Pharm
Inhaled Insulin
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Inhaled Insulin
, Insulin Inhalation Powder, Exubera, Afrezza
Background
Exubera (listed for historical reasons)
Off U.S. Market as of October 2007 (based on business decisions, not on recall)
Indications
Diabetes Mellitus
when intollerant to
SQ Injection
Contraindications
COPD
Asthma
Lung Cancer
Tobacco
use
Mechanism
Dry powder form of rapid acting
Insulin
Delivery by oral inhalation
Large doses needed due to inefficient absorption
Most
Insulin
remains in lung and is inactive
Preparations
Afrezza
Released in 2014, as a
Bolus Insulin
substitute
Does not replace basal
Insulin
Dose
Delivered in 4 or 8 units cartridge
Convert
Insulin
unit for unit, and round dose up to nearest 4 unit cartridge
Cost
Twice the cost of
Bolus Insulin
Activity
Onset of activity is similar to SC injected
Bolus Insulin
Duration is shorter than SC injected
Bolus Insulin
Preparations
Exubera (off market as of 2007)
Historical information only
Dosing
Powder 1 mg (in
Blister
pack) =
Insulin
3 units
Powder 3 mg (in
Blister
pack) =
Insulin
8 units
Preparations
Starter:
Inhaler
/parts, 180 packs 1 mg, 90 packs 3 mg
Refill 12: 90 packs 1 mg, 90 packs 3 mg (990 units)
Refill 15: 180 packs 1 mg, 90 packs 3 mg (1260 units)
Cost: Expensive (twice the cost of SQ
Insulin
)
Starter: $190
Refills: $140-180
Efficacy
Similar to SC
Bolus Insulin
Adverse Effects
Exubera
Hypoglycemia
(esp. when used with
Oral Hypoglycemic
s)
Cough
(<5%)
Chest Pain
(<5%)
Dyspnea
(<5%)
Dry Mouth
(<5%)
Monitoring
Pulmonary Function Test
s
Schedule: Baseline, 6 months and annually
Stop Inhaled Insulin if
FEV1
with >20% decline from baseline
References
(2015) Presc Lett 22(3): 13-4
Borja (2007) Am Fam Physician 75: 1546-7 [PubMed]
Cefalu (2001) Ann Intern Med 134:203-7 [PubMed]
Quattrin (2004) Diabetes Care 27:2622-7 [PubMed]
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