Rapid-acting Insulin Analogue Pregnancy: Limited data (<300 pregnancy outcomes); animal studies show no difference from human insulin. Caution when prescribing in pregnancy; careful glucose monitoring is essential. Insulin requirements may decrease during the first trimester and generally increase during the second and third; they decline rapidly immediately after delivery.

Insulin Glulisine

Brand names: Apidra

Insulin glulisine is a rapid-acting recombinant insulin analogue used at mealtimes to control postprandial glucose in type 1 and type 2 diabetes.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Individualised (no fixed dose stated) - dose adjusted to the patient

Route: Subcutaneous injection or continuous subcutaneous pump infusion (a vial is required if a syringe, intravenous route or infusion pump is used)

Frequency: Shortly (0-15 minutes) before or soon after meals (or by continuous subcutaneous pump infusion)

Rapid-acting insulin analogue (SPC: Apidra 100 Units/ml). Should be used in regimens that include an intermediate- or long-acting insulin or a basal insulin analogue, and can be used with oral hypoglycaemic agents. Potency is stated in units exclusive to Apidra (not the same as IU or units of other analogues). Inject in the abdominal wall, thigh or deltoid; abdominal injection gives slightly faster absorption. Rotate injection/infusion sites to reduce lipodystrophy/cutaneous amyloidosis. Must not be mixed with other products except NPH human insulin. Paediatric: insufficient clinical information on use in children younger than 6 years of age. Interaction list drawn from the US product label (APIDRA) as the captured UK SPC sections did not include section 4.5.

Dose adjustments

Renal

Pharmacokinetic properties are generally maintained in renal impairment, but insulin requirements may be reduced. In hepatic impairment requirements may also be diminished.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to insulin glulisine or to any of the excipients
Hypoglycaemia

Side effects

Hypoglycaemia (most frequent) - symptoms usually sudden; may become severe, causing unconsciousness and/or convulsions and, rarely, death
Hyperglycaemia (potentially leading to diabetic ketoacidosis)
Injection site reactions and local hypersensitivity reactions (redness, swelling, itching)
Lipodystrophy and cutaneous amyloidosis at the injection site (may delay local insulin absorption)
Systemic hypersensitivity reactions (urticaria, chest tightness, dyspnoea, allergic dermatitis, pruritus); severe generalised allergy including anaphylaxis may be life-threatening

Interactions

Drugs that may increase the risk of hypoglycaemia (may need dose adjustment and more frequent glucose monitoring): other antidiabetic agents, ACE inhibitors, angiotensin II receptor blockers, disopyramide, fibrates, fluoxetine, MAO inhibitors, pentoxifylline, pramlintide, salicylates, somatostatin analogue (e.g. octreotide), sulfonamide antibiotics
Drugs that may reduce the blood-glucose-lowering effect: atypical antipsychotics, corticosteroids, danazol, diuretics, oestrogens, glucagon, isoniazid, niacin, phenothiazine derivatives, progestogens, protease inhibitors, somatropin, sympathomimetics (e.g. albuterol, adrenaline, terbutaline), thyroid hormones
Alcohol, beta-blockers, clonidine and lithium salts may increase or decrease the glucose-lowering effect; pentamidine may cause hypoglycaemia sometimes followed by hyperglycaemia; beta-blockers may mask hypoglycaemia warning symptoms

Clinical monograph

How it works

It activates the insulin receptor to drive glucose uptake into muscle and fat and inhibit hepatic glucose production; amino-acid substitutions reduce self-association so it is absorbed rapidly after subcutaneous injection.

Prescribing in practice

Its rapid onset means hypoglycaemia can occur soon after dosing if a meal is delayed or missed, so it is given just before or shortly after eating.
Use as the bolus component alongside a basal insulin in a basal-bolus regimen, rotating injection sites.
Match the timing of the dose closely to carbohydrate intake to avoid post-meal highs and inter-meal lows.

Monitoring

Monitor capillary blood glucose around meals and HbA1c, titrating the mealtime dose to carbohydrate intake and glycaemic response.

Counselling the patient

Inject immediately before eating and do not give a dose if you are not going to eat.
Keep fast-acting glucose to hand to treat hypoglycaemia promptly.
Rotate injection sites and never share pens or needles.

Evidence & guidelines

Rapid-acting insulin analogues are standard mealtime therapy in basal-bolus regimens within UK diabetes practice.

Reference: NICE NG17 (Type 1 DM); MHRA Insulin Safety Alert; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Insulin Lispro · Rapid-acting Insulin Analogue

Pathways