8°C), the vial in use may be kept at room temperature (below 86°F, 30°C) for up to 28 days (discard if not used by this point).

What are the possible side effects of using this medication?

Hypoglycemia, injection reaction, nasopharyngitis, upper respiratory injection, headaches, peripheral edema, and arthralgia (joint pain).  Hypoglycemia is the largest concern with rapid acting insulin and can be life-threatening so extra care should be taken when using insulin.  If you feel unsure of your dose contact your health care professional and always err on the side of caution.

Note this is not a complete list of side effects for APIDRA (Insulin Glulisine), only common ones.