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Inhalable Insulin

The new treatment for diabetes

Couple of man and woman breathing deep fresh airInhaled insulin is much more acceptable to patients with type 2 diabetes. This means that more patients with poorly controlled diabetes would be willing to be started on insulin, which no longer requires painful injections.

In June 2014, the Food and Drug Administration (FDA) of the United States approved the new inhaled insulin Afrezza for patients with both type 1 and type 2 diabetes. It may be commercially available as soon as early 2015.

Methods to Manage Diabetes

There are three main types of diabetes mellitus:

  • Type 1 diabetes is caused by the insulin-making cells in the pancreas being destroyed by the white cells of the body (i.e. autoimmune disease).
  • Type 2 diabetes is related to obesity, a sedentary lifestyle and genetics. The body develops resistance to insulin and the pancreas will try to compensate at first. Ultimately, however, the pancreas fails and the patient develops high blood sugar.
  • Gestational diabetes is related to hormones of pregnancy antagonising the action of insulin.

Patients with Diabetes doing glucose level test. Vegetables in backgroundtype 1 diabetes must use insulin for the rest of their lives. Usually it is one basal insulin injection with three pre-meal insulin doses. They can also use an insulin pump, but this is rather expensive.

Patients with type 2 diabetes are usually managed with diet, exercise and then oral medication. Only when their diabetes gets out of control, are they given insulin.

Patients with gestational diabetes are mostly managed with diet and exercise, but if they cannot manage it they are started on insulin.

Just Breathe

Afrezza, or Technosphere insulin, is a fast-acting inhaled insulin therapy used to improve glycemic control in adults with diabetes mellitus. Technosphere Insulin Inhalation Powder is delivered using a palm-sized inhaler. Administered at the start of a meal, Technosphere insulin dissolves rapidly once inhaled to the deep lung and delivers insulin quickly to the bloodstream. Peak insulin levels are achieved within 12 to 15 minutes, and fall back to baseline (the ‘normal’ level) in approximately 180 minutes. This is comparable to the normal insulin secreted from the pancreas, where insulin peaks at 30 – 45 minutes and returns to baseline by 90 – 120 minutes.

Afrezza can replace the short-acting insulins but not the long-acting ones, so patients with type 1 diabetes would still need to inject the basal insulin, but would then just need to inhale before meal times. This effectively saves them three injections. Patients with type 2 diabetes who inject insulin can now just use this inhaler.

iStock_000013488204_LargeTried and Tested

In a large randomised trial published in 2010, inhaled Technosphere insulin when given with once-daily insulin was compared to pre-mixed twice-daily insulin. It resulted in similar blood sugar levels after meals, less weight gain and lower risk of hypoglycemia (blood sugar level too low). Side effects were not major, such as transient cough.

However, patients with previous asthma and chronic lung disease experienced bronchospasm (airway narrowing), so Afrezza cannot be given to such patients. The FDA has also ordered post-marketing studies of the drug.

This is great news for patients who are currently injecting insulin multiple times a day, as inhaled insulin is much more acceptable to patients with type 2 diabetes. This means that more patients with poorly controlled diabetes would be willing to be started on insulin, which no longer requires painful injections. Hopefully this new inhaled insulin will arrive in Singapore soon.

 

References:

  1. http://www.fda.gov/newsevents/newsroom/pressannouncements/ucm403122.htm
  2. http://en.sanofi.com/Images/37059_20140811_Sanofi_MannKind_en.pdf
  3. Greenspan and Gardner. Basic and Clinical Endocrinology, 6th edition.
  4. Rosenstock et al. Lancet 2010; 375: 2244–53.
  5. http://www.dynamicmt.com/dataform3.html
  6. Petrak et al. Diabetes Technol Ther. 2013 Aug;15(8):703-11.

 

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Dr Daniel Wai Chun Hang is a Consultant Endocrinologist at Mount Elizabeth Hospital, Singapore.
Posted by ezyhealth on Nov 6 2014. Filed under Medical Express. You can follow any responses to this entry through the RSS 2.0. Both comments and pings are currently closed.

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