Determining the dose

The Big Diabetes Lie

Effective Home Treatments to Cure Diabetes

Get Instant Access

Inhaled insulin takes the place of rapid-acting insulin. Its onset is a little slower than that of rapid-acting insulin, but it's faster than the onset of regular insulin. It lasts longer than rapid-acting insulin and almost as long as regular. You take inhaled insulin just before the meal begins or after the meal.

Inhaled insulin isn't basal insulin. A person with T1DM who takes inhaled insulin continues to need a shot of long-acting insulin such as glargine in order to provide the basal insulin.

The device used to inhale the insulin, manufactured by Nektar Therapeutics, is in Figure 10-5. The insulin comes in two different doses called blisters and is measured in milligrams rather than units. The 1-mg blister is equal to 3 units of rapid-acting insulin, whereas the 3-mg blister is equal to 8 units of rapid-acting insulin.

Figure 10-5:

The device used to administer inhaled insulin.

Reproduced with permission from Pfizer Inc.

The initial dose taken before each meal is based on your weight. If you need more than one blister, you take it immediately after the first blister. Table 10-4 shows the starting dosage for inhaled insulin based on weight in pounds. For example, if you weigh 90 pounds, you start with two 1-mg blisters before each meal and adjust this dose based upon your blood glucose reading before the next meal or at bedtime in the case of supper.

Table 10-4 Doses of Inhaled Insulin According to Body Weight

Body Weight (pounds)

Exubera Dose before Each Meal

66-87

1 mg

88-132

1 mg, 1 mg

133-176

3 mg

177-220

1 mg, 3 mg

221-264

1 mg, 1 mg, 3 mg

265-308

Front view (closed)

Inhaler (closed)

Bottom view

Figure 10-5:

The device used to administer inhaled insulin.

Base

Date of First Use Label

Side view (open)

Base

Mouthpiece (open position)

EXUBERA® Release Unit

Blue Handle

Black Pull Ring

265-308

When it comes to inhaled insulin, 1 plus 1 plus 1 does not equal 3. If you run out of blisters with 3 mg, don't substitute with three 1-mg blisters. Use two 1-mg blisters instead.

After you establish a starting dose, you need to continually measure your blood glucose so that you can change the dose as needed. The desired blood glucose levels are the same for inhaled insulin as they are for rapid-acting insulin; see Table 10-3. For example, if you're getting readings that are too high before lunch, add a 1-mg blister to the dose before breakfast. Stay at that dose for a few days and adjust it again if your readings still aren't satisfactory.

Curiously, despite the inability to give less than 3 units as the lowest dose, getting to the right dosage of Exubera has not been a problem with my patients. Nor have they experienced excessive amounts of hypoglycemia.

The steps for actually taking inhaled insulin are as follows:

1. Pull the base out of the chamber by pulling the black pull ring at the bottom of the chamber down until you hear a click.

2. Load the proper-sized blister into the slot above the blue handle, with the pocket containing the insulin facing down, and push it in as far as it will go.

3. Make sure the mouthpiece is closed. To pressurize the system, pull out the blue handle from the bottom as far as it will go and squeeze it until it snaps shut.

4. Hold the inhaler upright with the blue button facing you. Press the blue button until it clicks. A cloud of insulin fills the chamber.

5. Without delay, stand or sit up straight, and breathe out normally.

6. Turn the mouthpiece around to face you, place it in your mouth, and form a seal around it. In one breath, slowly and deeply breathe the insulin cloud in through your mouth.

7. Remove the mouthpiece, close your mouth, and hold your breath for five seconds. Then breathe out normally.

A little insulin may escape when the mouthpiece is turned around, and there may be a little left in the chamber after you breathe in. Neither fact affects your dose. The insulin isn't pushed into your lungs by pressure but rather is breathed in by your inhalation.

My experience with inhaled insulin

I have patients with both type 1 and type 2 diabetes taking inhaled insulin. Some of my discoveries about using it include:

I Patients with T1DM using inhaled insulin are generally happier than they were on insulin shots.

I There has been no loss of diabetic control; in fact, those who were well controlled before using inhaled insulin remain that way, and those who weren't as well controlled have improved.

I The patients haven't had more hypoglycemia since starting on inhaled insulin.

I The patients feel that their quality of life has improved as a result of the inhaled insulin.

I None of them is embarrassed to use their inhaler in public, although some say that it's a large device.

I'm generally very satisfied with the results of using inhaled insulin and plan to expand my use of it to more patients.

Was this article helpful?

0 0
Diabetes Sustenance

Diabetes Sustenance

Get All The Support And Guidance You Need To Be A Success At Dealing With Diabetes The Healthy Way. This Book Is One Of The Most Valuable Resources In The World When It Comes To Learning How Nutritional Supplements Can Control Sugar Levels.

Get My Free Ebook


Post a comment