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Rapid-acting Insulin Analogue Pregnancy: Limited data — NICE NG3 recommends insulin aspart or lispro in pregnancy. Seek specialist advice.

Insulin Glulisine

Brand names: Apidra

Adult dose

Dose: Prandial: 0.05–0.1 units/kg per meal; total daily dose individualised as part of basal-bolus regimen
Route: Subcutaneous injection or CSII (insulin pump)
Frequency: Immediately before meals (0–15 minutes) or up to 20 minutes after starting meal
Max: Individualised per carbohydrate intake and insulin:carb ratio
MHRA safety requirement: prescribe by brand name (Apidra). Onset 10–20 min, peak 55 min, duration 3–5 hours. May be used in CSII (insulin pumps). Must always be used with a basal insulin in Type 1 DM.

Paediatric dose

Dose: 0.05 units/kg
Route: Subcutaneous injection
Frequency: With meals
Max: Individualised
BNFc: Licensed from age 6 years. Seek paediatric endocrinology specialist opinion for dose titration and insulin:carb ratios.

Dose adjustments

Renal

Insulin requirements may decrease — monitor glucose closely and reduce dose in moderate-severe renal impairment.

Hepatic

Increased hypoglycaemia risk in hepatic impairment — monitor closely.

Paediatric weight-based calculator

BNFc: Licensed from age 6 years. Seek paediatric endocrinology specialist opinion for dose titration and insulin:carb ratios.

Clinical pearls

  • Onset comparable to insulin aspart and lispro — clinical difference between rapid-acting analogues is minimal; switch based on availability or formulary
  • Antidote for hypoglycaemia: oral glucose (if conscious); IM glucagon 1mg or IV dextrose 10% 150mL (if unconscious)
  • Compatible with NPH insulin when mixed in syringe — use immediately; not compatible with other insulins in pump cartridges
  • CSII use: Apidra approved for insulin pump therapy — do not dilute in pump cartridge

Contraindications

  • Hypoglycaemia
  • Hypersensitivity to insulin glulisine or excipients

Side effects

  • Hypoglycaemia
  • Injection site reactions
  • Lipohypertrophy
  • Peripheral oedema

Interactions

  • Beta-blockers — mask hypoglycaemia symptoms
  • Corticosteroids — antagonise glucose-lowering effect
  • Alcohol, salicylates, ACE inhibitors — potentiate hypoglycaemia

Monitoring

  • Pre- and post-meal glucose
  • HbA1c 3 monthly
  • Continuous glucose monitoring (CGM) where available
  • Pump site inspection (if CSII)

Reference: BNFc; BNF 90; NICE NG17 (Type 1 DM); MHRA Insulin Safety Alert. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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