insulin glulisine

BEERS REMS, High Alert

Type 1 or type 2 diabetes mellitus.

Contraindicated in:

Hypoglycemia;
Allergy or hypersensitivity to insulin glulisine.

Use Cautiously in:

Stress and infection, which may temporarily ↑ insulin requirements;
Renal impairment (may ↓ insulin requirements);
Hepatic impairment (may ↓ insulin requirements);
OB: May temporarily ↑ insulin requirements during pregnancy;
Pedi: Children <4 yr (safety and effectiveness not established);
Geri: Appears on Beers list. ↑ risk of hypoglycemia in older adults. Avoid use of regimens containing only short- or rapid-acting insulin without concurrent use of basal or long-acting insulin.

Endo: HYPOGLYCEMIA

F and E: hypokalemia

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

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS)

Drug-drug:

Beta blockers and clonidine may mask some of the signs and symptoms of hypoglycemia.
Corticosteroids, thyroid supplements, estrogens, isoniazid, niacin,phenothiazines, and rifampin may ↑ insulin requirements.
Alcohol, ACE inhibitors, MAO inhibitors, octreotide, oral hypoglycemic agents, and salicylates, may ↓ insulin requirements.
Concurrent use with pioglitazone may ↑ risk of fluid retention and worsening HF.

Drug-Natural Products:

Glucosamine may worsen blood glucose control.
Fenugreek, chromium, and coenzyme Q-10 may produce additive hypoglycemic effects.

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

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.

Apidra, Apidra Solostar

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.

Therapeutic Classification: antidiabetics, hormones

Pharmacologic Classification: pancreatics

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.

(hypoglycemic effect)

ROUTE	ONSET	PEAK	DURATION
SUBQ	within 15 min	1–2 hr	3–4 hr

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.

IN-su-lin gloo-LYE-seen

section name header

Indications ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Availability ⬆ ⬇

Route/Dosage ⬆ ⬇

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Classifications ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Pronunciation ⬆