Insulin Glulisine

Insulin Glulisine is a rapid-acting human insulin analog produced by recombinant DNA technology using a non-pathogenic laboratory strain of Escherichia coli (K12). It binds to insulin receptors to regulate glucose metabolism, facilitating glucose uptake in muscle and fat cells and inhibiting glucose output from the liver. It has a more rapid onset and shorter duration of action compared with human insulin after subcutaneous administration.

• Improvement of glycemic control in adults and pediatric patients with diabetes mellitus

Adult Dose (Subcutaneous):

• Diabetes Mellitus: 0.5-1 unit/kg/day (individualized)
• Inject within 15 minutes before a meal or within 20 minutes after starting a meal
• Should generally be used in regimens with intermediate or long-acting insulin
• Hepatic impairment: Dose reduction may be needed

Child Dose (Type 1, 4-17 years): 0.8-1.2 units/kg/day during growth spurts; otherwise adult dosing (0.5-1 unit/kg/day)

Side Effects:

• Hypoglycemia
• Allergic reactions
• Injection site reactions
• Lipodystrophy
• Pruritus
• Rash
• Weight gain

Precautions:

• Your ability to drive may be affected if blood sugar is too low or too high
• Hypoglycemia may be life-threatening; increase frequency of glucose monitoring with changes to insulin dosage, coadministered glucose lowering medications, meal pattern, physical activity
• Caution in patients with renal impairment or hepatic impairment or hypoglycemia unawareness
• Hypoglycemia due to medication errors: Check insulin labels before injection
• Hypokalemia: Monitor potassium levels in patients at risk
• Fluid retention and heart failure can occur with concomitant use of TZDs

Contraindications:

• Hypoglycemia
• Hypersensitivity to insulin glulisine or any excipients

Drug Interactions:

• Oral antidiabetic agents, ACE inhibitors, disopyramide, fibrates, fluoxetine, MAOIs, propoxyphene, salicylates, somatostatin analog, sulfonamide antibiotics increase effect
• Corticosteroids, niacin, danazol, diuretics, sympathomimetic agents, isoniazid, phenothiazine derivatives, somatropin, thyroid hormones, oral contraceptives, lithium decrease effect
• Beta-blockers, clonidine, guanethidine, reserpine may blunt signs/symptoms of hypoglycemia

Food Interactions: It is unsafe to consume alcohol with Insulin Glulisine.

Use in Pregnancy: Category C; animal studies have shown adverse effect on fetus; no adequate human studies; potential benefits may warrant use despite potential risks.

Use in Lactation: Unknown whether insulin glulisine is excreted in human milk; caution due to many drugs excreted in human milk; lactating women may require adjustments of insulin doses.

Renal Impairment: Dose reduction may be needed; regular blood glucose monitoring recommended.

Hepatic Impairment: Dose reduction may be needed; regular blood glucose monitoring recommended.

Overdose: Excess insulin may cause hypoglycemia and, particularly when given intravenously, hypokalemia; mild episodes treated with oral glucose; severe episodes (coma, seizure, neurologic impairment) treated with IM/SC glucagon or IV glucose; hypokalemia must be corrected appropriately.