Insulin glulisine (Apidra) is the third ultra-short-acting insulin analogue listed on the PBS, the others being insulin lispro and insulin aspart (see Table 1). The PBAC agreed that insulin glulisine was no less effective than insulin lispro at reducing HbA1c levels in people with type 1 and type 2 diabetes.1
The safety and efficacy of insulin glulisine has not been established in children (≤ 12 years) or in pregnant women.2 As such, prescribers should continue to use other rapid-acting insulin analogues for these patients.
Like other ultra-short-acting insulins, insulin glulisine is a clear solution injected subcutaneously immediately before meals. One unit of insulin glulisine is equivalent to one unit of insulin lispro. Carefully monitor blood glucose levels and concomitant medication if switching a patient between different types or brands of insulin.
Table 1 Pharmacokinetic profiles of non-mixed insulins available in Australia*
| Insulin type
|
Onset of action
|
Peak action
|
Duration of action
|
|---|
| Ultra-short acting
|
insulin lispro (Humalog)
aspart (Novorapid)
|
15 minutes
|
1 hour
|
4–5 hours
|
insulin glulisine (Apidra)†
|
15 minutes
|
~ 1 hour
|
4 hours
|
| Short acting
|
| neutral (Actrapid/Humulin R/Hypurin Neutral)
|
30 minutes
|
2–3 hours
|
6–8 hours
|
| Long acting
|
| non-mixed (Humulin NPH/Protaphane/Hypurin Isophane)
|
1–2.5 hours
|
4–12 hours
|
16–24 hours
|
| insulin detemir (Levemir)
|
3–4 hours
|
9 hours
|
12–20 hours
|
| insulin glargine (Lantus)
|
1–2 hours
|
No peak
|
24 hours
|
* Adapted from Australian Medicines Handbook3
† Source: Dailey G (2006)4
|
