Diabetes Treatment (cont.)
Inhaled Insulin
Inhaled insulin, marketed by Pfizer in 2006, was approved by the FDA. This
inhaled form of insulin is called
Exubera. The insulin is packaged in dry
blister packs that are inserted into an inhalation device. This device lances
the powder packs allowing the insulin to enter a chamber that has a mouth piece
through which the user can inhale the insulin. Exubera has a peak of action
similar to Humalog (rapid acting), and a duration of action similar to regular
insulin (short acting). It can be combined with oral medication in patients with
type 2 diabetes or used alone. In patients with type 1 diabetes the insulin
should be combined with a longer acting basal insulin such as glargine.
The side effect profile of inhaled insulin is similar to other insulins, and
the user must be aware of hypoglycemia. In addition, since the insulin is
absorbed through the lungs, there was initial concern regarding lung function.
While there is a slight decrease in lung function with the initial use of
Exubera, this stabilizes quickly and returns to baseline of aged matched
controls when the Exubera is discontinued. Since this is still a new product, it
is recommended that any patient starting on inhaled insulin have lung function
tests done prior to starting treatment. If baseline values of
FEV1 (a measure of
lung function) are < 70%, Exubera is not given. After six months of use lung
function tests are performed again; if deterioration is noted, Exubera is
discontinued.
Exubera is not to be used in regular or intermittent
smokers and patients
requiring very small doses of insulin. Nevertheless, in the right population,
this is a great option.
Note: Unfortunately, acceptance of Exubera was poor over the year or so it was available since it's launch in 2006. Recently in October 2007, the company Pfizer decided not to sell the product anymore. Part of this issue was the time required to teach the device and the uniqueness of the format of delivery. While no major medical concerns were noted with it's use, it simply has not been accepted by patients and doctors. Perhaps we will see this modality come back in a new easier to use incarnation.
Next: Intranasal, Transderm »
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