Inhaled Insulin
| Author: Judy Kohn, RN, BSN, CDE |
| Last Updated: Monday, October 22, 2007 |
Q: "Can you tell me about a type of insulin available now that is inhaled? I take a shot of rapid insulin with each meal and a shot of long-acting insulin at bed. I would love to get rid of syringes if I can."
A: EXUBERA® became available as an inhaled form of insulin in 2006. It is a prescription medication that contains an insulin powder that you breathe in (inhale) through your mouth using the EXUBERA® Inhaler.
While I will provide the key points about EXUBERA, please be sure to visit the EXUBERA website for more details as well as to discuss this fully with your healthcare team. *
| IMPORTANT NOTE: Pfizer announced on October 18, 2007 that they will no
longer be making EXUBERA available. Pfizer will return the worldwide rights
back to Nektar Therapeutics, the company from which they licensed the inhaled
insulin technology. Pfizer will support EXUBERA patients for the next 3 months
as they transition to other glucose-lowering therapies, but after that, Pfizer
will no longer promote or sell EXUBERA. This decision was not based on any
safety problems but rather on the fact that too few patients are taking
EXUBERA. Pfizer emphasized that this is not a recall, nor the result of any
specific safety issues that would put patients at risk. Rather, Pfizer stated
that while EXUBERA remains a safe and effective medicine, it simply has not met
the needs of prescribing physicians in managing patients with diabetes. Be sure to discuss this with your diabetes team. |
How EXUBERA Works:
- You inhale EXUBERA through your mouth using a special device, within 10 minutes before eating a meal. Then your lungs absorb the insulin into your blood stream.
- The onset of EXUBERA is within 10 minutes, comparable to a rapid-acting insulin analog. The peak action occurs at about 90 minutes, and the duration is comparable to that of regular insulin (although the period of peak action is shorter than that of regular insulin). The duration is approximately 6 hours.
- The dosage is based on weight.
- EXUBERA is supplied in 1-mg dose "blisters" and 3-mg dose blisters, which are small, foil dose packets. "Blister" is a standard term for the shape and type of foil dose packet that holds the insulin powder.
- 1-mg blister of EXUBERA inhaled insulin is approximately the same as 3 units of subcutaneously injected regular human insulin; a 3-mg blister is approximately equivalent to 8 units of regular human insulin.
- NOTE: Three 1-mg dose blisters are not equivalent to one 3-mg dose blister; consecutive inhalation of three 1-mg blisters caused significantly greater insulin exposure than did inhalation of one 3-mg blister, related to the energy discharged through the inhaler-i.e. a higher proportion of the powder in a single 1-mg blister is converted into fine particles than in that of a 3-mg blister. Be sure to review this with your healthcare team, and to read the Medication Guide provided with your EXUBERA which is also available on the EXUBERA website.
Who Can Use EXUBERA:
- Adults age 18 and older.
- If you have type 1 diabetes, you will still need to take some form of longer-acting basal/background insulin by injection, such as NPH, Lantus®, or Levemir®.
- If you have type 2 diabetes, you may be able to use EXUBERA by itself, or you may use it along with diabetes pills or with a longer-acting insulin.
- If you have a respiratory illness (such as bronchitis, upper respiratory tract infection, rhinitis), you can still use the inhaler, but note that close monitoring of your blood glucose and dosage adjustments may be required.
Who Should NOT use EXUBERA:
Do not use EXUBERA if you:
- Smoke --This is because insulin exposure is expected to be 2-to-5-times higher in smokers than in nonsmokers, which would put you at increased risk of hypoglycemia.
- Stopped smoking less than 6 months ago.
- Resumed smoking--- if you resume smoking, stop using EXUBERA right away.
- Have an unstable or poorly controlled lung disease (such as asthma, chronic obstructive pulmonary disease, or emphysema).
- Are allergic to insulin or any of the ingredients in EXUBERA.
- Are under 18 years of age, because EXUBERA has not been tested enough in children and teenagers.
Also discuss with your healthcare team if you:
- Are using any other inhaled medications.
- Have liver or kidney problems-as your dose may need to be adjusted.
- Are pregnant or plan to become pregnant-as EXUBERA has not been tested enough in pregnant women.
- Are breast-feeding or plan to breast-feed-many medicines, including insulin, pass into breast milk and could affect your baby. Talk to your healthcare team about the best way to feed your baby.
- Are taking any medicines or supplements-including prescriptions, over-the counter medications, herbal supplements, and vitamins, since any of these may affect your blood glucose or your insulin requirements.
Side Effects of EXUBERA:
Below are some but not all of the possible side effects that can occur, so be sure to discuss this further with your healthcare team.
- Lung function: Because EXUBERA is inhaled, it may lower your lung function. You will be required to take a breathing test of your pulmonary function before you can start this insulin, after 6 months of therapy, and at least yearly thereafter. Your healthcare team will determine specifically how frequently this is necessary for you.
- Cough, dry mouth, or chest discomfort.
- Low blood sugar (hypoglycemia): EXUBERA has been shown to have about the same rate of hypoglycemia as mealtime insulin.
The EXUBERA Inhaler:
- A fully assembled EXUBERA inhaler consists of the inhaler base, a chamber, and an EXUBERA® Release Unit.
- You can view a video on the EXUBERA website to see how it is used as well as how to clean it properly.
- Store EXUBERA in a dry place at room temperature below 86°.
- Protect the small foil blister packs from humid places, such as from steam and water.
- Do not refrigerate or freeze EXUBERA, or expose it to excessive heat.
- Be sure to clean the inhaler weekly to prevent medicine buildup that could affect your dose.
- You should change the EXUBERA® Release Unit in your inhaler every 2 weeks. The replacement dates can be marked on the release unit carton.
- The inhaler must be replaced once a year.
Summary:
I have provided only the most important information. In your situation, if you were to use EXUBERA, it would replace your rapid-acting insulin but you would still need to inject your long-acting insulin. Should you decide to try Exubera, note that it is a prescription drug and that you should obtain instruction and guidance from a trained healthcare professional.
Expert opinions have been mixed on this new form of insulin due to the debate whether or not the potential benefit of improved satisfaction and adherence to this regimen outweighs the higher cost. Some are concerned with the teaching issues that are required to safely use this insulin; others welcome it as another tool to help improve diabetes control and reduce diabetes complications, especially for those who have been reluctant to start or continue insulin therapy due to fear of needles or concerns with handling syringes.
Many other companies are developing additional inhaled insulin products, so stay tuned for future updates.
Regardless, be sure to discuss this with your diabetes team to see if it is right for you.
You can read more details about EXUBERA in the related links below.
You can call the EXUBERA Center for more information at:
1-800-EXUBERA (1-800-398-2372).
*Resources for this answer were: The EXUBERA Website, the EXUBERA Medication Guide, the EXUBERA product insert January 2007, EXUBERA FAQs for healthcare professionals, and Clinical Diabetes, volume 24, #3, 2006.
Related Questions
Why does insulin have to be injected
Q:
"Why does insulin have to be injected?"
How Insulin Works
Q:
"What does insulin do and why does the pancreas make extra insulin when a
person eats?"
Hypoglycemic Reaction
Q:
"I've been diagnosed as type 2 since March of this year with a BG of 547 (I
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Related Links
EXUBERA®
http://www.EXUBERA.com
American Diabetes Association
http://www.diabetes.org
Important Notice: The responses provided by the team of Diabetes Educators are based on their personal experiences and expertise as practicing diabetes healthcare professionals, and are not to be considered diabetes management advice from Abbott Laboratories. Remember that information provided by the team of Diabetes Educators is for general background purposes and is not intended as a substitute for medical diagnosis or treatment by a trained professional. You should always consult your physician about any healthcare questions you may have, especially before trying a new medication, diet, fitness program, or approach to healthcare issues.
All tradenames and trademarks not owned by Abbott Laboratories are the property of their respective owners. For details on tradenames and trademarks and their respective owners, visit the non-Abbott trademarks listing.
