Apidra is a brand name for insulin glulisine, a fast-acting human analog[2] manufactured by Aventis. It is a soluble insulin and can be used intravenously for diabetic emergencies such as DKA. Apidra has been found to be equipotent (equally potent) to R/neutralR-DNA/GE/GM insulin when administered intravenously.
Given subcutaneously in normal injection form, Apidra has a more rapid onset and shorter duration than R human insulin[3].
The alterations to the human insulin molecule that produces insulin Glulisine are all to the B insulin chain; position B-#3, which is normally amino acid asparagine is replaced with lysine and the lysine amino acid which is normally found at position B-#29 is replaced by glutamic acid[4]. Making substitutions at these positions on the B insulin chain, inhibits hexamer formation[5].
Since insulin in hexamer form must break down into dimers and monomers to become active, inhibiting the molecule's natural tendency to form hexamers by self-association, means better, faster absorption, more rapid onset, peak and shorter duration. Apidra[6] may be diluted for all uses except in insulin pumps. It may be mixed in the same syringe with NPH/isophane insulin only.
There is no clinical data regarding same syringe mixing of Apidra and any other insulin preparations in humans, but testing conducted in dogs indicates a slower onset when mixed with NPH/isophane insulin. Used on its own, Apidra displayed an earlier onset with them[7]. Antibody formation in the dog was noted.
Dr. Nelson of University of California-Davis said in his lecture at the Ohio State Endocrinology Symposium in 2006 that if the short-acting analog insulins have any role in feline and canine diabetes, it is not yet determined[8].