For years, people will diabetes have been faced with many challenges, including finding insulin that helps prevent post-meal spikes in blood sugars. While many pump users can try to bolus up to 30 minutes before eating or try extended bolusing, not everyone uses a pump. As an alternative to giving oneself multiple injections of fast-acting insulin, there is one other option: inhaled insulin. First developed in 2006, inhaled insulin at that time was not widely used because there were several issues, including a bulky device to deliver the insulin. Over time, more research was conducted leading to development of the fastest acting insulin on the market, Afrezza. It works so quickly that it may make pre-bolusing a thing of the past. Afrezza is currently approved in the US for adults and is being studied in children ages 4 to 18.
Here’s some key information on inhaled insulin:
- Inhaled insulin is safe for most people; however, you should not take inhaled insulin if you have lung cancer or chronic lung disease such as asthma or COPD1
- Inhaled insulin works faster, but does not last as long in the bloodstream compared with the fast-acting mealtime insulins (Humalog, NovoLog, Admelog, etc.)2
- You may need to take more insulin after meals than your typical dosing with injected insulin2
One of the interesting aspects of Afrezza is that it comes in 4-unit increments for dosing. In the study comparing inhaled insulin to injected insulin, the recommended dosing was to take about 1.5x the normal injected dose to help account for the differences in absorption. Researchers also found many participants in the study were not willing to take additional doses if they were high after meals, especially at night.
This is one of the challenges with the inhaled insulin – fear of hypoglycemia. Four units sounds like a lot when you are used to taking two units with meals, but the reality is that it does not have the same impact on blood sugars as injectable insulin. Since it is inhaled, it both starts working faster and stops working faster. The lungs have a more direct path into the bloodstream, as opposed to the subcutaneous tissue where we do injections where it takes longer to get into the bloodstream.
There is a quick and easy lung test that you can have done at the beginning before you start taking the inhaled insulin, at six months, and one year. It’s called an “FEV-1” and there are certified trainers to help health care providers, but it’s quite simple and all you need to do as the person taking inhaled insulin is exhale into the device. Afrezza has a lot more information on their website and can help you navigate how to use the inhaled insulin and more. In addition, author Ginger Viera recently wrote about her personal experience using Afrezza, as did Mike Joyce.
Diabetes is not a one-size-fits-all condition and finding the treatments that fit best into your life makes a huge difference to management. Trying new things can be anxiety-inducing at times, but if you are able to monitor your glucose levels with a BG meter or a CGM, you will be able to see how the new treatment is working for you.
- Improved Postprandial Glucose with Inhaled Technosphere Insulin Compared with Insulin Aspart in Patients with Type 1 Diabetes on Multiple Daily Injections: The STAT Study
Written and clinically reviewed by Marissa Town, RN, BSN, CDCES