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The studies done on inhaled insulin prior to bringing it to market didn't show any permanent damage to patients' lungs. However, the studies were short term. The FDA requires that all potential users have their lungs checked before use, at six months after use begins, and every 12 months, or more often if lung symptoms develop. The lung test, called spirometry, involves the patient blowing all the air out of his lungs as rapidly as possible. If the patient can successfully blow out 70 percent or more of the air in his lungs in one second, he passes the test.

A number of patients aren't permitted to use inhaled insulin for one reason or another. These include:

^ Children: The long-term effects of inhaled insulin aren't known yet, and if children were to use it, they'd have many decades of exposure. Until doctors and researchers have years of experience in prescribing inhaled insulin and seeing its effect on patients, it will remain off-limits to children with diabetes.

^ Pregnant women: The risk to the fetus is unknown, so for now pregnant women aren't permitted to use inhaled insulin.

^ Patients with chronic lung disease: Uptake of the inhaled insulin is too variable in these patients, so it can't be used.

^ Patients exposed to secondary smoke regularly: These diabetes patients also have irregular uptake.

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