====== Insulin Glulisine ======

Insulin glulisine is a rapid-acting insulin analog used for prandial (mealtime) glucose control.

It has a rapid onset and short duration similar to other rapid-acting analogs.

→ [[endocrine:insulin:start|Insulin Therapy]]

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===== Mechanism of Action =====

Insulin glulisine binds to the insulin receptor (a tyrosine kinase receptor).

This activates:

  * IRS signaling pathways
  * PI3K/Akt cascade
  * GLUT4 translocation in muscle and adipose tissue

Physiologic effects:

Liver:
  * ↓ Gluconeogenesis
  * ↑ Glycogen synthesis

Muscle:
  * ↑ Glucose uptake
  * ↑ Glycogen storage

Adipose:
  * ↑ Glucose uptake
  * ↓ Lipolysis

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===== Structural Modification =====

Glulisine differs from human insulin by:

  * Asparagine (B3) → Lysine
  * Lysine (B29) → Glutamic acid

These substitutions reduce self-association and allow rapid absorption.

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===== Pharmacokinetics =====

Onset:
  * ~10–20 minutes

Peak:
  * ~1 hour

Duration:
  * 3–5 hours

Compared to:

  * [[endocrine:insulin:regular|Regular Insulin]] → faster onset, shorter duration
  * [[endocrine:insulin:lispro|Lispro]]
  * [[endocrine:insulin:aspart|Aspart]]

Glulisine is clinically comparable to other rapid-acting analogs.

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===== Clinical Use =====

  * Mealtime insulin
  * Correction dosing
  * Insulin pumps
  * Basal-bolus regimens

Typically administered:

  * Immediately before meals
  * Can be given shortly after starting a meal

Often combined with:

  * [[endocrine:insulin:glargine|Glargine]]
  * [[endocrine:insulin:detemir|Detemir]]
  * [[endocrine:insulin:degludec|Degludec]]

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===== Advantages =====

  * Rapid onset
  * More physiologic prandial profile
  * Reduced late hypoglycemia compared to regular insulin

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===== Adverse Effects =====

  * Hypoglycemia
  * Weight gain
  * Injection site reactions

Hypoglycemia risk increases with:

  * Missed meals
  * Increased physical activity
  * Excess dosing

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===== Glulisine vs Other Rapid-Acting Insulins =====

Comparable to:

  * [[endocrine:insulin:lispro|Lispro]]
  * [[endocrine:insulin:aspart|Aspart]]

All three are rapid-acting analogs used for prandial glucose control.

Choice is often based on:

  * Insurance coverage
  * Formulary preference
  * Patient-specific response

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===== Clinical Pearls =====

  * Rapid-acting insulin analog
  * Give at mealtime
  * Short duration reduces stacking
  * Used in basal-bolus regimens
  * Clinically interchangeable with lispro and aspart

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===== Related =====

  * [[endocrine:insulin:start|Insulin Therapy]]
  * [[endocrine:insulin:lispro|Lispro]]
  * [[endocrine:insulin:aspart|Aspart]]
  * [[endocrine:insulin:regular|Regular Insulin]]
  * [[endocrine:diabetes:start|Diabetes Pharmacology]]