Inhaled Insulin: A Step Forward, A Step Back

 If you take insulin injections but, like many people are afraid of needles, you may be excited to learn about a newly approved inhaled insulin.

 That’s right, insulin you inhale.

 The Food and Drug Administration (FDA) recently approved the first-ever inhaled insulin.  It was developed by Pfizer and approved for type 1 and type 2 diabetes.

 You May Still Need Insulin by Injection

 The inhaled insulin, called Exubera, is not a substitute for all insulin shots.  The new product is a short-acting powder form of insulin that can be taken before meals.  Many people, including almost everyone with type 1 diabetes, will still need to get long-acting insulin by injection, according to the FDA.

 How the Inhaled Insulin Works

 Exubera is a dry powder which comes in a tablet. The tablet is placed into an inhaler device that crushed the tablet as you pull a trigger.  You then inhale the crushed tablet into your lungs where it would then pass into your bloodstream.

 The Exubera inhaler weighs about four ounces and is about the size of an eyeglass case when closed.

 Some Concerns to Keep in Mind

 Side effects include coughing, shortness of breath, sore throat and dry mouth.

 Some patients in clinical trials experienced a small decrease in lung function but it did not worsen over two years of study.  Pfizer promised further long-term safety studies.

 According to Dr. Steven Galson, director of the FDA's Center for Drug Evaluation and Research, the inhaled insulin “will not replace all injectable insulin and should not be used by smokers.”

Smokers should avoid Exubera because more of the inhaled insulin gets in their blood, putting them at risk for overdose.

 FDA officials also advised against use by people with asthma or other chronic lung conditions until more research determines if inhaled insulin is safe for them.

 Several alerts, cautions and exceptions have been raised:

• People who take insulin will still need to take long-acting insulin by injection because Exubera is only a meal-time insulin.
• People who want to take Exubera will need to carry the rather large inhaling device with them.
• Precise dosing may be a problem, especially for people on small meal-time doses.
• People who take large amounts of rapid-acting insulin before meals may need to take more than one dose at a time. 
• People will need adequate training to learn how to use Exubera and the inhaling device.
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Ask for More Information

Certainly, the idea of inhaled insulin is exciting, especially if you don’t like needles.  But, as with any medical advance, it will take time until all the wrinkles are ironed out.  In the meantime, continue managing your diabetes and, as always, speak to your health care provider for more information.