BRAND NAMES
 MECHANISM OF ACTION
Diabetes is a disease in which the body does not produce enough insulin to control the level of blood glucose. Insulin glulisine is a recombinant human insulin analogue that is equipotent to regular human insulin. It differs from human insulin in that the amino acid asparagine at position B3 is replaced by lysine and the lysine in position B29 is replaced by glutamic acid. Insulin glulisine has a more rapid onset of action and a shorter duration of action than regular human insulin. Insulin glulisine starts to work within 15 minutes after injection, peaks in about an hour, and continues working for 2 to 4 hours. The primary activity of insulins and insulin analogues, including insulin glulisine, is regulation of glucose metabolism. Insulins lower blood glucose levels by stimulating peripheral glucose uptake, especially by skeletal muscle and fat, and by inhibiting hepatic glucose production. Insulin inhibits lipolysis in the adipocyte, inhibits proteolysis and enhances protein synthesis.
Insulin glulisine and the other two ultra-fast-acting insulins (insulin lispro, insulin aspart) allow improved control of postprandial glucose compared with regular human insulin, and can be given within 15 minutes before or within 20 minutes after starting a meal.
Insulin glulisine is indicated to improve glycemic control in adults and children with diabetes mellitus.
Insulin glulisine is given by injection under the skin in the abdominal wall, the thigh or the shoulder, or by continuous infusion using an insulin pump. It should be given up to 15 minutes before or just after a meal. The site of injection should be changed with each injection to avoid changes to the skin (such as thickening) that can make the insulin work less well than expected. Patients can inject it under the skin themselves. Insulin glulisine can also be injected into a vein, but this can only be done by a doctor or nurse.
The patient’s blood glucose levels should be regularly tested to find the lowest effective dose. The total daily insulin requirement may vary and is usually between 0.5 to 1 Unit/kg/day.
Insulin glulisine is used in combination with intermediate- or long-acting insulins or insulin analogues (modified forms of insulin). It may also be used in combination with oral antidiabetic medicines.
- Insulin glulisine is contraindicated during episodes of hypoglycemia
- hypersensitivity to Insulin glulisine
 WARNINGS AND PRECAUTIONS
- Closely monitor blood glucose in all patients treated with insulin. Change insulin regimens cautiously and only under medical supervision.
- Hypoglycemia: Most common adverse reaction of insulin therapy and may be life-threatening.
- Allergic reactions: Severe, life-threatening, generalized allergy, including anaphylaxis, can occur with any insulin, including Insulin glulisine
- Hypokalemia: All insulins, including Insulin glulisine can cause hypokalemia, which if untreated, may result in respiratory paralysis, ventricular arrhythmia, and death.
- Renal or hepatic impairment: Like all insulins, may require a reduction in the Insulin glulisine dose.
- Mixing: Insulin glulisine for subcutaneous injection should not be mixed with insulins other than NPH insulin. Do not mix Insulin glulisine with any insulin for intravenous administration or for use in a continuous infusion pump
- Certain drugs affect glucose metabolism and may necessitate insulin dose adjustment:
- Drugs that may enhance the blood-glucose-lowering activity and increase susceptibility to hypoglycemia include: oral antidiabetics, ACE inhibitors, disopyramide, fibrates, fluoxetine, monoamine oxidase inhibitors (MAOIs), pentoxifylline, propoxyphene, salicylates and sulfonamide antibiotics.
- Drugs that may reduce the blood-glucose-lowering activity and increase susceptibility to hyperglycemia include corticosteroids, danazol, diazoxide, diuretics, glucagon, isoniazid, phenothiazine derivatives, somatropin, sympathomimetic medicinal products (e.g. epinephrine [adrenaline], salbutamol, terbutaline), thyroid hormones, estrogens, progestins (e.g. in oral contraceptives), protease inhibitors and atypical antipsychotic medicinal products (e.g. olanzapine and clozapine).
- The signs of hypoglycemia may be reduced or absent in patients taking anti-adrenergic drugs (e.g., beta-blockers, clonidine, guanethidine, and reserpine).
 PREGNANCY AND LACTATION
- Pregnancy Category C (US)
- Use of Insulin glulisine is compatible with breastfeeding, but women with diabetes who are lactating may require adjustments of their insulin doses.
 SIDE EFFECTS
Adverse reactions commonly associated with Insulin glulisine include hypoglycemia, allergic reactions, injection site reactions, lipodystrophy, pruritus, and rash.
 RELATED LINKS
|Diabetes (Antidiabetic drugs)|
|Insulin Secretagogues (drugs that increase insulin release from pancreas)||Sulfonylureas||Chlorpropamide (Diabinese) • Glibenclamide or Glyburide (Diabeta, Micronase, Glynase, Daonil, Euglycon) • Gliclazide (Diamicron) • Glimepiride (Amaryl, Solosa) • Glipizide (Glucotrol, Minidiab, Glibenese) • Gliquidone (Glurenorm)|
|Meglitinides||Repaglinide (Prandin, Novonorm) • Nateglinide (Starlix)|
|Dipeptidyl peptidase-4 inhibitors||Linagliptin (Trajenta) • Saxagliptin (Onglyza) • Sitagliptin (Januvia) • Vildagliptin (Galvus)|
|Incretin mimetics (GLP-1 agonists and analogs)||Exenatide (Byetta) • Liraglutide (Victoza) • Lixisenatide (Lyxumia) • Dulaglutide (Trulicity)|
|Insulin Sensitizers (drugs that decrease insulin resistance)|
|Drugs that retard the digestion and absorption of carbohydrates in the small intestine|
|Alpha-glucosidase inhibitors||Acarbose (Glucobay, Precose)|
|Drugs that reduce glucose absorption in the kidney and increase glucose excretion in the urine|
|Sodium glucose cotransporter 2 (SGLT2) inhibitors||Canagliflozin (Invokana) • Dapagliflozin (Farxiga) • Empagliflozin (Jardiance, Glyxambi, Synjardi)|
|Insulin and insulin analogs|
|Intermediate acting insulins||Insulin lispro protamine (Humalog BASAL) • Isophane human insulin : Human insulin protamine (NPH) (Humulin I, Protaphane)|
|Long-acting insulins||Insulin detemir (Levemir) • Insulin glargine (Lantus)|
|Fast-acting insulins||Regular insulin : Insulin (Human recombinant) (Actrapid, Humulin R)|
|Ultra-rapid-acting insulins||Insulin aspart (Novorapid) • Insulin glulisine (Apidra) • Insulin lispro (Humalog) • Insulin human (Inhalation Powder) (Afrezza)|
|Premixed insulin (ultra-rapid-acting + intermediate acting||Insulin aspart / Insulin aspart protamine (Novomix) • Insulin lispro / Insulin lispro protamine (Humalog Mix)|
|Inhaled Insulin||Insulin human (Inhalation Powder) (Afrezza)|
|Sulfonylurea + Metformin||Glibenclamide / Metformin (Bieuglicon M, Diaglimet, Glibomet, Gliconorm, Glicorest, Suguan M)|
|Thiazolidinedione + Metformin||Pioglitazone / Metformin (Competact, Glubrava)|
|Thiazolidinedione + Sulfonylurea||Pioglitazone / Glimepiride (Tandemact)|
|Dipeptidyl peptidase-4 inhibitors + Metformin||Linagliptin / Metformin (Jentadueto) • Sitagliptin / Metformin (Efficib, Janumet, Velmetia) • Vildagliptin / Metformin (Eucreas)|