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Defeat Diabetes Foundation

Defeat Diabetes
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Inhaled Insulin Coming in September

Posted: Thursday, August 31, 2006

It will be limited at first by the endo’s and then eventually by the family practitioner and internist. So how does it work?

The air you breathe is full of germs — bacteria, viruses, fungi. But most of the time, you don’t get sick. Your immune system destroys these germs before they reach the deep recesses of your lungs. This keeps the germs from moving into your bloodstream.

Your lungs will try to protect your body from any stray protein that you breathe in. This includes insulin. For insulin to be delivered through your lungs to your bloodstream, the insulin must be protected from this first-line defense.

Researchers at Nektar Therapeutics found a way. They developed “glass stabilization.” This doesn’t really involve glass but rather sugars that make a hard “glassy” coating. Insulin is first coated with sugars and then sprayed into a mist. The tiny particles dry, making a fine powder. When this powder is breathed in, the tiny sugary spheres get past the immune system and make it further into the lung where they are dissolved. The insulin can then get into the bloodstream.

Pfizer has used Nektar’s method to develop Exubera, the first inhaled insulin to reach the market. Exubera is approved for people with type 1 or type 2 diabetes. It is a rapid-acting insulin that covers meals. It does not cover your basal insulin needs. If you take a basal (long-acting) insulin plus mealtime insulin, you will still need to inject a basal insulin.

Exubera Action Profile: Take 10 minutes before eating.

Onset (starts to lower blood glucose): 30 minutes, Peak: 30 to 90 minutes, Lasts: 6 hours

You should not use Exubera if you smoke or have smoked in the last 6 months or you have lung problems. Exubera has not been tested enough in pregnant women, children under age 18, or people with kidney or liver problems.

Exubera is packaged as a powder in blister packs with either 1-mg or 3-mg doses. A 1-mg blister of Exubera is about equal to 3 units of injected regular insulin. A 3-mg blister is about 8 units. Combine blister sizes to use the fewest blisters possible. For example, if you need 4 mg of inhaled insulin, use a 3-mg plus a 1-mg blister rather than four 1-mg blisters.

Your lung function should be tested before you start Exubera. This is done with spirometry. You take a deep breath and blow into a tube as hard as you can. This test should be done again 6 and 12 months after you start using Exubera.

When you’re new to Exubera, you might cough within seconds or minutes after using it. This usually happens less as you keep using Exubera. But if you develop a longer-lasting cough or wheezing, or you find yourself often short of breath, your lung function should be tested more often. You can expect to lose a little bit of lung function, but you shouldn't notice this in your everyday life. Any more than that and you will need to stop using Exubera.

With your prescription of Exubera, you will get a guide that tells you how to use and clean the device. Still, a book can’t do it all. You’ll want to see a diabetes educator to learn how to use Exubera, to practice with someone with experience, and to ask questions.

Analysts project a $4-per-day cost for Exubera, up to four times more than injected insulin. Will insurance plans cover it? That remains to be seen. Studies show that people are more likely to agree to use insulin when they can choose inhaled insulin rather than injected insulin. Insurance companies may see inhaled insulin as a way to get people who need insulin to use it. This would lead to better health in those patients and lead to lower costs in the long-term for the insurance company.

Most analysts agree that if health insurers do cover inhaled insulin, it will likely be with a high co-payment. You and your doctor will have to decide if the cost is worth it.

Source: Diabetes In Control