Back to Browse Journals » Vascular Health and Risk Management » Volume 3 » Issue 3

Combining insulins for optimal blood glucose control in type 1 and 2 diabetes: focus on insulin glulisine

Authors Heather Ulrich, Benjamin Snyder, Satish K Garg

Published Date August 2007 Volume 2007:3(3) Pages 245—254

DOI http://dx.doi.org/

Published 15 August 2007

Heather Ulrich1,4, Benjamin Snyder1,Satish K Garg1,2,3

1Barbara Davis Center for Childhood Diabetes; 2Department of Medicine; 3Pediatrics; 4Department of Clinical Pharmacy, School of Pharmacy, University of Colorado at Denver and Health Sciences Center, Denver, CO, USA

Abstract: Normalization of blood glucose is essential for the prevention of diabetes mellitus (DM)-related microvascular and macrovascular complications. Despite substantial literature to support the benefits of glucose lowering and clear treatment targets, glycemic control remains suboptimal for most people with DM in the United States. Pharmacokinetic limitations of conventional insulins have been a barrier to achieving treatment targets secondary to adverse effects such as hypoglycemia and weight gain. Recombinant DNA technology has allowed modification of the insulin molecule to produce insulin analogues that overcome these pharmacokinetic limitations. With time action profiles that more closely mimic physiologic insulin secretion, rapid acting insulin analogues (RAAs) reduce post-prandial glucose excursions and hypoglycemia when compared to regular human insulin (RHI). Insulin glulisine (Apidra®) is a rapid-acting insulin analogue created by substituting lysine for asparagine at position B3 and glutamic acid for lysine at position B29 on the B chain of human insulin. The quick absorption of insulin glulisine more closely reproduces physiologic first-phase insulin secretion and its rapid acting profile is maintained across patient subtypes. Clinical trials have demonstrated comparable or greater efficacy of insulin glulisine versus insulin lispro or RHI, respectively. Efficacy is maintained even when insulin glulisine is administered post-meal. In addition, glulisine appears to have a more rapid time action profile compared with insulin lispro across various body mass indexes (BMIs). The safety and tolerability profile of insulin glulisine is also comparable to that of insulin lispro or RHI in type 1 or 2 DM and it has been shown to be as safe and effective when used in a continuous subcutaneous insulin infusion (CSII). In summary, insulin glulisine is a safe, effective, and well tolerated rapid-acting insulin analogue across all BMIs and a worthy option for prandial glucose control in type 1 or 2 DM.

Keywords: glycemic control, glycosylated hemoglobin A1c (HbA1c), rapid-acting insulin analogues, type 1 diabetes mellitus, type 2 diabetes mellitus, insulin glulisine, body mass index (BMI)

Download Article [PDF] 

Readers of this article also read:

Disruption of human papillomavirus 16 E6 gene by clustered regularly interspaced short palindromic repeat/Cas system in human cervical cancer cells [Corrigendum]

Yu L, Wang XL, Zhu D, Ding WC, Wang LM, Zhang CL, Jiang XH, Shen H, Liao SJ, Ma D, Hu Z, Wang H

OncoTargets and Therapy 2015, 8:365-366

Published Date: 4 February 2015

Increased risk of posterior circulation infarcts among ischemic stroke patients with cervical spondylosis

Chen CC, Chung CY, Lee TH, Chang WH, Tang SF, Pei YC

Neuropsychiatric Disease and Treatment 2015, 11:273-278

Published Date: 3 February 2015

Diagnosis of carotid artery stenosis with oculopneumoplethysmography alone and in combination with MRA

Elias RM, Wald JT, Kallmes DF

Vascular Health and Risk Management 2012, 8:631-639

Published Date: 23 November 2012

Corrigendum

Schneider EW, Johnson MW

Clinical Ophthalmology 2011, 5:1315-1316

Published Date: 16 September 2011

Corrigendum: Softec HD hydrophilic acrylic intraocular lens: biocompatibility and precision

Espandar L, Sikder S, Moshirfar M

Clinical Ophthalmology 2011, 5:159-160

Published Date: 6 February 2011

Erratum

RA Kurt, K Gündüz

Clinical Ophthalmology 2010, 4:981-982

Published Date: 6 September 2010

Role of aliskiren in cardio-renal protection and use in hypertensives with multiple risk factors

Eduardo Pimenta, Suzanne Oparil

Vascular Health and Risk Management 2009, 5:453-463

Published Date: 19 May 2009

30-days mortality in patients with perforated peptic ulcer: A national audit

Anne Nakano, Jørgen Bendix, Sven Adamsen, Daniel Buck, Jan Mainz, et al

Risk Management and Healthcare Policy 2008, 1:31-38

Published Date: 30 November 2008

Safety and efficacy of nateglinide/metformin combination therapy in the treatment of type 2 diabetes

Marc K Israel, Eva Istvan, Michelle A Baron

Vascular Health and Risk Management 2008, 4:1167-1178

Published Date: 2 September 2008

Folic acid: a marker of endothelial function in type 2 diabetes?

Arduino A Mangoni, Roy A Sherwood, Belinda Asonganyi, Emma L Ouldred, Stephen Thomas, Stephen HD Jackson

Vascular Health and Risk Management 2005, 1:79-83

Published Date: 29 January 2005