glulisine

Glulisine is a rapid-acting insulin analog used to improve glycemic control in people with diabetes mellitus. It is sold under the brand name Apidra, among others, and is produced by recombinant DNA technology. The molecule carries two amino acid substitutions at positions B3 and B29 (an asparagine to lysine change at B3 and a lysine to glutamic acid change at B29) that promote faster absorption after subcutaneous injection compared with regular human insulin.

Pharmacologically, glulisine acts like insulin to promote glucose uptake by tissues and to suppress hepatic glucose production. After subcutaneous injection, it begins to work within about 15 minutes, reaches a peak effect in roughly 1 to 2 hours, and generally provides action for about 3 to 5 hours.

Glulisine is administered by subcutaneous injection, typically taken before meals or within minutes after starting a meal, depending on the treatment regimen. It can be used in multiple daily injection regimens or in insulin pump therapy, and injections can be given in common sites such as the abdomen, thigh, or upper arm.

Indications include improving glycemic control in adults and pediatric patients with type 1 diabetes, and in combination with a longer-acting insulin for type 2 diabetes. As with other insulins, the principal adverse effect is hypoglycemia; other possible effects include weight gain and local injection-site reactions. Care is advised in pregnancy and during illness or stress, when dose adjustments may be needed. Glulisine is available in vials, prefilled pens, and cartridge formats for various delivery devices. Related rapid-acting insulins include lispro and aspart.