Inhalable Prandial Insulin?

[VaioSson]

I just came across some info on a new way to treat diabetics via inhalable insulin (https://www.afrezza.com/). Is anyone else aware of this treatment? I've tried going through the technical details but it sounds like this is used for meal times but is separate from daily/basal insulin.

It sounds amazing but I have no idea, as I've never met a patient using this type of insulin. Anyone here have experience with this? It's intriguing but I'm wondering why it's not better known

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[InterviewI]

I'm an insulin-dependent diabetic. I've heard of inhalable insulin but never personally used it and I've received zero information about it from both my family doctor and endocrinologist. I guess this particular form is akin to short acting insulin and is still not a replacement for your long-acting insulin. There also seems to be a lot of risk associated with it if you have any difficulties breathing.

I'm interested in how the insulin hormone is stored in the device and how it travels to its to its final destination. Does it diffuse like O2 into the blood?

 

[Lannister]

I read your title and legitimately thought it was a foreign language, my brain completely did not process the words "inhalable" or "insulin" and I didn't realize my mistake until I opened the thread and saw your post was in English.

Oops.

Just had to share that.

 

[VaioSson]

I'm an insulin-dependent diabetic. I've heard of inhalable insulin but never personally used it and I've received zero information about it from both my family doctor and endocrinologist. I guess this particular form is akin to short acting insulin and is still not a replacement for your long-acting insulin. There also seems to be a lot of risk associated with it if you have any difficulties breathing.

I'm interested in how the insulin hormone is stored in the device and how it travels to its to its final destination. Does it diffuse like O2 into the blood?

From what I understand, there's a polymeric nanoparticle that delivers the insulin hormone into the lung. If my understanding is correct, the insulin within this particular treatment is monomeric and not hexameric, which is the form usually found in injectable prandial insulin. I'm not exactly sure what the implications of that is. However, I believe it somehow allows the insulin to peak very quickly and also be eliminated quickly, which decreases the chance of hypoglycemia.

What I'm wondering is:

How substantial is the black box warning? Patients with asthma or COPD are probably precluded from using this treatment, but does this have an influence on the safety of patients without chronic lung diseases?

Is the metabolism of insulin expected to be different between inhalation vs. injection?

 

[Eclipse010]

From what I understand, there's a polymeric nanoparticle that delivers the insulin hormone into the lung. If my understanding is correct, the insulin within this particular treatment is monomeric and not hexameric, which is the form usually found in injectable prandial insulin. I'm not exactly sure what the implications of that is. However, I believe it somehow allows the insulin to peak very quickly and also be eliminated quickly, which decreases the chance of hypoglycemia.

What I'm wondering is:

How substantial is the black box warning? Patients with asthma or COPD are probably precluded from using this treatment, but does this have an influence on the safety of patients without chronic lung diseases?

Is the metabolism of insulin expected to be different between inhalation vs. injection?

A major difference between injectable vs. inhalable insulin is indeed the fact that the injectable form is hexameric and is administered into the subcutaneous tissue, while the inhalable form is monomeric and diffuses directly into the bloodstream. In the former case, insulin must diffuse from the tissue into the bloodstream, which takes around 60-90 minutes to reach peak levels. When insulin is inhaled as the monomer, on the other hand, it reaches peak levels in about 15 minutes. As can be imagined, this leads to less susceptibility to hypoglycemia and also allows diabetics to better control blood glucose, since the patient doesn't need to plan/wait an hour to eat. (http://insulinnation.com/treatment/inhalable-insulin-a-breathtaking-development/)

Presumably, the inhalable insulin is more expensive, given the fact that injectable insulin's been available for decades. The concept of inhalable insulin's been around for a long, long time, but it was only recently achieved and approved by the FDA.

I have no idea of the safety of inhalable insulin, since the FDA is by nature very conservative with labeling.

Would be interested in hear what healthcare providers have to say about this!

 

[Petrichor1]

I wonder if it has some form of side effects: physiologically and psychologically (see what I did there Lannister ) after repetitive uses of the inhalable kind. Does it form some sort of dependency because of its faster acting method? Would be interesting to know for patients.