Adult Dosing
Diabetes Mellitus
Apidra
- Individualizing regimens with an intermediate or long-acting insulin plus a rapid-acting insulin before meals is common
- 50%-70% of total insulin requirements are usually provided by rapid/ultra-short insulin, with the remaining 30%-50% provided by intermediate or long-acting insulin
- Usual total daily insulin requirements are 0.5-1 U/kg/day SC divided 2-4 times daily; give <15 min before meals
- May infuse SC by an external insulin pump. Diluted insulin should not be used in external insulin pumps. Programming insulin infusion pumps is based on the patient’s usual total daily insulin dose
- Onset approx 15-30 minutes (regular insulin 30-60 minutes), peak approx 1-3 hours, duration 3-5 hours for rapid-acting insulins
- Patient’s need to be aware that insulin dose changes should be done based upon an agreed upon protocol under medical supervision
- Notes
- Rapid Insulin may be administered IV, diluted in 0.9% sodium chloride in concentrations of 0.05-1 unit/mL
- Any change of insulin dose should be made with careful consideration of glucose levels, current dosage and patterns of high and/or low blood glucose levels
- Safety and efficacy in pediatric patients <2 yrs has not been established
- Continuous subcutaneous infusion pump
- Avoid mixing or diluting when using in an external insulin infusion pump
- Intravenous infusion
- Dilute to 0.05-1 unit/mL for IV administration in 0.9% sodium chloride in polyvinyl chloride infusion bags
- Dosing typically 0.1 U/kg/hr as an IV infusion (for DKA) [see separate topic on DKA]
- As with all IV uses of insulin; carefully monitor glycemic response and potassium levels
Pediatric Dosing
Diabetes Mellitus-Children >2 yrs
Apidra
- Individualizing regimens with an intermediate or long-acting insulin plus a rapid-acting insulin before meals is common
- 50%-70% of total insulin requirements are usually provided by rapid/ultra-short insulin, with the remaining 30%-50% provided by intermediate or long-acting insulin
- Usual total daily insulin requirements are 0.5-1 U/kg/day SC divided 2-4 times daily; give <15 min before meals
- May infuse SC by an external insulin pump. Diluted insulin should not be used in external insulin pumps. Programming insulin infusion pumps is based on the patient’s usual total daily insulin dose
- Onset approx 15-30 minutes (regular insulin 30-60 minutes), peak approx 1-3 hours, duration 3-5 hours for rapid-acting insulins
- Patient’s need to be aware that insulin dose changes should be done based upon an agreed upon protocol under medical supervision
- Notes
- Rapid Insulin may be administered IV, diluted in 0.9% sodium chloride in concentrations of 0.05-1 unit/mL
- Any change of insulin dose should be made with careful consideration of glucose levels, current dosage and patterns of high and/or low blood glucose levels
- Safety and efficacy in pediatric patients <2 yrs has not been established
- Continuous subcutaneous infusion pump
- Avoid mixing or diluting when using in an external insulin infusion pump
- Intravenous infusion
- Dilute to 0.05-1 unit/mL for IV administration in 0.9% sodium chloride in polyvinyl chloride infusion bags
- Dosing typically 0.1 U/kg/hr as an IV infusion (for DKA) [see separate topic on DKA]
- As with all IV uses of insulin; carefully monitor glycemic response and potassium levels
- Monitor glucose in patients receiving insulin therapy. Exercise caution while making changes to an insulin regimen and medical supervision is of utmost importance. Adjustment of concomitant oral antidiabetic therapy may be necessary. Modifications of insulin dosages may be necessary in patients changing their level of physical activity or meal plan
- Risk of hypoglycemia increases with tighter glycemic control. Educate patients to recognize and manage hypoglycemia. Unconsciousness and/or convulsions may lead to temporary or permanent impairment of brain function or death on development of severe hypoglycemia
- Severe hypoglycemia may occur requiring the assistance of another person and/or parenteral glucose infusion or glucagon administration. Factors such as changes in food intake, injection site, exercise, and concurrent medications may also alter the risk of hypoglycemia. Hypoglycemia may also result in impairment of patients ability to concentrate and react
- Rapid alterations in serum glucose levels may induce symptoms similar to hypoglycemia in patients with diabetes, regardless of the glucose value. Under certain conditions, such as longstanding diabetes/diabetic nerve disease/use of medications such as beta-blockers/or intensified diabetes control early warning symptoms of hypoglycemia may be different or less pronounced
- Closer monitoring for hypoglycemia is essential on IV administration of insulin as compared to SC administration
- Severe, life-threatening, generalized allergy, including anaphylaxis may occur with insulin products
- Risk of hypokalemia is associated with this drug. If untreated may lead to respiratory paralysis, ventricular arrhythmia, and death. Frequently monitor glucose and potassium when this drug is administered intravenously
- Frequently monitor glucose and insulin dose reduction may be required in patients with renal or hepatic impairment
- For SC administration avoid mixing this drug with insulin preparations other than NPH insulin. If mixed with NPH insulin draw this drug first into the syringe. Inject immediately after mixing. Avoid mixing with other insulins for IV administration or for use in a continuous SC infusion pump. For IV administration avoid dilution of this drug with solutions other than 0.9% sodium NaCl (normal saline). The efficacy and safety of mixing this drug with diluents or other insulins for use in external SC infusion pumps have not been established
- When using in an external insulin pump for SC infusion avoid dilution or mixing of this drug with any other insulin. Change drug in the reservoir at least q48 hrs and avoid exposing to temperatures >98.6°F (37°C). Malfunction of the insulin pump or infusion set or insulin degradation leads to hyperglycemia and ketosis. Promptly identify and correct the cause of hyperglycemia or ketosis. Interim SC injection may be essential. Train patients having continuous SC insulin infusion pump therapy to administer insulin by injection and have alternate insulin therapy available in case of pump failure
- During IV administration closely monitor glucose and potassium levels to avoid potentially fatal hypoglycemia and hypokalemia. Avoid mixing of this drug with other insulins for IV administration. Dilute only in normal saline solution
- Some medications are associated with alterations of insulin requirements and the risk for hypoglycemia or hyperglycemia
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- Infection, illness, or stress
- Hypokalemia
- Patients with hypoglycemia unawareness
- Patients having fast or erratic food intake
- Pediatric patients
- Concomitant use with potassium-lowering medications
- Concomitant use with medications sensitive to serum potassium concentrations
Pregnancy Category:C
Breastfeeding: Unknown whether insulin glulisine is excreted in human milk. Use of this drug is compatible with breastfeeding, but women with diabetes who are lactating may require modifications of their insulin doses. Manufacturer advises caution when this drug is administered to a nursing woman.
Pricing data from www.DrugStore.com in U.S.A.
- Apidra SoloStar 100 UNIT/ML SOLN [Pen] (SANOFI-AVENTIS U.S.)
3 ml = $47.99
9 ml = $130.97
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
