INSULIN GLULISINE

INSULIN GLULISINe
(in'su-lyn glu-li'seen)
Apidra
Classifications: hormone; antidiabetic agent; insulin rapid-acting;
Therapeutic: antidiabetic
; insulin rapid-acting
Prototype: Insulin injection (Regular)
Pregnancy Category: C

Availability

100 units/mL multidose (10 mL) vials

Action

Insulin glulisine, formed by recombinant DNA, is a rapid-acting insulin. Insulin lowers blood glucose by stimulating peripheral glucose uptake by skeletal muscle and fat and by inhibiting hepatic glucose production. Insulin causes lipolysis in the adipocytes, inhibits proteolysis, and enhances protein synthesis.

Therapeutic Effect

Insulin glulisine has a more rapid onset of action and a shorter duration of action than regular human insulin; thus, it provides good postprandial blood glucose control.

Uses

Treatment of diabetes mellitus.

Contraindications

Hypoglycemia; systemic allergy to insulin; pregnancy (category C).

Cautious Use

Renal impairment, hepatic dysfunction; thyroid disease; fever; older adults; children; lactation.

Route & Dosage

Diabetes
Adult: SC 5–10 units within 15 min before starting a meal or within 20 min after starting a meal. Dose should be individualized.

Administration

Subcutaneous
  • Give within 15 min before or up to 20 min after a meal.
  • Store refrigerated at 36° F to 46° F (2° C to 8° C). Discard vial if frozen. Protect from light.

Adverse Effects (≥1%)

[See INSULIN (REGULAR)] Body as a Whole: Allergic reactions. Metabolic: Hypoglycemia. Skin: Injection site reactions, lipodystrophy, pruritus, rash.

Diagnostic Test Interference

See INSULIN INJECTION (REGULAR).

Pharmacokinetics

Absorption: 70% bioavailable from injection sites. Onset: 15–30 min. Peak: 55 min. Duration: 3–4 h. Metabolism: In liver with some metabolism in the kidney. Half-Life: 42 min SC.

Nursing Implications

Assessment & Drug Effects

  • Monitor for S&S of hypoglycemia (see Appendix F). Initial hypoglycemic response begins within 15 min and peaks, on average, 40–60 min after injection.
  • Lab tests: Periodically monitor fasting and postprandial blood glucose and HbA1C.

Patient & Family Education

  • Do not inject into areas with redness, swelling, itching, or dimpling.
  • If mixing with NPH human insulin, draw up insulin glulisine first. Inject immediately after mixing.
  • Ingest some form of sugar (e.g., orange juice, dissolved table sugar, honey) if symptoms of hypoglycemia develop, and seek medical assistance.
  • Check blood sugar as prescribed, especially postprandial values; notify physician of fasting blood glucose <80 and >140 mg/dL.
  • Notify the physician of any of the following: fever, infection, trauma, diarrhea, nausea, or vomiting. Dosage adjustment may be needed.
  • Do not take any other medication unless approved by the physician.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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