Apidra (Insulin Glulisine) – Subcutaneous

What Is Apidra?

Apidra (insulin glulisine) is a rapid-acting insulin that lowers blood sugar in adults and children with diabetes. It is a human insulin analog, meaning it is made in a lab and altered slightly to work faster than natural human insulin.

There are many types of insulin available. They generally are grouped by how quickly they work to lower blood sugar. Apidra is a rapid-acting insulin. It lowers blood sugar within 15 minutes and peaks one hour after injection. It continues working for about two to four hours.

Apidra is a prescription product, so you can’t purchase it over the counter (OTC). You’ll receive a prescription from your healthcare provider to fill the medication at your pharmacy. It is available for subcutaneous use, meaning it is injected under the skin.

What Is Apidra Used For?

The Food and Drug Administration (FDA) approved Apidra to treat diabetes and diabetes-related high blood sugar levels. It is most commonly used in individuals with type 1 diabetes whose bodies do not produce enough insulin. It is sometimes also used in type 2 diabetes when lifestyle changes and oral medicines are not enough to control blood sugar.

Insulin is a hormone produced by the pancreas. It helps your body effectively use or store the glucose (sugar) that comes from carbohydrates in your diet. When there isn’t enough insulin in your body, glucose can’t enter your cells to be used for energy. As a result, glucose builds up in your blood.

Injecting insulin helps shift glucose from the blood into cells, lowering blood sugar levels. Keeping blood sugar levels within a normal range helps prevent complications of diabetes, such as kidney disease or nerve damage.

Since type 1 diabetes is usually a genetic condition, it is often diagnosed at a young age. Early symptoms of type 1 diabetes may include excessive hunger or thirst, frequent urination, fatigue, unintended weight loss, and blurred vision.

How to Take Apidra

Apidra is available as two different products: vials of 10 milliliters and prefilled SoloStar pens of 3 milliliters.

Vials will require you to draw up the insulin with a syringe. With prefilled pens, attach a needle and then twist the dial on the pen to load the amount of insulin you want to inject. Insulin syringes and the needles you attach to pens (called pen needles) come in various sizes, with different thicknesses and lengths to choose from.

Insulin is injected the same way between vials and pens. It is a subcutaneous injection with the following steps:

1. Gather your supplies. You will need an alcohol pad and your insulin, either in a pen or vial, and a syringe.
2. Wash your hands.
3. Select the injection site (any area with some fat like your abdomen, thigh, or upper arm) and clean it using the alcohol pad.
4. Draw up the correct dose in the prefilled pen or syringe.
5. Take a large pinch of skin to pull the fatty tissue away from the muscle underneath it.
6. Holding the pen or syringe like a dart, quickly insert the needle at a 90-degree angle to the skin.
7. Slowly inject the medication.
8. Release the pinch of skin, then withdraw the needle.
9. If needed, you can apply a bandage or gauze, but this is not usually necessary with insulin injections.
   

Storing Apidra

Unopened vials and pens should be stored in the refrigerator (between 36 and 46 degrees Fahrenheit), ideally in their original box or carton to protect them from light. Never store insulin in the freezer or allow it to freeze. If this does happen, you will need to discard it. Unopened vials or pens not stored in the fridge must be used within 28 days.

Opened vials must be used within 28 days of opening, whether or not you refrigerate them. If you choose not to refrigerate the vial, make sure to keep it away from direct heat and light at a temperature below 77 degrees.

Opened pens should not be refrigerated, but keep them at temperatures below 77 degrees and away from direct heat and light. An opened pen is good for 28 days, starting when you remove it from the fridge. After 28 days, it must be discarded.

If you’re traveling by plane, you’ll want to keep Apidra in your carry-on luggage so that you aren’t separated from it in case your checked baggage goes missing. No need to worry about TSA liquid restrictions with insulin, as medications are exempt from this rule.

If traveling by car, do not leave your insulin in hot or cold temperatures for long periods, like overnight in the car.

If you need to transport extra unopened vials or pens while traveling, keep them in a cooler or an insulated bag with ice packs until they can be refrigerated again. It’s a good idea to check for locations of nearby pharmacies wherever you’ll be traveling, just in case you need to get more insulin.

What Are the Side Effects of Apidra?

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

Common side effects associated with Apidra include the following:

• Hypoglycemia (low blood sugar) is the most commonly observed adverse reaction in people using insulin. This is any blood sugar level below 70 milligrams per deciliter (mg/dL). Earlier symptoms of hypoglycemia include hunger, tiredness, headache, shakiness, and sweating. If this occurs, test your blood sugar. If it is low, consume 15 grams of fast-acting carbs like half a cup of fruit juice or sugary soda, or take a glucose tablet.
• Nasopharyngitis, which causes symptoms that feel like allergies or a common cold, especially in the nose and throat.
• Injection site reactions such as redness or bruising may occur when injecting your insulin. Be sure to rotate sites to minimize this risk.
  

Severe Side Effects

Hypoglycemia can become a severe side effect of Apidra if left untreated. Symptoms of severe hypoglycemia include confusion, slurred speech, blurred vision, and eventually seizures, fainting, and coma. Do not ignore early symptoms of hypoglycemia, like shaking, sweating, or headache, as this may lead to severe hypoglycemia and the need for medical attention.

Long-Term Side Effects

Long-term use of Apidra (and any insulin) can cause lipodystrophy at the site of repeated insulin injections or infusions. In lipodystrophy, the fatty tissue can either get thicker or thinner and may not be able to absorb insulin as well over time.

Be sure to rotate insulin injection sites within the same area to reduce this risk. Rotate between your abdomen and thighs, and rotate the specific spots on those sites where you inject.

Dosage: How Much Apidra Should I Take?

Modifications

Sometimes, you may need to take precautions while taking or administering this medication.

Pregnancy

Apidra has not been studied in pregnancy. Talk with your healthcare provider about controlling your blood sugar while pregnant. They may prescribe insulin that is more commonly used in pregnant people, such as insulin aspart or lispro and, therefore, considered lower risk.

Breastfeeding

According to research, Apidra is likely to transfer into breast milk. However, there doesn’t seem to be any harm to breastfed infants. It is unknown how using insulin products like Apidra influences breast milk production. People with diabetes who are breastfeeding may also require insulin dose adjustments.

Children

Apidra is safe and effective for children age 4 to 17 with type 1 diabetes. It has not been studied in children younger than 4 with type 1 diabetes or in children with type 2 diabetes. Just as in adults, Apidra dosing should be tailored to each child based on individual needs and frequent monitoring of blood sugar levels.

Missed Dose

Ideally, you should take Apidra 15 minutes before or 20 minutes after starting a meal. It’s best to get into a routine of giving the dose at the same time relative to each meal so that it becomes a habit.

There is no set course of action to take if you forget to give your dose since it depends on how long ago the injection was meant to be given.

If you realize in the middle of a meal or even up to about two hours later that you forgot to give a dose, it is most likely fine to go ahead and take it. However, in that case, the insulin action will not align with your sugar levels as it typically would. This may cause high or low blood sugar.

Monitor your blood glucose levels more often than usual and contact your healthcare provider if you have questions or concerns.

Overdose: What Happens If I Take Too Much Apidra?

Because of the risk of hypoglycemia, it is important to take Apidra exactly as prescribed. Test your blood sugar if you experience symptoms of low blood sugar, such as sweating, fast heart rate, or shakiness. If it’s low, you can take 15–20 grams of fast-acting carbs such as a glucose tablet or 4 ounces (half a cup) of sugary soda or juice.

Check your blood sugar again 15 minutes later and repeat this process until your sugar reads at least 70 milligrams per deciliter.

Call 911 or go to the emergency department immediately if you experience symptoms of severe hypoglycemia like confusion, slurred speech, or blurred vision.

Precautions

What Are Reasons I Shouldn't Take Apidra?

Apidra is not or may not be the best option if you:

• Have advanced liver or kidney disease: These conditions may make you more likely to experience hypoglycemia.
• Become pregnant: Tell your healthcare provider if you are pregnant or plan to become pregnant so they can determine whether Apidra is the best option for you.
  

What Other Medications Interact With Apidra?

When starting any new medication, always make sure that your healthcare providers (including your pharmacist) are aware of your full medication list so that they can identify any potential interactions and make adjustments if necessary.

The following drugs have the ability to lower your blood sugar or hide symptoms of low blood sugar, so you’ll want to look out for signs of hypoglycemia:

• Oral antidiabetic medicines, such as Glucophage (metformin), Glucotrol (glipizide), Amaryl (glimepiride), Actos (pioglitazone), Januvia (sitagliptin), Tradjenta (linagliptin), Farxiga (dapagliflozin), and Jardiance (empagliflozin)
• Nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil or Motrin (ibuprofen) and Aleve (naproxen)
• Azole antifungals like miconazole or fluconazole
• Aspirin
• Sulfonamides like the antibiotic Bactrim (sulfamethoxazole and trimethoprim)
• Angiotensin-converting enzyme (ACE) inhibitors that are often used to treat high blood pressure or heart failure, such as Zestril (lisinopril) or Altace (ramipril)

The following drugs may reduce how well Apidra works, causing a risk of increased blood sugar:

• Thiazides and other diuretics such as Microzide (hydrochlorothiazide), Thalitone (chlorthalidone), Lasix (furosemide)
• Corticosteroids such as Medrol (methylprednisolone) or Rayos (prednisone)
• Thyroid products such as Synthroid (levothyroxine)
• Estrogens and oral contraceptives (birth control)
• Calcium channel blocking drugs such as Cardizem (diltiazem), Verelan (verapamil), or Norvasc (amlodipine)

Your healthcare provider may increase your dose of Apidra if you take any of these medications for a long period.

What Medications Are Similar?

Other rapid-acting insulins that begin working in 15 minutes and last for two to four hours include Admelog and Humalog (insulin lispro), and Fiasp and NovoLog (insulin aspart).

Short-acting insulins that begin to work within 30 minutes and last for three to six hours include Humulin R and Novolin R (insulin human regular).

These are not other drugs recommended to take with Apidra. Discuss any questions or concerns about these medications with a pharmacist or healthcare provider.

How Can I Stay Healthy While Taking Apidra?

Getting diagnosed with diabetes can be overwhelming. However, know that it is a common condition and there are many available resources to help you learn how to manage and cope with it. Lifestyle changes, like a healthy diet and physical activity, will make a big difference in controlling your blood sugar. Blood sugar control is essential to prevent diabetes-related complications.

While there is no cure for type 1 diabetes, new research is ongoing, and numerous devices and technologies have made it easier to manage the condition. For example, continuous glucose monitoring devices allow you to track your blood sugar levels without having to do a finger stick each time.

Communicating with your healthcare providers is important for gaining a better understanding of how to manage your diabetes. A certified diabetes care and education specialist can help you improve self-management by providing diabetes education, treatment management, and support. You can also find support groups to connect with other people with diabetes. All this and more can empower you to take control of your diabetes and improve your overall quality of life with the condition.