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Inhaled Insulin

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Inhaled Insulin, Insulin Inhalation Powder, Afrezza, Exubera

  • See Also
  1. Insulin
  2. Bolus Insulin
  3. Analog Basal Insulin
  4. Insulin Dosing
  5. Glucose Metabolism
  6. Type II Diabetes Medications
  7. Type 1 Diabetes Mellitus
  • Indications
  1. Bolus Insulin in Diabetes Mellitus when intollerant to SQ Injection
  • Contraindications
  1. COPD
  2. Asthma
  3. Chronic lung disease
  4. Lung Cancer
  5. Tobacco use
  • Mechanism
  1. Dry powder form of rapid acting Insulin
  2. Delivery by oral inhalation
  3. Large doses needed due to inefficient absorption
    1. Most Insulin remains in lung and is inactive
  • Medications
  • Afrezza
  1. Background
    1. Released in 2014, as a Bolus Insulin (Short-Acting Insulin) substitute
    2. Does not replace Basal insulin (Long-Acting Insulin)
    3. Not approved for use in children
  2. Supplied
    1. Delivered in 4, 8 or 12 units/cartridge
    2. Convert Insulin unit for unit, and round dose up to nearest 4 unit cartridge
  3. Dosing: Insulin Naive
    1. Start: 4 units inhaled immediately before meals
  4. Dosing: Switching from Bolus Insulin (Short-Acting Insulin)
    1. Convert unit for unit of prior Bolus Insulin to Inhaled Insulin, rounding to nearest 4 units (4 to 24 units)
  5. Dosing: Switching from Pre-mixed Insulin (e.g. 70/30 or 50/50)
    1. Inhaled Dose: Divide 50% of total daily premixed Insulin equally over 3 meals
    2. Give Inhaled Insulin dose, rounding to nearest 4 units (4 to 24 units), immediately before meals
  6. Cost
    1. Twice the cost of Bolus Insulin
  7. Activity
    1. Onset of activity is similar to SC injected Bolus Insulin
    2. Duration is shorter than SC injected Bolus Insulin
  • Medications
  • Exubera (off market as of 2007)
  1. Historical information only
    1. Off U.S. Market as of October 2007 (based on business decisions, not on recall)
  2. Dosing
    1. Powder 1 mg (in Blister pack) = Insulin 3 units
    2. Powder 3 mg (in Blister pack) = Insulin 8 units
  3. Preparations
    1. Starter: Inhaler/parts, 180 packs 1 mg, 90 packs 3 mg
    2. Refill 12: 90 packs 1 mg, 90 packs 3 mg (990 units)
    3. Refill 15: 180 packs 1 mg, 90 packs 3 mg (1260 units)
  4. Cost: Expensive (twice the cost of SQ Insulin)
    1. Starter: $190
    2. Refills: $140-180
  • Efficacy
  1. Similar to SC Bolus Insulin
  • Safety
  1. Unknown safety in pregnancy
  2. Unknown safety in Lactation
  • Adverse Effects
  • Exubera
  1. Hypoglycemia (esp. when used with Oral Hypoglycemics)
  2. Bronchospasm
  3. Cough (<5%)
  4. Chest Pain (<5%)
  5. Dyspnea (<5%)
  6. Dry Mouth (<5%)
  1. Schedule: Baseline, 6 months and annually
  2. Stop Inhaled Insulin if FEV1 with >20% decline from baseline
  • Resources
  1. Afrezza (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=29f4637b-e204-425b-b89c-7238008d8c10
  • References
  1. (2015) Presc Lett 22(3): 13-4
  2. Borja (2007) Am Fam Physician 75: 1546-7 [PubMed]
  3. Cefalu (2001) Ann Intern Med 134:203-7 [PubMed]
  4. Quattrin (2004) Diabetes Care 27:2622-7 [PubMed]