My nine year old son is was diagnosed at age eight. Currently he is on combined N and R twice a day and is doing well with it, but we know that it will increase in time. My pharmacist told me that he has just returned from taking a course to make his own insulin sprays. He has a lab and will begin making them in the new year.

How effective are insulin sprays? What is your thoughts of these sprays? It would certainly cut down on the needles.

Insulin sprays either from solution or as very small particles have been around for a number of years, but the recent emphasis on meticulous control with the consequent increase in the number of insulin injections and blood sugar assays has boosted demand for more practical devices. Certainly in the last two years there have been several clinical studies in adults that have shown that inhaled insulin maintains control as well as injected insulin. The leading device (by Pfizer and Inhale Therapeutics) so far is ingenious, but still somewhat cumbersome and has some significant drawbacks: 1) It uses 10 times as much insulin as conventional injection therapy, 2) The insulin capsules come in only two sizes so that precise dosage may require more than one inhalation, 3) So far, you can’t use any of the long acting insulins such as NPH. Possibly, glargine will be an exception, but, in the meantime, they have to be given by separate injection. It is still not authorised for general distribution in the U.S. and has not been fully tried out in children. In addition, there are still doubts as to the possible long term effects on lung tissue of prolonged use, and there is almost no published experience as to how to cope with respiratory infections.

Another spray device being supported by Eli Lilly uses the buccal mucosa and is still in the earliest stages of clinical trials in this country, though it has shown promise in Britain. In short, I would wait a year or two to see how this trend develops.

Finally, I wonder if, perhaps, you have misunderstood your pharmacist. I feel it is more probable that he is planning to stock one of the inhalation devices. Certainly, I would be hesitant to accept a device he has made himself unless you know it has been approved by the Canadian equivalent of the FDA.

DOB