Rachel will be started on a combination of Apidra prior to meals and snacks, with glargine given in the a.m. and p.m. Describe the onset, peak, and duration for each of these types of insulin

Question

Her discharge dosages are as follows: 7 u glargine with Apidra prior to each meal or snack—1:15 insulin: carbohydrate ratio. Rachel's parents want to know why she cannot take oral medications for her diabetes like some of their friends do. What would you tell them?

Answer 1

Because individuals with type 1 DM are lacking insulin, an exogenous source of insulin is required on a daily basis in order to manage blood glucose levels. When answering her parent's question regarding her insulin and the reason she cannot take oral medication alone, describe the pathophysiology of both type 1 and type 2 diabetes, emphasizing that an oral medication can only be used for someone who is able to produce insulin. This is because oral medications typically target insulin resistance and in type 1 diabetes, insulin is not produced. Additionally, with insulin being a protein, the stomach acid and GI proteolytic enzymes will digest it if it is given orally. That is why insulin injections are a necessary route of administration.
Insulin Type Onset of Action Peak of action Duration of Action
Apidra (glulisine) 5-15 minutes 30-90 minutes 3-5 hours
Glargine 2-4 hours None 20-24 hours

Apidra's rapid onset of action, peak, and shorter duration make it an excellent form of insulin to mimic normal physiological postprandial levels after a meal. On the other hand, glargine's long duration of steady action allows it to mimic the constant insulin levels produced throughout the day needed to feed her cells.