GETTYSBURG MEDICAL NEWS
The Clinical View
by P. E. Hoffsten, M.D.
16 August 2006

INHALED INSULIN

          One of the hated aspects of being diabetic is injecting insulin.  Somehow or other, the idea of needles and injections is just very unpleasant.  Through the years, various methods of administering insulin have been considered, but the backbone of insulin therapy today is still injections with a needle.

          Recently, the Pfizer drug company has developed a powdered form of insulin that can be inhaled through a special device provided by the pharmacy.  This type of insulin is inhaled into the lungs where it is absorbed and acts very quickly.  The advantage of this is the ability to treat blood sugars when they are high and “titrate” the blood sugar down towards the normal range.

          The disadvantages of this product primarily revolve around the newness of it.  It takes some getting used to.  It is not quite as hard as playing the piano, but the device does take some coordination to breathe the powder in.  Secondly, the product is not uniformly absorbed.  If a person happens to have emphysema or bronchitis, absorption is not as predictable.  A cold or a case of the flu can disrupt treatment and the person has to go back to injections.  The product is not recommended for smokers.  Lastly, the long-term effects are simply not known since we haven’t had this product for long term.

          Tests using this type of insulin with diabetics have generally been very favorable.  Younger individuals seem to like this product much better than injectable insulin.  The degree of control achieved is comparable to injectable insulin.

          Unfortunately, the expense is going to be higher than the usual injectable insulins.  Estimates at this time are that it will cost between $3.50 to $5.00 per day, depending on how much insulin the person uses.

          Remember that there are two types of diabetics.  In one type, the person has the onset of the condition at a young age.  They lose much or all of their insulin secretory capability and they simply don’t have any insulin.  This is the person this product is most designed for.  The second type of diabetic results from the person becoming resistant to the insulin they do have.  Generally, this so called type II diabetic makes three or four times the normal amount of insulin, but it simply doesn’t work.  While some of these individuals are given even more insulin by injection, most generally insulin supplementation in this group is not as successful as in the younger age group.  The inhaled insulin probably won’t be much help in the type II diabetic.

          In summary, this is a new product of which the big advantage is the avoidance of needle injections for insulin.  It is best used for the juvenile onset diabetics.  It will probably be more expensive than the injectable insulins.  It has recently been approved by the Food and Drug Administration, but after calling several pharmacies today, it is not available until September 1, 2006.