Short answer: Both are rapid-acting mealtime insulins for adults and children with diabetes.12 Humalog (insulin lispro) is injected within 15 minutes before a meal or right after. Apidra (insulin glulisine) is injected within 15 minutes before a meal or within 20 minutes after starting one. In the Apidra label's trials against insulin lispro, HbA1c changes were similar. Neither has a boxed warning.
| Humalog | Apidra | |
|---|---|---|
| Insulin | Insulin lispro, 100 or 200 units/mL1 | Insulin glulisine, 100 units/mL only2 |
| When injected | Within fifteen minutes before a meal or immediately after a meal1 | Within 15 minutes before a meal or within 20 minutes after starting a meal2 |
| Forms | U-100: vials, KwikPen, Junior KwikPen, Tempo Pen, cartridge. U-200: KwikPen1 | 10 mL vial and 3 mL SoloStar pen2 |
| How fast (label studies) | Peak serum levels 30 to 90 minutes after a dose in healthy volunteers1 | Median time to peak level 60 minutes in type 1 diabetes2 |
| Type 1 adults, 26 weeks | Insulin lispro: HbA1c −0.1%2 | HbA1c −0.1%; difference 0.0%2 |
| Children 4 to 17, 26 weeks | Insulin lispro: HbA1c +0.2%; severe lows 19.3%2 | HbA1c +0.1%; severe lows 16.2%2 |
| Insulin pump | U-100 only; change the reservoir at least every 7 days1 | Change the reservoir at least every 48 hours2 |
| Mixing in a syringe | U-100 with NPH insulin only1 | With NPH insulin only2 |
| Missed dose | No instruction in the label1 | No instruction in the label2 |
| Boxed warning | None1 | None2 |
In a 26-week non-inferiority trial of adults with type 1 diabetes, all on insulin glargine, HbA1c fell 0.1% on Apidra (339 people) and 0.1% on insulin lispro (333 people), a difference of 0.0% (95% CI −0.1 to 0.1). Severe low blood sugar affected 4.8% and 4.0%. In a 26-week trial of children aged 4 to 17 with type 1 diabetes, HbA1c rose 0.1% on Apidra and 0.2% on insulin lispro, and severe lows affected 16.2% and 19.3%.2 The label says "insulin lispro" and does not say the comparator was Humalog.
In the children's trial, headache was reported by 6.9% on Apidra and 11.2% on insulin lispro, and hypoglycemic seizure by 6.1% and 4.7%.2
Apidra comes only as U-100 in a vial and SoloStar pen, and in a pump it is changed at least every 48 hours. Humalog also comes as U-200 and in several pens, and Humalog U-100 in a pump is changed at least every 7 days; U-200 is not used in a pump.21 Both labels share the usual insulin warnings: low blood sugar, never sharing pens, mix-ups, low potassium, allergic reactions, heart failure with thiazolidinediones and pump failure.
Which, if either, fits is for your prescriber. More detail: Humalog side effects, Apidra side effects, the Humalog and Apidra dosing schedules, the Humalog missed-dose page, how to store Humalog and Humalog vs NovoLog: what is different between the two mealtime insulins?.