Insulin Glulisine Dosage

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Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Diabetes Type 1

Total daily insulin requirements:
Initial dose: 0.5 to 0.8 unit/kg/day subcutaneously
Honeymoon phase: 0.2 to 0.5 unit/kg/day subcutaneously
Split dose therapy: 0.5 to 1.2 unit/kg/day subcutaneously
Insulin resistance: 0.7 to 2.5 units/kg/day subcutaneously

Conventional regimen: The total daily insulin dose is administered as a mixture of rapid/short-acting and intermediate-acting insulins in 1 to 2 injections. Twice daily injections are preferred for better glycemic control. With the 2-injection regimen, generally two-thirds of the daily dose is given before breakfast and one-third is given before the evening meal.

Intensive regimen: The total daily dose is administered as 3 or more injections or by continuous subcutaneous infusion to cover basal and pre-meal bolus insulin requirements. The basal requirement is approximately 30 to 50% of the total dose, given as intermediate or long-acting insulin (NPH, zinc, extended zinc, lispro-protamine, glargine), 1 to 2 times daily. Meal boluses are approximately 50 to 70% of the total dose, given as rapid/short-acting insulin (regular, aspart, lispro, glulisine) 2 to 5 times daily before meals.

Usual Adult Dose for Diabetes Type 2

Initial dose, monotherapy: 0.5 to 1.5 unit/kg/day subcutaneously.
Maintenance dose, monotherapy: Total daily insulin requirements may progress to 2.5 units/kg or higher in patients with obesity and insulin resistance.

Conventional regimen:
-Initial dose, monotherapy: Total insulin requirement: 0.1 unit/kg/day. When insulin is used alone, twice daily injections are recommended for better glycemic control. The total daily insulin dose is administered as a mixture of rapid/short-acting and intermediate-acting insulins in 1 to 2 injections. With the 2-injection regimen, generally two-thirds of the daily dose is given before breakfast and one-third is given before the evening meal. Once daily injections are sometimes used in children with suboptimal compliance; however, this may lead to more nocturia, fasting hyperglycemia, morning glucosuria, and a risk of ketoacidosis if the doses are missed.

-Maintenance dose, monotherapy: Total daily insulin requirements may progress to 1.5 to 2.5 units/kg or higher in patients with obesity and insulin resistance.

Intensive regimen:
The necessity for and efficacy of intensive insulin therapy in type II diabetes has been controversial. The total daily dose is administered as 3 or more injections or by continuous subcutaneous infusion to cover basal and pre-meal bolus insulin requirements. This method may be appropriate for closely supervised and highly motivated older children or adolescents who are able to inject their insulin, monitor their blood glucose, and recognize hypoglycemia. The basal requirement is approximately 30 to 50% of the total dose, given as intermediate or long-acting insulin (NPH, zinc, extended zinc, lispro-protamine, glargine), 1 to 2 times daily. Meal boluses are approximately 50 to 70% of the total dose, given as rapid/short-acting insulin (regular, aspart, lispro, glulisine) 2 to 5 times daily before meals.

Usual Pediatric Dose for Diabetes Type 1

4 years and older:
Total daily insulin requirements:
Initial dose: 0.5 to 0.8 unit/kg/day subcutaneously
Honeymoon phase: 0.2 to 0.5 unit/kg/day subcutaneously
Split dose therapy: 0.5 to 1.2 unit/kg/day subcutaneously
Insulin resistance: 0.7 to 2.5 units/kg/day subcutaneously

Conventional regimen: The total daily insulin dose is administered as a mixture of rapid/short-acting and intermediate-acting insulins in 1 to 2 injections. Twice daily injections are preferred for better glycemic control. With the 2-injection regimen, generally two-thirds of the daily dose is given before breakfast and one-third is given before the evening meal.

Intensive regimen: The total daily dose is administered as 3 or more injections or by continuous subcutaneous infusion to cover basal and pre-meal bolus insulin requirements. The basal requirement is approximately 30 to 50% of the total dose, given as intermediate or long-acting insulin (NPH, zinc, extended zinc, lispro-protamine, glargine), 1 to 2 times daily. Meal boluses are approximately 50 to 70% of the total dose, given as rapid/short-acting insulin (regular, aspart, lispro, glulisine) 2 to 5 times daily before meals.

Renal Dose Adjustments

Dose reduction may be required; however, no specific guidelines have been suggested.

Liver Dose Adjustments

Dose reduction may be required; however, no specific guidelines have been suggested.

Dose Adjustments

-Dosage adjustments are made to achieve target blood glucose levels and are based on frequent blood glucose measurements, diet and exercise levels.
-Insulin requirements may be altered during stress, major illness, or with changes in exercise, meal patterns, or coadministered drugs.
-Supplemental doses may be prescribed to correct high preprandial blood glucose.
-Dosage adjustments may be required when the brand, type, or species of insulin is changed.
-Total daily doses should not be adjusted by more than 10% increments.

Precautions

Consult WARNINGS section for dosing related precautions.

Dialysis

Data not available

Other Comments

Administration advice:

Subcutaneous:
-Dosage must be individualized
-Given 1 to 4 times a day within 15 minutes before a meal or within 20 minutes after starting a meal.
-Subcutaneous injection should general be used in regimens with an intermediate or long-acting insulin
-Administer in the abdominal wall, thigh, or upper arm.
-Rotate injection sites to reduce risk of lipodystrophy

Continuous subcutaneous infusion:
-Administer in the abdominal wall
-Do not use diluted or mixed insulins
-Rotate infusion sites to reduce the risk of lipodystrophy
-Initial programming of the external insulin infusion pump should be based on the total daily insulin dose of the previous regimen
- The manufacturer has studied the following insulin pumps: Disetronic H-Tron plus V100 and D-Tron with Disetronic catheters (Rapid, Rapid C, Rapid D and Tender); MiniMed Models 506, 507, 507c, and 508 with MiniMed catheters (Sof-set, Ultimate QR and Quick-set). Before using another pump make sure it has been evaluated with insulin glulisine.
-Information on the pump use in the prescribing information, patient information leaflet, and the pump manufacturer's manual should be carefully read. Failure to follow instructions may lead to serious adverse effects.
-An alternative insulin delivery system should be available in case of pump system failure
-Infusion sets and the insulin glulisine in the reservoir must be changed at least every 48 hours.

Intravenous:
-Administer intravenously under medical supervision
-Closely monitor glucose and serum potassium
-Use polyvinyl chloride (PVC) bags
-Inspect for particulate matter and discoloration prior to administration
-Insulin mixtures should not be administered intravenously

Storage requirements:
-Unopened vial/cartridge system/SoloStar: Store in refrigerator, do not freeze, discard if frozen, use within 28 days if not refrigerated
-Open (in-use) Vial: Use within 28 days
-Open (in-use) Cartridge System and SoloStar prefilled pen: Do not refrigerate and discard within 28 days
-Infusion sets: Discard after 48 hours or use or exposure to temperature above 98.6 F
-Intravenous use: If prepared as indicated, stable at room temperature for 48 hours.

Reconstitution/preparation techniques: Refer to the manufacturer's product information.

IV compatibility:
-Insulin glulisine has been shown to be stable only in 0.9% sodium chloride.
-Use polyvinyl chloride (PVC) bags

General:
-Insulin glulisine is a recombinant insulin analog that is equipotent to human insulin.
-The total daily insulin requirement may vary and is usually between 0.5 to 1 Unit/kg/day.
-Common regimens include injections of rapid/short acting insulin before each meal along with injections of intermediate or long-acting insulin in the morning and/or evening.

Monitoring:
-At least twice weekly blood glucose monitoring is recommended for type I and II diabetes on conventional insulin therapy.
-Urine ketone testing is recommended for patients with type I diabetes if they develop symptoms of colds, influenza, nausea, vomiting, or other illnesses, polyuria, or if blood glucose levels are unexpectedly high or inconsistent.
-Glycosylated hemoglobin measurements are recommended every 3 months.
-At least yearly serum creatinine, BUN, ECG determinations, and ophthalmologic examinations are recommended.

Patient Advice:
-Check blood sugar level before each use
-Check the label to confirm correct insulin type
-Do not share needles, insulin pens or syringes with others

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