Inhaled Insulin Pros and Cons

The burden of repeated insulin injections is often cited as a factor of resistance to starting traditional insulin products.

In the last decade, an inhaled insulin product failed to meet high expectations, and some experts believe it was because of its inconvenience factor and large inhaler size.

Nevertheless, a study published in the May 2016 issue of the Journal of the American Academy of Physician Assistants detailed appropriate dosing, use, and monitoring of the newest inhaled insulin product, Afrezza.

This product’s pharmacokinetic profile is similar to insulin aspart (a rapid-acting insulin) and noninferior to twice-daily neutral protamine hagedorn use in terms of hypoglycemia and weight gain.

Insulin-naïve patients can be started on 4 units of Afrezza immediately before each meal, and insulin-experienced patient may be converted based on the manufacturer’s recommendations.

Inhaled insulin may be an option for patients concerned about weight gain or hypoglycemia, or those who fear injections or want to reduce injections. However, the need for multiple inhalations, contraindications, precautions, and high cost limit the product’s use.

Patients who use inhalers may also develop cough or throat pain and irritation. Of note, Afrezza has a boxed warning concerning the possibility of acute bronchospasms in patients with asthma or chronic obstructive pulmonary disease.

Spirometry, a detailed medical history, and physical examination are necessary before starting Afrezza. Spirometry monitoring should be repeated at 6 months and yearly thereafter. Patients with a high risk of lung cancer or a history of lung cancer are cautioned against using the product.

Dosing is accomplished by loading the device with single-use 4- or 8-unit cartridges. Pharmacists need to review the product’s storage information, assembly, and dosing routine with patients.

Inhaled insulin human may be used to achieve insulin administration for patients showing resistance to traditional insulin products. However inhaled insulin’s contraindications, lung toxicity concerns, and throat irritation may limit its widespread use. In addition, its cost is significantly higher than that of insulin aspart or lispro.