By Tricia Santos, MD
Many people with type 2 diabetes have fears about starting insulin therapy. Some are afraid of needles and injections, others think that they have “failed” at diabetes management if they have to start insulin, and some people are afraid of the risk of hypoglycemia (low blood sugar) that can happen with insulin. Using inhaled insulin, one of the newest insulin options, may get around some of these fears. One thing is for sure, using ANY type of insulin will help control your diabetes and does not represent a failure on your part. Diabetes is a progressive disease and at least a third of people with type 2 diabetes will eventually need insulin.
How does inhaled insulin work?
Normally insulin is injected under the skin. Afrezza is a man-made insulin powder made by MannKind Corporation that is inhaled into the lungs using an inhaler device. The inhaled insulin is absorbed into the blood stream more rapidly than insulin injected under the skin. Afrezza starts working in 12-15 minutes and is out of your system in about 3 hours! This means that Afrezza works as a fast-acting insulin to be used at meal time or to quickly lower a high blood sugar. In fact, Afrezza inhaled insulin works even faster than our fastest injectable meal-time insulins such as humalog, novolog, or apidra. The rapid on/rapid off effects of Afrezza can help control blood sugar even better than traditional meal-time insulin and reduce the risk of hypoglycemia (low blood sugar) after meals because the insulin is out the body in a few short hours.
Are dosages similar to other types of insulin?
Inhaled insulin is delivered to the body with an inhaler device instead of an insulin pen or syringes & vials that patients are used to with traditional insulin. This means it is possible to use insulin to control the blood sugar spikes with all of your meals, but without adding more injections. Now that’s pretty cool! Afrezza inhaled insulin comes in color-coded single dose cartridges containing either 4 units (blue), 8 units (green), or 12 units (yellow) of inhaled insulin. A single cartridge is loaded into the small, hand-held inhaler device and is then inhaled. If you need higher doses of insulin with your meal, you may need to take 2 inhalations per meal.
If you are on insulin already, you may know that we talk about insulin in terms of “units” to discuss how much insulin a person is taking. It should be noted that the units of inhaled insulin may not correlate exactly with the units of traditional injectable insulin. For example, 8 units of Afrezza inhaled insulin is about equal to 5 units of traditional meal time insulin (humalog, novolog, apidra.) This does not necessarily mean that you are getting more insulin into your system since one cannot directly compare units of inhaled insulin and injectable insulin. If you are prescribed inhaled insulin, you should work closely with your doctor to determine which dose is right for you.
When should you take it?
Afrezza inhaled insulin should be taken immediately before a meal since it works very quickly (not 15-20 minutes before the meal as with injectable mealtime insulin.) Afrezza is approved for use in people with both type 1 and type 2 diabetes.
Is inhaled insulin safe?
The most common side effects associated with Afrezza are hypoglycemia and cough. However, the cough is usually mild and only occurs at the time of inhalation. Afrezza can also cause a very mild decrease in lung function. When this happens, the lung function usually returns back to normal when Afrezza is stopped. Your doctor should order a baseline test called spirometry to check your lung function before you start this medication. The safety of Afrezza has not been well-studied in patients with chronic lung disease (such as asthma, emphysema, or COPD) or in smokers. Therefore, you should not use this medication if you have chronic lung disease, if you are an active smoker, or you recently quit smoking within the last 6 months.
Although it has been almost a century since insulin was discovered, inhaled insulin is relatively new. Afrezza inhaled insulin offers an exciting opportunity for a faster acting insulin with fewer injections. The rapid-on/rapid-off effects of Afrezza may be a better option to control high glucose spikes after meals while decreasing the risk of delayed hypoglycemia.