section name header

Pronunciation ⬇

IN-su-lin gloo-LYE-seen

Classifications ⬆ ⬇

Therapeutic Classification: antidiabetics, hormones

Pharmacologic Classification: pancreatics

Indications ⬆ ⬇

BEERS REMS, High Alert

Action ⬆ ⬇

  • Lowers blood glucose by:
    • stimulating glucose uptake in skeletal muscle and fat,
    • inhibiting hepatic glucose production.
  • Other actions of insulin:
    • inhibition of lipolysis and proteolysis,
    • enhanced protein synthesis.
  • A rapid-acting insulin with more rapid onset and shorter duration than human regular insulin; should be used with an intermediate- or long-acting insulin.
Therapeutic effects:
  • Control of hyperglycemia in diabetic patients.

Pharmacokinetics ⬆ ⬇

Absorption: Very rapidly absorbed from SUBQ administration sites.

Distribution: Identical to endogenous insulin.

Metabolism/Excretion: Metabolized by liver, spleen, kidney and muscle.

Half-Life: 42 min.

Time/Action Profile ⬆ ⬇

(hypoglycemic effect)

ROUTEONSETPEAKDURATION
SUBQwithin 15 min1–2 hr3–4 hr





Contraind./Precautions ⬆ ⬇

Contraindicated in:

Use Cautiously in:

Adv. Reactions/Side Effects ⬆ ⬇

Endo: HYPOGLYCEMIA

F and E: hypokalemia

Local: cutaneous amyloidosis, lipodystrophy, pruritus, erythema, swelling

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS)

Interactions ⬆ ⬇

Drug-drug:

Drug-Natural Products:

Route/Dosage ⬆ ⬇

  • SC IV (Adults and Children ≥4 yr): Dose depends on blood glucose, response, exercise level, and many other factors. Should be administered within 15 min before a meal or within 20 min after starting a meal. May be given as an injection or via an external infusion device.

Availability ⬆ ⬇

  • Solution for injection (vials and prefilled pens): 100 units/mL

Assessment ⬆ ⬇

  • Assess patient for signs and symptoms of hypoglycemia (anxiety; restlessness; tingling in hands, feet, lips, or tongue; chills; cold sweats; confusion; cool, pale skin; difficulty in concentration; drowsiness; nightmares or trouble sleeping; excessive hunger; headache; irritability; nausea; nervousness; tachycardia; tremor; weakness; unsteady gait) and hyperglycemia (confusion; drowsiness; flushed, dry skin; fruit-like breath odor; rapid, deep breathing; polyuria; loss of appetite; nausea; vomiting; unusual thirst; stomach pain; rapid heart rate) periodically throughout therapy.
  • Monitor body weight periodically. Changes in weight may necessitate changes in insulin dose.
  • Assess patient for signs of allergic reactions (rash, shortness of breath, wheezing, rapid pulse, sweating, low BP) during therapy.

Lab Test Considerations:

  • Monitor blood glucose every 6 hr during therapy, more frequently in ketoacidosis and times of stress. A1C may be monitored every 3–6 mo to determine effectiveness of therapy.
    • Monitor serum potassium in patients at risk for hypokalemia (those using potassium-lowering agents, those receiving IV insulin) periodically during therapy.

Toxicity and Overdose:

  • Overdose is manifested by symptoms of hypoglycemia. Mild hypoglycemia may be treated by ingestion of oral glucose. Severe hypoglycemia is a life-threatening emergency; treatment consists of IV glucose, glucagon, or epinephrine. Early signs of hypoglycemia may be less pronounced by long duration of diabetes, diabetic nerve disease, and use of beta blockers; may result in loss of consciousness prior to patient's awareness of hypoglycemia.

Implementation ⬆ ⬇

  • Medication errors involving insulins have resulted in serious patient harm and death. Clarify all ambiguous orders, and do not accept orders using the abbreviation “u” for units, which can be misread as a zero, or the numeral 4 and has resulted in tenfold overdoses. Insulins are available in different types and strengths. Check type, dose, and expiration date with another licensed nurse. Do not interchange insulins without consulting health care professional.

  • Do not confuse Apidra with Spiriva.
  • Due to the short duration of action, insulin glulisine must be used with a longer acting insulin or insulin infusion pump therapy.
    • Use only U-100 insulin syringes to draw up dose.
    • When mixing insulins, draw insulin glulisine into syringe first to avoid contamination of insulin glulisine vial. May be mixed only with NPH insulin. Administer immediately after mixing. Solution should be clear and colorless with no particulate matter.
    • Store unopened vials of insulin glulisine in refrigerator. Keep open vials refrigerated or as cool as possible. Use within 28 days. Do not use vials past expiration date.
  • SC: When used as mealtime insulin, administer 15 min before or within 20 min after starting a meal. Administer into abdominal wall, thigh, or upper arm SUBQ. Rotate sites with each injection to prevent lipodystrophy and cutaneous amyloidosis. Repeated insulin injections into areas of localized cutaneous amyloidosis may cause hyperglycemia; a sudden change to an unaffected injection site may cause hypoglycemia.
    • For administration via infusion pump, as a SUBQ infusion into abdominal wall. Solution is stable for 48 hr and at temperatures not higher than 98.6°F. Discard infusion sets (reservoirs, tubing, catheters) after no more than 48 hr. Infusion sites that are erythematous, pruritic or thickened should be reported to health care professional and a new site selected; continued infusion may increase skin reaction and alter absorption of insulin glulisine.
    • Store unopened pens in refrigerator; do not freeze. Do not refrigerate once opened. Apidra Solostar pen can be kept at room temperature up to 28 days.

IV Administration:

  • IV: May be administered IV with close monitoring of blood glucose and potassium levels to avoid hypoglycemia and hypokalemia.
  • Intermittent Infusion: Dilute to a concentration of 1 unit/mL with 0.9% NaCl, using polyvinyl chloride (PVC) with a dedicated infusion line. The use of other bags and tubing has not been studied.
    • When administered via pump, change insulin glulisine in pump every 48 hr.
  • Y-Site Incompatibility: Dextrose solutions.
    • Ringer's solutions.

Patient/Family Teaching ⬆ ⬇

  • Instruct patient on proper technique for administration. Include type of insulin, equipment (syringe, cartridge pens, external pumps, alcohol swabs), storage, and place to discard syringes. Discuss the importance of not changing brands of insulin or syringes, selection and rotation of injection sites, and compliance with therapeutic regimen. Caution patient not to make any changes in type of insulin or dose without consulting health care professional. Advise patient to read the Patient Information prior to use and each time prescription is refilled.
  • Demonstrate technique for mixing insulins by drawing up insulin glulisine first and rolling intermediate-acting insulin vial between palms to mix, rather than shaking (may cause inaccurate dose).
  • Caution patient not to share pen device with another person, even if needle is changed; may risk transmission of blood-borne pathogens.
  • Explain to patient that this medication controls hyperglycemia but does not cure diabetes. Therapy is long term.
  • Instruct patient in proper testing of serum glucose and ketones. These tests should be closely monitored during periods of stress or illness and health care professional notified of significant changes.
  • Advise patient not to share insulin glulisine with another person, even if they also have diabetes; may cause harm.
  • Emphasize the importance of compliance with nutritional guidelines and regular exercise as directed by health care professional.
  • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other Rx, OTC, herbal products, or alcohol.
  • Advise patient to notify health care professional of medication regimen prior to treatment or surgery.
  • Advise patient to notify health care professional if nausea, vomiting, or fever develops, if unable to eat regular diet, or if blood sugar levels are not controlled.
  • Instruct patient on signs and symptoms of hypoglycemia and hyperglycemia and what to do if they occur.
  • Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
  • Patients with diabetes mellitus should carry a source of sugar (candy, glucose gel) and identification describing their disease and treatment regimen at all times.
  • Emphasize the importance of regular follow-up, especially during first few wk of therapy.

Evaluation/Desired Outcomes ⬆ ⬇

  • Control of blood glucose levels in patients with diabetes without the appearance of hypoglycemic or hyperglycemic episodes.

US Brand Names ⬆

Apidra, Apidra Solostar