Is Inhaled Insulin A Viable Alternative For Patients With Diabetes?

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Patients with diabetes can use Exubera (Pfizer) to inhale insulin. As the authors note, insulin is absorbed more rapidly through inhalation than through subcutaneous injection.
One study looked at patients between 35 and 80 with type 2 diabetes. Researchers discovered hyperglycemia was slightly lower in those who inhaled insulin before a meal and also injected insulin before bedtime.
Is Inhaled Insulin A Viable Alternative For Patients With Diabetes?
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Author(s): 
By Jennifer Pahira and John S. Steinberg, DPM

     As reported by the American Diabetes Association, events of mild hyperglycemia are lowered slightly among people who inhale insulin. A six-month trial done by Hollander, et. al., studied a group of men and women between the ages of 35 and 80 with type 2 diabetes who had a history of taking at least two insulin shots daily.3 One treatment group took inhaled insulin pre-meal along with one dose of long-acting injected insulin at bedtime and the other took two daily shots of injected insulin alone.

     Confirming previous studies, investigators found lowered hemoglobin A1c levels in both patient groups. Additionally, hyperglycemia was slightly lower among inhaled insulin patients (1.4 events per patient per month) with no differences in severe episodes.3

Some Caveats You Should Keep In Mind

     The FDA has not approved Exubera for children or teens. Additionally, smokers are discouraged from using Exubera because more of the insulin is able to enter the body through the lungs and could cause an overdose. Interestingly, researchers found that smokers who utilized inhaled insulin had a higher systemic absorption while non-smokers who were exposed to secondhand smoke had a lower systemic absorption. Inhaled insulin may perform differently in other patients with pulmonary diseases such as asthma, bronchitis or chronic obstructive pulmonary disease. The known side effects at this time are coughing, shortness of breath, sore throat and dry mouth.

     Exubera was expected to be widely available on the shelves of pharmacies in late summer of 2006. Early cost comparisons put the price of inhaled insulin at approximately three times that of traditional injected forms. Although pricing may be modified by Pfizer along the way, there is concern that this high cost could create some challenging coverage and formulary battles with health insurance plans, etc.

In Conclusion

     Many people need short acting insulin before meals in order to cope with the spike in blood sugars caused by eating. As a possible alternative to avoiding injections before every meal, the short-acting inhaled insulin delivery method maintains glycemic levels while keeping the person comfortable. By providing a less invasive option, one would hope to achieve better patient compliance to dosing regimens. Although long-acting insulin injections are still required, Exubera and future inhaled insulin may provide patients with a painless solution to multiple pre-meal injections.

Pahira is a second-year undergraduate student at the University of Pennsylvania.

Dr. Steinberg (pictured) is an Assistant Professor in the Department of Plastic Surgery at the Georgetown University School of Medicine in Washington, D.C. He is a Fellow of the American College of Foot and Ankle Surgeons.

Editor’s note: For related articles, see “Can An Exercise Pill Enhance Blood Glucose Control?” in the January 2004 issue, “Proactive Measures To Prevent Diabetic Complications” in the October 2005 issue or visit the archives at www.podiatrytoday.com.




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