Managing diabetes involves using insulin, which is a crucial treatment for maintaining healthy blood sugar levels, especially for those with Type 2 diabetes who cannot rely on diet alone. A study has shown that to keep Type 2 diabetes under control (with an HbA1c level of less than 7%), insulin is needed within six years for approximately 50% of people with diabetes. Typically, insulin is administered through injections, which can be inconvenient and painful. However, injections are the only effective way to deliver insulin, as taking it orally would render it ineffective due to digestion.

With technological advancements, a new form of insulin is now available that doesn’t require needles. Known as inhaled insulin, this innovative approach involves breathing insulin in a powder form directly into the lungs using an inhaler. This method marks a significant shift from traditional injections, offering a potentially more appealing option for diabetes management. 

In this article, you will discover how inhaled insulin works, compare its effectiveness and safety with traditional insulin injections, and examine whether it offers a real advantage in managing diabetes.

Key Takeaways

  • Inhaled insulin, like Afrezza, offers a needle-free alternative for diabetes management, rapidly entering the bloodstream through the lungs to control blood sugar levels efficiently.
  • Studies indicate that inhaled insulin starts working within minutes of administration, providing a quicker response than injected insulin, which is especially beneficial for managing blood sugar spikes during meals.
  • Due to its ease of use and fast action, inhaled insulin significantly enhances lifestyle flexibility and diabetes management for those who are needle-phobic or seek a simpler treatment method.
  • However, inhaled insulin is not recommended for everyone; it’s generally unsuitable for individuals with chronic lung diseases, such as asthma or COPD, due to the risk of exacerbating breathing problems.
  • The cost and availability of inhaled insulin can be limiting factors; it tends to be more expensive and less accessible than traditional injectable insulin, affecting its adoption among patients.
  • While inhaled insulin is primarily designed for adults with Type 1 or Type 2 diabetes, it is currently not advisable for pediatric use or those with a history of hypersensitivity to insulin or inhaler ingredients, pending further studies to confirm its safety and effectiveness in these groups.

What Is Inhaled Insulin?

Inhaled insulin is a type of insulin that can be inhaled through your mouth using a special inhaler. This type of insulin is designed to regulate blood sugar levels in individuals with diabetes and serves as an alternative to injections that are typically needed for insulin delivery. 

Inhaled Insulin is a fine powder that comes in small cartridges or capsules which are loaded into the inhaler. “Afrezza” is one of the brand names for inhaled insulin and has been approved by the FDA as a faster-acting and safer inhalable insulin. This option can be particularly appealing to those who are looking for a needle-free method of taking their insulin.

How Does Inhaled Insulin Work?

An insulin inhaler works by entering the lungs and then quickly passing into the bloodstream, helping to lower blood sugar levels. Because it’s inhaled, it starts working faster than most injected insulins. Typically, inhaled insulin acts within minutes, offering a rapid response that can be helpful at meal times to manage spikes in blood sugar. 

Unlike long-acting injectable insulins that work for an extended period, the effects of inhaled insulin last for a shorter time. This makes it similar to the body’s natural insulin response during meals, a quick but effective burst of insulin to manage the sugar from the food you eat.

How Does Inhaled Insulin Differ from Injectable Insulin?

Inhaled insulin differs significantly from traditional injectable insulin in its administration method. While injectable insulin requires subcutaneous injections, inhaled insulin is delivered directly into the lungs using a device similar to asthma inhalers. This delivery method allows for rapid absorption of insulin into the bloodstream.

Advantages

  • Ease of Use: Inhaled insulin simplifies the process of insulin administration, making it less challenging and more manageable for many patients, especially those who are needle-phobic.
  • Faster Action: Because it is absorbed through the lungs, inhaled insulin can begin to work more quickly than injected insulin, which is beneficial for controlling blood sugar levels around meal times.

Disadvantages

  • Limited Suitability: Inhaled insulin is not suitable for all types of diabetes; it is primarily recommended for adults with type 1 and type 2 diabetes and may not be appropriate for those with respiratory issues.
  • Cost and Availability: Inhaled insulin can be more expensive and less readily available than traditional injectable insulin.

Did you know

In a study, 79% of patients opted to switch from traditional insulin injections to inhaled insulin. This indicates that inhaled insulin is gaining popularity among patients and is considered more convenient and easier to use compared to traditional insulin injections.

Who Can Use Inhaled Insulin?

Inhaled insulin, such as Afrezza, is typically suitable for adults with Type 1 or Type 2 diabetes looking for a needle-free way to manage their blood sugar levels, especially around meal times due to its rapid action. It can be a good option for those who prefer not to use injections and are in good health without significant lung issues.

However, not everyone should use inhaled insulin. It’s not recommended for:

  • Individuals with Chronic Lung Diseases: People with conditions such as asthma or chronic obstructive pulmonary disease (COPD) are advised against using inhaled insulin due to the potential for exacerbated breathing problems.
  • Smokers: Smoking can affect lung function significantly, which might alter the effectiveness and safety of inhaled insulin. Therefore, current smokers or those who have recently quit should not use this form of insulin.
  • Patients with Hypersensitivity to Insulin or Inhaler Ingredients: If a patient has a history of allergic reactions to any form of insulin or the components of the inhaler, using inhaled insulin might pose serious health risks.
  • Children: Currently, inhaled insulin is not recommended for pediatric use as further studies are needed to establish its safety and efficacy in children.

How Effective Is Inhaled Insulin in Treating Diabetes?

Clinical studies have shown that inhaled insulin is effective in treating both type 1 and type 2 diabetes. For example, one trial with type 2 diabetes patients demonstrated a significant reduction in HbA1c levels by 2.28% when inhaled insulin was added to oral diabetes treatments, compared to only a 0.13% reduction with oral treatments alone. 

In type 1 diabetes, inhaled insulin was as effective as subcutaneous injections, with similar reductions in HbA1c levels. Inhaled insulin also offers advantages regarding rapid absorption and onset of action, with one pharmacokinetic study showing faster absorption times compared to subcutaneous insulin. Patient satisfaction tends to be higher with inhaled insulin, attributed to the ease of use and reduced pain compared to injections. Overall, inhaled insulin is considered a safe and effective option for managing diabetes, potentially improving patient compliance due to its convenience.

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What Are the Potential Risks and Side Effects of Inhaled Insulin?

Inhaled insulin, like any medication, comes with potential risks and side effects that patients should know before beginning treatment. Understanding these risks and managing any side effects can help ensure the safer use of the medication. Below are the potential side effects of inhaled insulin:

  • Hypoglycemia (Low Blood Sugar): Symptoms might include shaking, sweating, rapid heartbeat, and confusion. This is a common side effect of all insulin therapies, including inhaled insulin. Always carry a source of fast-acting sugar (like glucose tablets or hard candies) and monitor your blood sugar levels regularly. Adjust your insulin dosage as your healthcare provider recommends based on your blood sugar readings.
  • Respiratory Issues: Some users may experience coughing, throat irritation, or wheezing. More severe issues could include exacerbation of asthma or COPD. If you experience mild symptoms like a cough or sore throat, these may not require medical attention unless they persist or worsen. For worsening symptoms, especially if you have pre-existing lung conditions, consult your healthcare provider immediately.
  • Diabetic Ketoacidosis (DKA): Although rare, DKA is a serious condition that may occur. It is characterized by increased thirst, urination, dry mouth, fruity breath odor, nausea, vomiting, and difficulty breathing. This requires immediate medical attention. Be aware of the symptoms and seek help if you suspect DKA.
  • Allergic Reactions: These can range from local reactions at the inhalation site to systemic reactions, including rashes, itching, or swelling of the face, lips, tongue, or throat. For severe allergic reactions, seek emergency medical help. For milder reactions, consult with your healthcare provider about possible allergy medications or adjustments to your insulin therapy.
  • Low Potassium Levels (Hypokalemia): Symptoms may include muscle pain or cramps, unusual weakness or fatigue, and irregular heartbeats. A balanced diet that includes potassium-rich foods (like bananas, oranges, and potatoes) can help. However, if symptoms persist, medical evaluation is necessary.

What May Interact with Inhaled Insulin?

Inhaled insulin, such as Afrezza, can interact with various substances, which may affect its effectiveness and the patient’s overall health. Here’s a list of potential interactions:

  • Inhaled Medications: Using other inhaled drugs, such as those for asthma or COPD, along with inhaled insulin may impact lung function or drug delivery.
  • Alcohol-containing Beverages: Alcohol can increase the risk of hypoglycemia or, in some cases, cause delayed hypoglycemia.
  • Antiviral Medications for HIV or AIDS: These can affect how the body metabolizes insulin, potentially altering blood sugar control.
  • Aspirin and Aspirin-like Medications: These may increase the risk of hypoglycemia when used with insulin.
  • Beta-blockers (e.g., metoprolol, propranolol): These can mask the symptoms of hypoglycemia and make it harder to recognize.
  • Blood Pressure and Heart Disease Medications: Certain medications can affect insulin sensitivity and glucose metabolism.
  • Diuretics: Commonly affect blood sugar levels and may lead to variability in how inhaled insulin affects the body.
  • Hormone Therapies (e.g., estrogens, progestins, and birth control pills): These can influence how insulin works in the body, potentially requiring adjustments in insulin dosage.
  • MAOIs (e.g., Carbex, Eldepryl, Marplan, Nardil, Parnate): These can affect blood sugar levels and insulin needs.
  • Steroid Medications (e.g., prednisone, cortisone): These typically raise blood sugar levels, potentially requiring higher doses of insulin.
  • Thyroid Hormones: These can increase insulin requirements as they generally raise blood sugar levels.
  • Smoking: Nicotine can increase insulin resistance, which may affect how inhaled insulin manages blood glucose levels.

Final Thoughts

Inhaled insulin is a promising alternative for individuals with diabetes, especially those who are needle-phobic or have difficulty with injections. It offers a fast-acting and convenient option for managing blood sugar levels around meal times. However, it is essential to note that inhaled insulin is not suitable for everyone, particularly those with respiratory issues or hypersensitivity to insulin or inhaler components. Patients should discuss their options with their healthcare providers to determine whether inhaled insulin is an appropriate treatment option for them. With careful consideration and proper management, inhaled insulin can be a safe and effective way to manage diabetes.

FAQs About Inhaled Insulin

What is the new inhaled insulin called?

Afrezza is the new inhaled insulin. It is a quick-acting insulin that you breathe in through an inhaler. It allows you to eat on your schedule while effectively managing your blood sugar.

How much does inhaled insulin afrezza cost?

In the United States, the estimated price of Afrezza (90 powder) is around $484. Prices may vary depending on the pharmacy you visit. US patients can save more when ordering medication online through Canadian pharmacies.

How is Afrezza inhaled insulin administered?

Afrezza is administered through a handheld inhaler using powdered insulin cartridges typically taken at the start of a meal.

Can inhalable insulin replace all my insulin injections?

Inhalable insulin is mainly used to regulate blood sugar levels after meals. However, it cannot fully replace the need for long-acting insulin injections. Therefore, it’s crucial to consult a healthcare provider for a personalized diabetes treatment plan.

What is the advantage of inhaling insulin?

Inhaled insulin is a promising treatment option for people with diabetes. It offers several advantages over traditional insulin delivery methods, including convenience and faster action. However, like most delivery devices, there are also some things to be aware of before recommending it.

How fast does inhaled insulin work?

Inhaled insulin activates in the body quickly—within less than a minute, it appears in the bloodstream and starts reducing blood sugar levels in around 12 minutes.

Is Afrezza safe for the lungs?

Afrezza can lead to serious lung issues, such as bronchospasms. In studies, some patients with asthma who paused their asthma medication experienced these problems.

Is there a generic for Afrezza insulin?

There is no generic version of Afrezza available currently.

How do I store inhalable insulin?

Store inhalable insulin at room temperature, away from moisture and heat. Make sure to follow the storage instructions that come with the medication to maintain its effectiveness.

Sources

Mohanty, R. R., & Das, S. (2017). Inhaled insulin – Current direction of insulin research. Journal of Clinical and Diagnostic Research, 11(4), OE01–OE02. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5449846/

MannKind Corporation. (2014). AFREZZA® (insulin human) Inhalation Powder. U.S. Food and Drug Administration. https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/022472lbl.pdf

White, J. R., Jr., & Campbell, R. K. (2001). Inhaled insulin: An overview. Clinical Diabetes, 19(1), 13-16. https://diabetesjournals.org/clinical/article/19/1/13/69191/Inhaled-Insulin-An-Overview