Inhaled Insulin – Everything You Need to Know

‍Editorial Note:  This article is only to provide information and does not constitute medical advice.  It’s imperative to check with your healthcare provider to determine the correct insulin therapy for you.

Alternative Insulin Therapy for Type 1 Diabetes

With new insulin therapies (injected, inhaled, and oral), research is evolving with innovative alternatives for diabetes management. Scientists are now researching glucagon-like peptide-1 (GLP-1) receptor agonists (RA) typically used for weight loss to treat newly diagnosed type 1 patients, and inhaled insulin is FDA-approved for mealtime dosing.

Type 1 diabetes (T1D) requires exogenous insulin to be administered by multiple daily injection (MDI) insulin therapy, with an insulin pen, needles, or an insulin pump to control glucose levels. T1D diabetes management includes long-acting insulin (backup or basal insulin) and rapid-acting insulin (bolus or mealtime insulin) before meals.

As insulin therapy has evolved, the first alternative to needles was a continuous infusion via an insulin pump. This computerized device delivers a constant low (basal) dose throughout the day through a cannula that mimics the pancreas. The insulin pump innovation offered greater flexibility and smoother blood sugar level control.

To better control blood glucose levels, researchers are exploring options for type 1 diabetes that in the past were only considered for type 2 diabetes (T2D).

Inhalational insulin is an appealing alternative due to its accessibility and fast-acting absorption.

Inhaled Insulin

Afrezza® is a rapid-acting inhaled insulin that controls high blood sugar levels in adults with type 1 and 2 diabetes. Recently approved by the Food and Drug Administration (FDA), it’s quickly growing in popularity and interest in treating type 1 diabetes. One benefit of Afrezza, the only FDA-approved inhaled insulin, is that it is the fastest at entering the bloodstream to adjust blood sugars.

However, the rapid-releasing insulin cannot replace T1D or T2D’s basal insulin requirements. The inhaled variety must be used in conjunction with another subcutaneous insulin.

A Different Kind of Insulin Therapy

How Does it Work?

The man-made inhalable insulin, in powdered form, is delivered to the lungs with an inhaler. “It is considered a paradigm shift in insulin delivery as it differs in route of administration and dosing units,” the Centers for Disease Control and Prevention reports. The inhaler contains cartridges of either 4, 8, or 12 units of insulin, used to control high blood sugar in adults with diabetes mellitus.

Pro Tip: Once the foil package is opened, you can keep the unused pack in the refrigerator for up to a month or at room temperature for up to 10 days. Once the blister pack is opened, users should use whatever is left within three days.

Mealtime Insulin

As basal dosing is the continuous delivery of insulin throughout the day (like a working pancreas), bolus dosing is for mealtime or correcting a high blood sugar level.

Mealtime insulins are typically delivered through injectable insulin diabetes care and must be time-based to get your insulin working when the body starts breaking down the food into energy.

Inception of Inhaled Insulin

Like most inventions, the concept of inhaling insulin had a long road of try/fail testing until a safer version took root. German researchers first proposed the idea of inhalable insulin in 1924 and again in 1971. Newly administered methods through a concentrated inhalation powder took hold, and in 2006, the FDA approved Exubera for people with type 1 and type 2 diabetes. However, the pioneering product has a short shelf life.

What happened to Exubera?

Pfizer’s inhaled insulin, Exubera, was discontinued in 2007 due to safety concerns, low sales, and high costs. Users also claimed the inhaler was too bulky. It didn’t help that the FDA had concerns about a possible link to lung problems and cancer.

Afrezza – A New Needle-Free Alternative

In 2014, Afrezza released its fast-acting inhaled insulin. Afrezza delivers insulin through the lungs, and blood sugar starts to lower in about 12 minutes. Manufactured by MannKind Corporation, the second inhaled insulin began to gain traction with FDA approval and a petite, reusable package.

Pro Tip: Afrezza is not used to treat diabetic ketoacidosis and must be used with basal insulin in T1D patients. Afrezza is currently only available to adults 18 years and older.

Afrezza is delivered by inhaling dry powder insulin, using an oral inhaler, and allowing you to take your insulin right when the food arrives without needing injections at mealtime.

One of Afrezza’s brand ambassadors, Danica Collins, uses the inhalable insulin for mealtime dosing. Collins currently loops with the Tandem t:slim X2™ and Dexcom G7 and is happy with the integration and added benefits that Afrezza offers.

“To me, Afrezza mimics human insulin far more, and my body just reacts really well with it. I want fast insulin like the body’s supposed to work. Also, I can eat pizza and not have major spikes afterward. My body doesn’t like the adhesives, but the algorithm with the tandem t:slim is the best on the market. My basal, my time in range, my corrections are on point.”

Pros/Cons of Inhaled Insulin

T1D patients should consult their physician or healthcare team to discuss the right insulin therapy. When using inhaled insulin, blood sugar levels should be checked more frequently. Here is information to help you and your doctor make informative decisions about inhaled insulin. Also worth noting is that Afrezza is the only rapid-acting insulin on the market for mealtime control. Afrezza has proven mealtime control in studies of more than 3,000 people with either type 1 or type 2 diabetes.

PROS of Inhaled Insulin

Ultra Rapid-Acting Delivery

Afrezza starts lowering blood sugar as quickly as 12 minutes. Because it is inhaled it enters the large surface area of the lungs, allowing for ultra rapid absorption. Since it is released into the lungs and bloodstream, it starts working in less than one minute in some cases, similar to the body’s natural response.

No Needlesticks

The simple inhaled method lowers your blood sugar at mealtimes without the use of injections. Afrezza is the only needle-free insulin option on the market today.

Easy Accessibility

No pre-bolusing is necessary with Afrezza. Since it goes to work immediately, the timing and planning are obsolete. Afrezza lets you inhale your insulin right when the food arrives, allowing spontaneity without the pesky meal projection required with pumps, pens and injections. Injectible insulins must first be broken down into smaller parts by your body, so it takes longer to work; Afrezza skips this step.

Controlled Meal Dosing

Afrezza’s inhaled technosphere insulin technology, provides ultra rapid delivery to the lungs. The microparticle used in Afrezza consists of two main components: human insulin and an inactive ingredient. The technosphere insulin allows the insulin to enter and LEAVE the body fast. When it starts working with a meal, it takes about three hours to leave your body – with no excess insulin that may contribute to a low blood sugar episode after the food is digested. Plus, you can always take additional inhaled doses if needed.

Fast Corrections for High Blood Sugar

As Afrezza’s is intended to meet mealtime insulin needs, it can also be taken to treat high glucose levels quickly.

New Improved Device

The inhaler is inexpensive and easy to use. Unlike pricy insulin pumps and pens, the inhaler delivery device for Afrezza is low maintenance and simple to consume. It’s not battery-operated and doesn’t need a charge. The disposable cartridges can simply be thrown away.

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Cons of Inhaled Insulin

It’s a Secondary Option

As stated previously, T1Ds are still required to take basal insulin in addition to mealtime boluses. If you are experiencing mealtime spikes, it’s worth looking into.

Side Effects

Afrezza may cause an allergic reaction or serious side effects, including sudden lung problems (bronchospasms), low potassium, or diminished pulmonary function. Afrezza is not for patients with chronic lung diseases such as asthma and chronic obstructive pulmonary disease (COPD).

Of course, you should tell your doctor if you smoke, have recently stopped smoking, have ever had kidney or liver problems, have a history of lung cancer chronic lung disease, or are pregnant or breastfeeding. Other common side effects requiring medical attention include low blood sugar, a cough and a sore throat.

Fast Acting is Not Always the Best

When we eat a higher-fat or high-protein meal, users sometimes experience a tail-end blood sugar spike that may not be covered with Afrezza. A follow-up dose may be required. If using Afrezza, consult your doctor to determine which meals to use Afrezza and which to use the subcutaneous insulin therapy.

Insurance

Some insurance companies may not cover Afrezza, and though it’s less expensive than liquid insulin, there may be an out-of-pocket cost due to its newness. Afrezza offers financial support here to interested parties.

T1D Progress

These are exciting times as technology and research expand and reshape the T1D landscape. We should expect even more significant advancements in the next decade with crossover treatments for type 1 and type 2 diabetes. Inhaled insulin, stem cell therapies, GLP-1 RA drugs and other clinical trials show promise.