From the Guidelines
Alternatives to Apidra (insulin glulisine) include other rapid-acting insulin analogs such as Humalog (insulin lispro) and NovoLog/NovoRapid (insulin aspart), as well as Fiasp (faster-acting insulin aspart). These medications all work similarly to Apidra, beginning to lower blood glucose within 15-30 minutes, peaking in 1-2 hours, and lasting 3-5 hours. They are typically taken just before meals to control post-meal glucose spikes. For patients who need a different option, regular human insulin (Humulin R, Novolin R) can be used, though it has a slower onset (30-60 minutes) and longer duration (5-8 hours), requiring administration 30 minutes before meals. Ultra-rapid insulins like Lyumjev (insulin lispro-aabc) offer even faster onset than traditional rapid-acting analogs. When switching between these alternatives, patients should maintain the same dosing schedule but may need dose adjustments under medical supervision, as potency can vary slightly between products. All these insulins work by facilitating glucose uptake into cells and inhibiting glucose production by the liver, though their molecular modifications create differences in absorption rates and action profiles, as noted in the 2023 American Diabetes Association standards of care in diabetes 1. Key considerations for choosing an alternative include the patient's specific needs, such as the timing of meals and the presence of any comorbid conditions, as well as factors like cost and insurance coverage, with median costs for these insulins ranging widely 1. In clinical practice, the choice of insulin should be individualized, taking into account the patient's lifestyle, preferences, and ability to manage their diabetes regimen, with the goal of achieving optimal glycemic control while minimizing the risk of hypoglycemia and other adverse effects, as discussed in the context of insulin therapy initiation and adjustment 1.
From the FDA Drug Label
1 INDICATIONS AND USAGE HUMALOG is an insulin analog indicated to improve glycemic control in adults and children with diabetes mellitus.
The alternative to Apidra (insulin glulisine) is HUMALOG (insulin lispro), as it is also an insulin analog used to improve glycemic control in adults and children with diabetes mellitus 2.
- Key points:
- Insulin lispro has a similar rapid-acting profile to insulin glulisine
- It can be used as a substitute in the management of diabetes mellitus
- However, dosage adjustments may be necessary due to differences in insulin analogs.
From the Research
Alternatives to Apidra (Insulin Glulisine)
The following are alternatives to Apidra (insulin glulisine) as mentioned in various studies:
- Insulin lispro 3, 4
- Insulin aspart 3, 4
- Regular human insulin (RHI) 3, 4
- Insulin glargine and detemir (basal insulin analogs) 5, 6
- Biosimilars of rapid-acting insulin analogues (e.g. Humalog, Novolog/NovoRapid) 7
Comparison of Alternatives
Some studies have compared the efficacy and safety of these alternatives:
- Insulin glulisine and insulin lispro have similar effects on glucose levels 3
- Insulin glulisine is as effective as insulin lispro in patients with type 1 diabetes 3
- Insulin glulisine has a faster onset and shorter duration of activity than RHI 3, 4
- Basal insulin analogs (glargine, detemir) offer longer duration of action, less variability, and less hypoglycemia compared to human insulins 5, 6
Considerations for Choosing an Alternative
When choosing an alternative to Apidra, considerations should include: