Apidra (insulin glulisine) - Sanofi Canada

ACTION AND CLINICAL PHARMACOLOGY
Pharmacodynamics
The primary activity of insulins and insulin analogues, including insulin glulisine, is regulation
of glucose metabolism. Insulins lower blood glucose levels by stimulating peripheral glucose
uptake by skeletal muscle and fat, and by inhibiting hepatic glucose production. Insulins inhibit
lipolysis in the adipocyte, inhibit proteolysis, and enhance protein synthesis.
The glucose lowering activities of APIDRA and of regular human insulin are equipotent when
administered by the intravenous route.
After subcutaneous administration the effect of APIDRA is more rapid in onset and of shorter
duration compared to regular human insulin. This has been demonstrated in studies in healthy
volunteers and patients with diabetes.
In a study in patients with Type 1 diabetes (n= 20), the glucose-lowering profiles of APIDRA
and regular human insulin were assessed at various times in relation to a standard meal at a dose
of 0.15 U/kg (see Figure 1).
Figure 1: Glucose-lowering effect over 6 hours.
APIDRA given 2 minutes (glulisine-pre) before the start of a meal compared to
regular human insulin given 30 minutes (Regular - 30 min) before start of the meal
(Figure 1A) and compared to regular human insulin (Regular - pre) given 2 minutes
before a meal (Figure 1B). APIDRA given 15 minutes (glulisine-post) after start of a
meal compared to regular human insulin (Regular - pre) given 2 minutes before a
meal (Figure 1C). On the x-axis zero (0) is the start of a 15-minute meal.
Figure 1A Figure 1B Figure 1C
BLOOD GLUCOSE - mg/dL
200
180
160
140
120
100
80
MEAL
APIDRA - before
REGULAR - 30 min
-1 0 1 2 3 4 5 6
TIME - hour
Legend:
↑ = Injection time Regular Human Insulin
↑ = Injection time Apidra
BLOOD GLUCOSE - mg/dL
200
180
160
140
120
100
80
MEAL
-1 0 1 2 3 4 5 6
TIME - hour
APIDRA - before
REGULAR - before
BLOOD GLUCOSE - mg/dL
200
180
160
140
120
100
80
MEAL
-1 0 1 2 3 4 5 6
TIME - hour
APIDRA - after
REGULAR - before
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