Contents:
- Medical Video: Ask Joslin: Inhalable Insulin
- What is inhaled insulin?
- Excess inhaled insulin: work fast
- Risk of inhaled insulin: increases the risk of ketoacidosis
- Benefits of inhaled insulin: effective
- Risk of inhaled insulin: side effects
- Benefits of inhaled insulin: limit some of the side effects of injectable insulin
- How do you decide whether to use inhaled insulin or injections?
Medical Video: Ask Joslin: Inhalable Insulin
Most of us don't really think about insulin. After we consume food, our pancreas automatically releases insulin, which moves sugar (glucose) from the blood and into cells, so that it can be used either directly to be used as energy or stored in cells for later use.
However, in people with type 1 diabetes, the pancreas does not make insulin. In type 2 diabetes, for some reason the body does not make enough insulin, does not use it effectively, or, most often, both. People with type 1 diabetes must inject insulin to replace their lack of body hormones. Those who suffer from type 2 diabetes may need to use insulin to help keep their blood sugar within the target range.
Insulin cannot be taken in pill form because the stomach will begin to break down the drug before having the opportunity to work. So until now, people with diabetes most often use insulin by injection. People who need insulin must do it for themselves, one or more daily injections.
In recent years, there has been a breakthrough in the system of using insulin. A new form of insulin now allows people with diabetes to take their insulin by inhaling it. Although inhaled insulin will not replace injecting insulin in the near future, this can reduce the amount of supply that must be taken in some people.
What is inhaled insulin?
Inhaled insulin is insulin dissolved in dry powder, which is placed in a single dose container. You breathe using powder through a small inhaler, similar to an asthma inhaler. Insulin will be absorbed into your lungs and move from there into your bloodstream.
A different version of inhaled insulin has been studied for years. In 2006, Exubera became the first inhaled insulin FDA approved for sale in the United States. But only a year later, the producer, Pfizer, pulled it from the market because of poor sales. Other companies attract their inhaled insulin products before they even appear on the market. In 2014, the FDA approved a new inhaled insulin product called Afrezza. This inhaled insulin is expected to be publicly available in 2015.
Excess inhaled insulin: work fast
Inhaled insulin works quickly. It acts about 15 minutes after you use it at the beginning of a meal, similar to fast-acting insulin. For comparison, short-acting insulin generally has a starting time of 30-60 minutes.
However, if insulin works quickly can last up to 3-5 hours, inhaled insulin is removed from the body in 2-3 hours. This faster elimination can help reduce the risk of low blood sugar and weight gain.
Risk of inhaled insulin: increases the risk of ketoacidosis
According to prescription drug information published by the FDA, inhaled insulin increases a person's risk of diabetic ketoacidosis. Diabetic ketoacidosis occurs when substances called ketones accumulate in the blood. Diabetic ketoacidosis is a potentially dangerous complication. If left untreated, this can even be fatal.
Compared to other types of insulin, inhalants cause diabetic ketoacidosis more often in people with type 1 diabetes. If you are at an increased risk of diabetic ketoacidosis, be sure to talk to your doctor about possible complications of inhaled insulin.
Benefits of inhaled insulin: effective
In type 1 diabetics, insulin inhales blood sugar as well as fast-acting insulin injected. In those with type 2 diabetes, insulin inhales increases control of blood sugar further when added to the diabetes medication that is eaten.
Risk of inhaled insulin: side effects
Some of the main side effects of inhaled insulin involve the lungs. In fact, Afrezza brought a warning that was "boxed" about the risk of bronchospasm, which is a sudden muscle spasm in the airway that can cause difficulty breathing. For this reason, this type of insulin is not recommended for people with asthma or chronic obstructive pulmonary disease (COPD), or for those who smoke.
Some people who have used inhaled insulin have experienced a slight decrease in lung function. A 2007 study published in Diabetes Technology and Therapeutics looked at the effect of insulin inhaling on lung function. The researchers studied people with type 1 and type 2 diabetes who did not have lung disease. They found that, compared with injectable insulin and oral medications, inhaled insulin caused a small decrease in lung function. However, lung function does not worsen over time.
According to Afrezza's prescription information, the same applies to new drugs. People who use Afrezza also experience a small decrease in lung function. The manufacturer noted that there is currently not enough evidence to determine whether stopping drug use can improve lung function. They also advise doctors to assess a person's lung function continuously.
Other minor side effects of inhaled insulin include coughing and sore throat. More long-term studies are needed to determine the long-term effects of inhaled insulin on the lungs.
Benefits of inhaled insulin: limit some of the side effects of injectable insulin
Sometimes insulin can reduce blood sugar levels too much which leads to low blood sugar. Although inhaled insulin can also have these side effects, this can not be called a risk because the active period of inhaled insulin is shorter. The inhaled version may also reduce the risk of gaining weight, which is another common side effect of injectable insulin.
How do you decide whether to use inhaled insulin or injections?
Inhaled insulin may eliminate some pain from the treatment of diabetes, but it will not completely replace the injection form. If you use long-term insulin to help control your blood sugar levels, you will still need to inject insulin.
