What problems exist with regard to the use of inhaled insulin

• The existing inhalation appliances do not allow for an easy change of the dose of insulin.

• Only a small percentage (roughly 10 percent of the administered dose) is absorbed, since a quantity of insulin remains in the appliance (in the walls and the chamber), and, as mentioned before, particles smaller than 1 mm and larger than 10 mm are not absorbed.

This characteristic renders the treatment with inhaled insulin ten times more expensive than treatment with subcutaneous insulin. The improvement, however, of glycaemic control in patients who refuse to start subcutaneous insulin, may possibly have more economic benefit as a whole, due to the expected reduction of chronic diabetic complications.

• Anti-insulin antibodies develop with the inhalation of insulin in larger proportions compared with the use of subcutaneous insulin, an element without clinical importance (so far).

• The respiratory function deteriorated in some individuals with Type 2 DM who inhaled insulin in a 6-month study with a specific appliance. The deterioration concerned the decrease of the diffusion capacity of CO (DLCO in ml/min/mmHg) and receded after the interruption of the inhalations. A similar deterioration was not observed in other studies, with different appliances.

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