Insulin glulisine !
A rapid-acting mealtime insulin analogue. Two amino acid changes let it break into monomers and be absorbed quickly.
Updated 2026-11-01
The figure shows human insulin bound to site 1 of an insulin receptor fragment. Glulisine differs at B3 and B29 and binds the same receptor.
Mechanism of action
In glulisine, lysine replaces asparagine at B3 and glutamic acid replaces lysine at B29. These changes reduce self-association, so the insulin dissociates quickly into active monomers after injection and is absorbed faster than regular insulin. At the receptor it acts like human insulin.
- Changes at B3 and B29 reduce self-association
- Monomers are absorbed quickly from under the skin
- Activates the insulin receptor like human insulin
- Covers the glucose rise of a meal
Pharmacokinetics
- Absorption
- Subcutaneous, rapid; it can also be given intravenously by health staff in a healthcare setting.
- Onset and duration
- Rapid acting: injected up to 15 minutes before or within 20 minutes after starting a meal.
Indications
- Mealtime insulin in type 1 diabetes, with a basal insulin Type 1 diabetes mellitus →
- Mealtime insulin in type 2 diabetes Type 2 diabetes mellitus →
Adverse effects
Common
- Hypoglycemia
- Weight gain
- Injection-site reactions and lipodystrophy
Contraindications
- During an episode of hypoglycemia
- Hypersensitivity to insulin glulisine or an excipient
Key interactions
- Beta-blockers, clonidine
- Can blunt the warning signs of hypoglycemia.
- Other glucose-lowering drugs
- Raise the risk of hypoglycemia.
- Corticosteroids, diuretics, atypical antipsychotics
- Reduce the glucose-lowering effect.
What is monitored
- Blood glucose before and after meals
- HbA1c
- Injection or pump sites
Administration and safety
- Subcutaneous injection around the meal, or by an external pump when prescribed.
- Intravenous use only by health staff in a healthcare setting.
- May be mixed in the same syringe with NPH insulin when prescribed; not mixed with other insulins otherwise.
- Clear and colorless; the label is checked to avoid confusion with basal insulins.
Nursing care
- Before: blood glucose and confirmation that the meal is available.
- After: watch for hypoglycemia in the first hours.
- Teach the signs of hypoglycemia and how to treat them.
- In pump users, teach the signs of pump failure.
Pregnancy and breastfeeding
Insulin is the usual treatment for diabetes in pregnancy; the choice of analogue is individualized and glucose is checked often.
Test yourself
Think of the answer, then tap the question to see it.
Which residues are changed in insulin glulisine?
Lysine replaces asparagine at B3 and glutamic acid replaces lysine at B29.
Which are the three rapid-acting insulin analogues?
Lispro, aspart and glulisine.
With which insulin may glulisine be mixed in one syringe?
With NPH insulin, when prescribed; glargine and detemir are never mixed.
Related drugs
Related conditions
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Insulin Glulisine (rDNA origin) Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 51 (McGraw Hill, 2023); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.