Exubera Inhaled Insulin

Inhaled insulin is not a new insulin: it is simply an old insulin (regular insulin) that is delivered into the body in a different way. You use an inhaler (very much like an asthma inhaler) to inhale the insulin powder, which is available in 1 mg and 3 mg blister packs.

The 1 mg pack is equivalent to 3 units of insulin, and the 3 mg pack is about 8 units of insulin. Three 1 mg inhalations are not equivalent to one 3 mg inhalation—you get one-third more insulin with the former. This is because three separate inhalations result in more insulin being absorbed than one larger-dose inhalation.

Only about 10 percent of the delivered dose gets into the circulation, so an average adult has to inhale 300 to 400 units of insulin a day. The inhaled insulin is rapidly absorbed—the insulin profile is very much like the injected fast-acting insulin analogs, except it lasts longer (up to six hours).

The biggest unanswered question about inhaled insulin is whether it will damage the lungs if used for a long time. The studies so far have shown that when someone starts using inhaled insulin, there is a small negative effect on the lung function, but then these lung changes stabilize and do not get worse with time. Therefore, the FDA requires that anyone taking inhaled insulin should have lung function tests before starting it, at six months, and then yearly.

You should not use Exubera if you have lung disease such as asthma or bronchitis, or if you are a smoker. Smoking results in more of the insulin being absorbed, and you have to stop smoking for at least six months before you can start on inhaled insulin. There are higher levels of antibodies to insulin in the blood after using inhaled insulin compared to injected insulin, but this does not seem to have a negative effect. Other side effects include cough, shortness of breath, sore throat, and dry mouth. In the clinical trials of Exubera, approximately 2,500 adult patients with type 1 and type 2 diabetes were studied for an average duration of about two years. Many more people will need to take inhaled insulin for longer periods before we can be sure that it is as safe as injected insulin.

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