Inhalable insulin: I'll 'stick' with the needles (for now)

[boise1]

FDA Advisers Endorse Inhaled Insulin Exubera

The announcement by an FDA advisory panel that 'Exubra', an inhalable insulin, should be approved for use by both Type 1 and Type 2 diabetics, will provide relief for many who don't now successfully control their blood glucose levels with injections. For myself, however, I'll take a pass until the long-term pulmonary effects have been documented.

Essentially, the technology delivers tiny droplets of insulin in liquid or powder form using an inhaler(not a bong, but you get the idea). Some of the concerns raised are that inhaled insulin is not as effective in smokers, may diminish lung capacity in others, and may increase the body's anti-insulin antibodies.

[LynzM]

1. I will as well, though for different reasons

I actually work on the efficacy studies for this (as a contracted company). For me, the size of that inhaler, as well as the fact that the dosing is not as accurate as injections, mean I won't use it. But for people who are non-compliant due to dislike of needles, any pulmonary effects are probably negligible compared to what it does to your body to not take insulin when you need it.

[MockSwede]

2. Variable inhaled dose

This works for us asthmatics with b-agonists but it's being applied where needed and effect only needs to reach threshold of dose so that muscle relaxation can occur and airways open up. 'Too much' just results in a little buzz or higher blood pressure.

Don't see this working well when target is a tight blood glucose range and blood glucose level isn't sensible by patient (needs a blood glucose meter to determine level).

Not sure that antibodies would be issue. Usually more of problem with IV and SC routes that bypass 'normal' exposure routes. Now that all insulins used are recombinant bacterial produced purifications and not pig or cow source, there's been a lot less antibody and tissue degradation at injection sites, etc.

But, GOD, that does look like the bongs I saw kids in college drag about. Would have liked to see it as a mouth and nose mask held in place like asthmatic medication nebulizer with inhalations drawing in mist with medication in the air incoming and then exhaling out a side port.

[camero]

3. Also, the diabetic would still need shots

Even with inhalable insulin, shots for long acting insulin would still be required. Injected insulin is still the fastest way to bring BG numbers down.

[Sgent]

4. I wonder how the efficacy

of this compares to that of an insulin pump in non-compliant patients.

Both have their downsides -- but anything that increases GL control in non-compliant patients is welcome.