From the Guidelines
Apidra (insulin glulisine) should be initiated at a dose of 4 units or 10% of the amount of basal insulin at the largest meal or the meal with the greatest post-prandial excursion, with subsequent titration based on patient needs and blood glucose monitoring, as recommended by the most recent guidelines 1. The usage and dosage of Apidra in patients with diabetes mellitus are crucial for achieving optimal glycemic control.
Key Considerations
- Apidra is a rapid-acting insulin analog, which means it should be administered within 15 minutes before or within 20 minutes after starting a meal.
- The initial dosing for type 2 diabetes may start at 0.1-0.2 units/kg/day or 4 units before meals, adjusted based on blood glucose monitoring, with people with type 2 diabetes generally requiring higher daily doses (≥1 unit/kg) due to insulin resistance 1.
- Titration can be based on home glucose monitoring or A1C, and with significant additions to the prandial insulin dose, consideration should be given to decreasing basal insulin 1.
- Meta-analyses of trials comparing rapid-acting insulin analogs with human regular insulin in patients with type 2 diabetes have not reported important differences in A1C or hypoglycemia 1.
Administration and Storage
- Apidra should be administered via subcutaneous injection, with the usual starting dose for type 1 diabetes approximately 0.2-0.4 units/kg/day divided between meals.
- When used in insulin pumps, Apidra should be changed every 48 hours, with the infusion set replaced according to pump manufacturer guidelines.
- Patients should monitor for hypoglycemia, rotate injection sites, and store unopened vials in the refrigerator, while opened vials can be kept at room temperature for up to 28 days.
From the FDA Drug Label
APIDRA is a rapid-acting human insulin analog indicated to improve glycemic control in adult and pediatric patients with diabetes mellitus. Individualize and adjust the dosage of APIDRA based on route of administration, individual's metabolic needs, blood glucose monitoring results, and glycemic control goal. Subcutaneous Injection: Inject within 15 minutes before a meal or within 20 minutes after starting a meal into the abdomen, thigh, or upper arm. Continuous Subcutaneous Infusion (Insulin Pump): Refer to the insulin infusion pump user manual to see if APIDRA can be used. Intravenous Administration: Administer only under medical supervision after diluting to concentrations from 0.05 to 1 unit/mL APIDRA in 0.9% sodium chloride injection, USP using polyvinyl chloride infusion bags.
The usage and dosage of Apidra (insulin glulisine) in patients with diabetes mellitus is as follows:
- Indication: Improve glycemic control in adult and pediatric patients with diabetes mellitus.
- Dosage: Individualized and adjusted based on route of administration, metabolic needs, blood glucose monitoring results, and glycemic control goal.
- Administration:
- Subcutaneous injection: Within 15 minutes before a meal or within 20 minutes after starting a meal into the abdomen, thigh, or upper arm.
- Continuous subcutaneous infusion (insulin pump): According to the insulin pump user manual.
- Intravenous administration: Under medical supervision, diluted to concentrations from 0.05 to 1 unit/mL in 0.9% sodium chloride injection, USP. 2 2
From the Research
Usage of Apidra (Insulin Glulisine)
- Apidra (insulin glulisine) is a rapid-acting insulin analogue used for the treatment of diabetes mellitus 3, 4.
- It can be administered immediately before or after meals, providing flexibility in the dosing schedule 3, 4.
- Insulin glulisine has a rapid onset of action, with a peak effect at 1 hour and a shorter duration of action (approximately 4 hours) compared to regular human insulin 3.
Dosage of Apidra (Insulin Glulisine)
- The dosage of insulin glulisine should be individualized based on the patient's needs and glucose monitoring results 4.
- It can be administered via subcutaneous injection or continuous subcutaneous insulin infusion (CSII) 3, 4.
- In patients with type 2 diabetes, a single bolus of insulin glulisine can be added to basal insulin glargine and oral antidiabetic drugs to improve glycemic control 5.
Comparison with Other Insulins
- Insulin glulisine has been compared to other rapid-acting insulins, such as insulin aspart, in terms of its efficacy and safety 4, 6, 7.
- Studies have shown that insulin glulisine is effective in controlling postprandial blood glucose levels, but may have a slightly slower onset of action compared to insulin aspart 6, 7.
- However, insulin glulisine may be a suitable choice for patients with type 2 diabetes who are at high risk of post-exercise hypoglycemia 7.
Special Considerations
- In children with type 1 diabetes, insulin glulisine may not be as effective as insulin aspart in controlling postprandial blood glucose levels 6.
- In patients with type 2 diabetes, the timing of insulin glulisine administration (e.g., before or after meals) may not significantly affect glycemic control 5.