We have found out in the most recent camping experience for children with diabetes of this city of Monterrey, that are two new types of insulins — one is the inhaled one, and another one is Lantus, that of American origin, which would be of much utility for my 9-year-old son, who has had type one diabetes for the past year. Can you provide more information to me, such as commercial advantages, disadvantages, names, prices or locations that have these insulins available?

Inhaled insulin is still being researched. Studies look very promising and it appears to work well, a bit slower than some of the fast acting analogs (Humalog and Novolog), but faster than Regular human insulin. Inhaled insulin is not yet available commercially, but there is an expectation, if the safety studies continue to show no problems, that this may become available in another few years. There are still some problems with the delivery chamber since the research system is a bit cumbersome to use. Engineers are working on this problem. Many pharmaceutical companies and biotechnology firms are working on inhaled insulins. Most studied is the inhaled insulin produced by Pfizer and Aventis with the inhaler produced by Inhaled Therapeutics.

Lantus (insulin glargine) is one of the analogs of insulin where the insulin molecule has been synthetically modified in an effort to change how quickly or slowly it is absorbed. With Lantus, the effect produces a slower absorption and therefore appears to be a more predictable but also steadier basal insulin effect. This would be similar to the basal rate produced using an insulin pump and avoids the peaks of NPH, Lente or Ultralente insulins currently used to try to mimic such basal insulin delivery. Lantus should be coupled with fast acting insulins provided as boluses to cover meals and snacks. Lantus also holds promise for reducing nocturnal hypoglycemia and at the same time provided better pre-breakfast insulinization at the same time. Experience with children and adolescents is limited and Lantus is not yet approved for use for children under the age of six years.

The one downside to glargine insulin is a report, not yet confirmed, of binding to the IGF-1 receptor. This may or not be confirmed. Longer duration studies must be undertaken to be sure that this binding is not a problem related to long term growth effects in children and also in terms of stimulating cell growth in an unwarranted fashion. There is similar concern about whether or not such binding might induce kidney problems after many years. Nobody knows whether or not this is a real concern or merely a potential concern. As with all new medications, the benefits (less hypoglycemia, better basal insulinization and therefore smoother and more predictable glycemic control) must be weighed against the known or potential risks. This will require ongoing surveillance, but this is a new and very promising insulin product manufactured by Aventis.

SB