Latest Information on Diabetic Inhalers

Post updated: 20th May 2023

People with diabetes, researchers, as well as doctors, agree that conventional injected insulin is effective when it comes to managing diabetes. They’ll also probably agree that getting insulin into the body through anything other than an injection would be better.

Insulin can’t be administered through pills, but how about inhaling it. The effectiveness of insulin inhalers for managing diabetes means that insulin aerosolization (using compressed air to convert insulin into particles that can be inhaled and absorbed through blood vessels in the lungs) is a viable treatment option for type 1 and type 2 diabetes.

Although previous attempts to produce insulin inhalers have been unsuccessful, lessons were learned and modern insulin inhalers are again a thrilling area of modern diabetes technology.

How Does Inhaled Insulin Work?

Whilst the idea of inhaled insulin has been around for several decades, researchers only made it possible in the 1990s. With inhalers much like the ones used by asthma patients, people with diabetes simply breathe a fine aerosolized insulin powder into the lungs where it is absorbed into the blood through blood vessels.

Some diabetic inhalers work by converting dry compressed insulin into particles that can be inhaled. Other inhalers use the breath to activate insulin stored in powder form.

Modern Inhaled Insulin

The first inhaled insulin known as Exubera was approved by the FDA in 2006. Both type 1 and type 2 diabetes patients could use the drug to control blood sugar.

However, Exubera didn’t catch on with customers and it was taken off the market in 2007. Later, concerns were raised that the drug might cause lung cancer and other lung problems. Patients also thought the canister was too clunky and big. (Afrezza is smaller and easily portable).

Afrezza, an inhaler with rapid-acting pre-measured insulin, was approved by the FDA in June 2014. It is an inhaler that is taken before meals and is approved for use in the U.S. However, Afrezza should not be used for diabetes-related complications like DKA (diabetic ketoacidosis).

Inhaled insulin can have several side effects such as a cough, low blood sugar, and a sore or scratchy throat. People with type 1 diabetes still need to use long-acting insulin, to help control their blood sugar. Moreover, inhaled insulin should not be used by people who smoke or have lung diseases such as COPD (chronic obstructive pulmonary disease) or asthma.

Ultra-rapid Acting Insulin

Ultra-rapid-acting inhaled insulin means that insulin that is breathed directly into the lungs enters the bloodstream quicker and acts faster than injected insulin.

Rapid-acting insulin injections usually have their peak activity 30 to 90 minutes after injections but the Afrezza inhaler has its peak activity 12 to 15 minutes after use.

In the future inhaled basal (slow-acting) insulin could become a reality, however, there’s no indication that it will be available in the near future. Therefore, people who take long-acting insulin need to continue taking basal dose injections.

Benefits of Inhaled Insulin

    Studies show that insulin inhalers have become increasingly successful in insulin delivery and controlling blood sugar levels. Clinical studies of the recently approved Afrezza show proved it to be successful in reducing incidences of severe hypoglycemia in patients compared to rapid-acting insulin injections that are most commonly used to control blood sugar.

Whilst previous devices, such as Exubera, were cumbersome and large, modern insulin inhalers are notably smaller and more portable.

    One of the key advantages of inhaled insulin is its non-invasive nature. Unlike injections, which can be painful and inconvenient, inhaled insulin delivers insulin directly to the lungs through a handheld inhaler. This method eliminates the need for needles, reducing the discomfort associated with injections and making it a more comfortable option for individuals who fear or dislike needles.

    Moreover, inhaled insulin provides a rapid onset of action. It allows for the quick absorption of insulin into the bloodstream, resulting in faster blood sugar control. This is especially beneficial for mealtime insulin dosing, as it mimics the natural release of insulin in response to food consumption.

    Another advantage of inhaled insulin is its flexibility and convenience. With inhalable insulin, people with diabetes can discreetly administer insulin whenever and wherever necessary, without the need for privacy or special equipment. This flexibility empowers people with diabetes to better manage their condition, leading to improved adherence to insulin therapy.

    Furthermore, inhaled insulin offers a more precise dosing option. Inhalers are designed to deliver precise doses, allowing for accurate insulin administration. This can help individuals achieve better glycemic control, reducing the risk of hypo or hyperglycemia and promoting long-term health.

Disadvantages of Insulin Inhalers

    In recent clinical trials of Afrezza, the inhaled insulin drug was outperformed by daily injections, in terms of reducing HbA1c levels. Fortunately, the deference was a mere 0.4% or 4 mmol/mol.

    Insulin doses for inhaled insulin are not easy to vary as for injections. Injections can deliver insulin doses by half-unit increments but Afrezza, the latest inhaled insulin device, can only deliver doses by 4-unit increments.

    A few concerns exist such as the long-term effects of using insulin inhalers on people who have breathing problems as well as people who smoke.

    Although there’s no evidence that inhaled insulin increases the risk of lung cancer, the Food and Drug Administration in the United States continues to monitor inhaled insulin devices such as Afrezza just in case evidence of lung cancer causation emerges.

Precautions

Be sure to consult your doctor before using Afrezza to ensure that you’re making a sound and ‘safe’ decision. Tell your physicians if you are taking any medicines or have any allergic or unusual reactions to medications, including Afrezza. This will help your doctor determine whether doses need to be changed as well as how often you use your medications.