February 6, 2006
Question from Georgia, USA:
I want to know what your thoughts on the new recently approved inhaled insulin. My current regimen consists of 12 units of Lantus in the morning and 12 at bedtime as well as one unit of fast-acting insulin per 13 grams of carbohydrates at meals and a correction factor for blood glucose over 160 mg/dl [8.9 mmol/L] of BG – 100/30 and it works just fine, with A1cs running at 6.2 to 6.7. Is it worth it to change and see how well it works or will this also be a trial by error to find a right dose and fluctuate my blood glucose levels? What I like is the lack of shots. I have had diabetes since I was eight and now I am 23. I have done really well for the most part but, if diabetes research is finding better ways to treat this disease, then I want to upgrade my treatment as well without compromising my good control. I want to talk to my endocrinologist about this but wanted to get some outside opinions, as well as information to take with me. My doctor seems more responsive to my concerns and questions when I come prepared with information and the right questions.
I think you are asking the correct questions. First, this medication is approved, but it has not been settled in the endocrinology world what the best place for use of this medication might be. Clearly, the use of inhaled insulin is a consumer-driven issue. However, we do not have good information about the ability to carry out long-term intensive insulin therapy with inhaled insulin. No one has used inhaled insulin more than a year or two to look at long-term lung function. I am not sure that all the insulin inhaled is absorbed like it is with subcutaneous insulin. Finally, endocrinologists do not have enough experience with it yet to clearly equate the inhaled insulin dose with the subcutaneous dose. If you are doing well with your current regimen, I do not necessarily think you need to change over.