Insulin Glulisine

Indications

Insulin Glulisine is used for: Diabetes mellitus

Adult Dose

Subcutaneous Diabetes mellitus Dose should be individualised and depends on patient's needs. Usual range: 0.5-1 u/kg/day. Dosing considerations Equipotent to regular human insulin (ie, elicits same glucose lowering effects on unit per unit basis) when administered IV Insulin glulisine has a more rapid onset of action and a shorter duration of action than regular human insulin Dosage must be individualized; blood glucose monitoring is essential in all patients receiving insulin therapy Insulin requirements may be altered during stress, major illness, or with changes in exercise, meal patterns, or coadministered drugs Hepatic impairment: Dose reduction may be needed.

Child Dose

Type 1 Diabetes Mellitus Indicated to improve glycemic control in adults and children with diabetes mellitus <4 years: Safety and efficacy not established 4-17 years: May require 0.8-1.2 units/kg/day SC during growth spurts; otherwise use adult dosing (0.5-1 unit/kg/day)

Renal Dose

Renal impairment: Dose reduction may be needed.

Administration

SC injection Administer within 15 minutes before a meal or within 20 minutes after starting a meal When administered by SC injection, insulin glulisine should generally be used in regimens with an intermediate- or long-acting insulin Administered by SC injection in the abdominal wall, thigh, or upper arm Injection sites should be rotated within the same region (abdomen, thigh or upper arm) from one injection to the next to reduce the risk of lipodystrophy IV administration May be administered IV while under medical supervision for glycemic control with close monitoring of blood glucose and serum potassium to avoid hypoglycemia and hypokalemia When administered IV, use concentrations of 0.05-1 unit/mL in infusion systems using PVC bags Stable only in 0.9% NaCl (normal saline)

Contra Indications

Hypoglycaemia.Hypersensitivity to any of the components.

Precautions

Renal or hepatic impairment. Regular monitoring of blood glucose and HbA1c. Rotate Inj sites to reduce lipodystrophy . Pregnancy, lactation. Lactation: Considered safe during breastfeeding

Pregnancy-Lactation

Pregnancy Available pharmacovigilance data have not established an association with insulin glulisine use during pregnancy and major birth defects, miscarriage or adverse maternal or fetal outcomes; there are risks to mother and fetus associated with poorly controlled diabetes in pregnancy Poorly controlled diabetes in pregnancy increases maternal risk for diabetic ketoacidosis, preeclampsia, spontaneous abortions, preterm delivery, and delivery complications; poorly controlled diabetes increases fetal risk for major birth defects, still birth, and macrosomia related morbidity Animal data Animal reproduction studies have been conducted with insulin glulisine in rats and rabbits using regular human insulin as a comparator; insulin glulisine was given to female rats throughout pregnancy at subcutaneous doses up to 10 units/kg/day (2 times the average human dose, based on body surface area comparison) and to rabbits during organogenesis at subcutaneous doses up to 1.5 units/kg/day (0.5 times the average human dose, based on body surface area comparison); effects did not differ from those observed with subcutaneous regular human insulin Lactation Available data from published literature suggest that human insulin products are transferred into human milk; there are no adverse reactions reported in breastfed infants in literature; there are no data on effects of exogenous human insulin products, on milk production; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed infant or from underlying maternal condition

Interactions

Possible absence of hypoglycaemic warning symptoms with beta-blockers. Decreased hypoglycaemic effect with corticosteroids, danazol, diazoxide, diuretics, glucagon, isoniazid, phenothiazine derivatives, somatropin, sympathomimetic agents, thyroid hormones, oestrogens, progestins (e.g. in oral contraceptives), protease inhibitors and atypical antipsychotics (e.g. olanzapine and clozapine). Increased hypoglycaemic effect with oral antidiabetic agents, ACE inhibitors, disopyramide, fibrates, fluoxetine, MAOIs, pentoxifylline, propoxyphene, salicylates and sulfonamide antibiotics. Decreased insulin resistance with octreotide and lanreotide. Increased risk of wt gain and peripheral oedema with pioglitazone, rosiglitazone. Decreased effect of sermorelin.

Adverse Effects

Side effects of Insulin Glulisine : Hypoglycaemia, Inj site reactions, lipodystrophy, local and systemic hypersensitivity reactions.

Mechanism of Action

Insulin glulisine is a rapid acting human insulin analog produced by recombinant DNA technology using a non-pathogenic laboratory strain of Escherichia coli (K12). Insulin glulisine and insulin human are equipotent on a unit-for-unit basis. Insulin glulisine has a more rapid onset and shorter duration of action compared with insulin human after subcutaneous admin.