High-Alert Medications - Apidra (insulin glulisine)

 

Extra care is needed because Apidra is a high-alert medicine.

High-alert medicines have been proven to be safe and effective. But these medicines can cause serious injury if a mistake happens while taking them. This means that it is very important for you to know about this medicine and take it exactly as directed.

Top 10 List of Safety Tips for Apidra

When taking your medicine
1. Know your insulin. Apidra is a rapid-acting insulin that should be injected below the skin within 15 minutes before or 20 minutes after starting a meal. Have food ready before injection. After injecting the insulin, do not delay eating or skip a meal.
2. Prepare your insulin. Apidra can be mixed with insulin NPH (intermediate-acting insulin), but always draw Apidra into the syringe first and use immediately after preparing the mixture. Do not mix Apidra with other insulins if using an insulin pen or external pump. Do not vigorously shake insulin before use.
3. Don’t reuse or recycle. Dispose of used syringes/needles, pens, and lancets in a sealable hard plastic or metal container (e.g., empty detergent bottle or sharps container from your pharmacy). When the container is full, seal the lid before placing it in the trash. Do not reuse or recycle syringes/needles or lancets.
4. Don’t share. Even if you change the needle, sharing an insulin pen or syringe may spread diseases carried in the blood, including hepatitis and HIV.
To avoid serious side effects
5. Avoid mix-ups. If you use more than one type of insulin, make sure each vial or pen looks different to avoid mix-ups. For example, Apidra and Lantus (a long-acting insulin) are both clear medicines in elongated vials or pens that can look similar. To make them look different, put a rubber band around one type of insulin.
6. Check your medicine. Handwritten prescriptions for insulin glulisine (Apidra) can be misread as insulin glargine (Lantus, another type of insulin). When you pick up your insulin at the pharmacy, be sure it's the right type of insulin.
7. Treat low blood sugar (hypoglycemia). Always carry a quick source of sugar, such as glucose tablets, candy, or juice, to treat low blood sugar. Signs of low blood sugar are listed below.
8. Test your blood sugar. Ask your doctor how often you should test your blood sugar. Keep a log of your blood sugar levels and how much insulin you take each day. Bring the log each time you visit your doctor.
9. Get a periodic lab test. You should have a hemoglobin A1c test at least twice a year to determine how well your diabetes is being controlled. The test shows an average of your blood sugar control over a 6- to 12-week period. Your goal is a hemoglobin A1c of 7% or less.
When you should call your doctor
10. Call for illness or changes in habits. Your insulin needs may change because of illness, stress, changes in eating habits or physical activity, and other medicines you take. Call your doctor if you experience these conditions. Never change your insulin dose unless advised by your doctor.

 

      apidrapen

 

Signs of hypoglycemia (low blood sugar)

  • hunger
  • feeling shaky
  • fast heartbeat
  • lightheadedness
  • dizziness
  • sweating
  • headache
  • confusion
  • irritability

Hypoglycemia is caused by too much insulin or increased work or exercise without eating. Symptoms of hypoglycemia may be different for each person and can change from time to time. Hypoglycemia can affect your ability to think and react quickly, so driving a car could be risky. Severe hypoglycemia can lead to loss of consciousness, seizures, brain damage, or even death. Know the symptoms of hypoglycemia and treat it quickly by drinking juice or a sugar-containing beverage, or eating sugar or candy. Talk to your doctor if hypoglycemia is a problem for you.

 

Topics

Fast Facts

Generic name
  • insulin glulisine (pronounced IN soo lin gloo LIS een) (no generic available)
Common brand names
  • Apidra, Apidra SoloSTAR (prefilled pen)
  • Apidra cartridges are used with OptiClik pens
Type of insulin, onset, duration
  • Rapid-acting; begins working in 12 to 30 minutes and lasts 3 to 4 hours
Uses
  • Treatment of type 1 and type 2 diabetes mellitus to improve control of blood glucose
When to take the insulin
  • Inject Apidra under the skin within 15 minutes before or 20 minutes after starting a meal
Usual dose
  • The frequency and dose of insulin are unique to each individual
  • Daily doses of insulin are based upon body weight, diet, activity level, age, individual sensitivity to insulin, type of diabetes (1 or 2)
  • Multiple daily doses according to blood glucose levels are typical
Injecting the insulin
  • See safety tip #2 to determine if Apidra can be mixed with another insulin before injection
  • If you have questions, ask your doctor, nurse, or pharmacist to show you how to draw your dose of insulin into a syringe and inject it, select the dose on a pen device and inject the insulin, or use an insulin pump
  • If using an OptiClik pen, be sure you are not holding the pen upside down when viewing the dose in the window (see pictures)
  • Before injecting a dose, take the chill off refrigerated insulin by gently rolling the vial, pen, or cartridge between the palm of both hands (do not shake the insulin vigorously
  • Inject the insulin below the skin (not in the muscle) in the upper thighs, upper arms, buttocks, or abdomen; the injection site should be changed (rotated) with each dose
  • Don't use Apidra if the insulin appears cloudy instead of clear and colorless
Special instructions and precautions
  • Inject Apidra within 15 minutes before or 20 minutes after starting a meal
  • Follow the diet prescribed by your doctor; keep your eating habits and exercise regular
  • Tell the doctor who prescribes insulin about any new medicines you are taking
  • Do not share insulin pens, cartridges, or syringes/needles with others
Safety during pregnancy/breastfeeding
  • Talk to your doctor about managing your diabetes during pregnancy and breastfeeding
Storage and disposal
  • Store unopened vials, cartridges, and pens in the refrigerator until first use (do not freeze)
  • After first use, store vials in the refrigerator or at room temperature; discard after 28 days
  • After first use, store cartridges and insulin pens at room temperature (do not refrigerate); discard after 28 days
  • Safely dispose of used syringes/needles, pens, and lancets (safety tip #3)
Most common side effects
  • Hypoglycemia (low blood sugar); see signs and treatment of hypoglycemia above
  • Low potassium blood levels, fast heart rate, fatigue, headache, hunger, weight gain
Other conditions to report to your doctor
  • Chest pain or palpitations, persistent fatigue, confusion, numbness of mouth, lips, or tongue, muscle weakness or tremors, vision changes, swelling of feet, flu-like symptoms
  • Swelling, itching, redness, warmth, or pain at the injection site
Herbals that should not be taken with Apidra
  • These herbals can lower your blood glucose: chromium, garlic, gymnema
Prescription medicines that should not be taken with Apidra
  • Many prescription medicines can affect your blood sugar levels and insulin needs
  • Tell your doctor about all the medicines you take, particularly new medicines
Special tests your doctor may prescribe
  • Patients are often asked to test their own blood glucose using home testing equipment, test their urine for sugar and acetone, and take their blood pressure regularly
  • To monitor your diabetes, your doctor may periodically test your blood levels for hemoglobin A1c, potassium, cholesterol, and substances that measure kidney function

This information does not replace the need to follow your doctor's instructions and read the drug information leaflet provided with your prescription.

This project was supported by grant number R18HS017910 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not represent the official views of the Agency for Healthcare Research and Quality.

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