Afrezza, the Inhalable Insulin

Here is the Joslin Diabetes Center's report on Afrezza, the inhalable
insulin. It is FDA approved, and it appears to be safe. It may prove
to be valuable to people who are hesitant to use insulin injections, but
it is not yet approved for children.

This product is intended to be used as a supplement, so you cannot
stop injections altogether. It does not allow users to fine tune their
insulin doses. Peak activity occurs in 12-15 minutes, and it leaves the system rather quickly.

"Afrezza is not recommended for patients who smoke, have asthma or chronic lung disease. If you’re at high risk for Diabetic Ketoacidosis, (DKA) you probably shouldn’t start this new inhalable insulin at all. During the clinical trials, there was an increased rate of DKA."

http://blog.joslin.org/2014/10/could-you-add-inhalable-insulin-to-your-routine/

Can you be exactly sure how much insulin you are absorbing? It seems that it would work to quickly bring down high Glucose levels, but not much else. How would this work with Type 1s? Who should be using this device?

I have asthma so probably wouldn't be able to use this, but doesn't "risk of DKA" include almost everyone with Type 1, especially those who use a pump (which also increases risk of DKA)? Not sure how useful it would be even for bringing down highs if the dose can't be fine-tuned...

Bingo. I don't think the market is T1's, but is T2's who because of personal or cultural preferences can't shoot up or use a pump.

I don't know exactly how portable Afreeza is, but a previous insulin inhaler was more like a bong! http://www.forbes.com/sites/johnlamattina/2013/08/22/challenges-in-commercializing-inhaled-insulin/

I agree with you, Tim. Afrezza might be appreciated by type two people who might use it only when they have occasional highs.

Good point, Jen. I certainly want to fine-tune my doses.

I doubt it will be very effective for type 1 people. But there are 27 million type 2 folks and it could prove useful fo them to do a quick correction for occasional highs. I'm just guessing.

Actually, Tim, the #1 reason by far is that it is very hard to get insurance approval for basal/bolus insulin therapy for T2's.

You essentially have to be wildly out of control without oral meds getting you under control.

Or, you have to have a really good, really supportive endo. That's how I got on the pod and the G4.

The concept of Afrezza, with its immediate onset, 12-15 minute peak, and short duration appeals to me, a T1D. I would use it to quickly bring down hyperglycemia. If it works, it would be a great additional tool in the toolbox. It wouldn't replace my current pump therapy.

The big market for Afrezza will be T2Ds, especially those reluctant to take insulin injections, a significantly large cohort.

I had no difficulty getting insurance to approve insulin. They didn't even ask to see any records, just approved it.

The market for Afrezza, whether intended or not, will probably include

  • Those averse to needles
  • Anyone needing fast corrections, which could be any insulin user of whatever type

Regardless, it will probably be used mostly as an adjunct to existing insulins rather than a replacement for them -- "in addition to" rather than "instead of".

The biggest stumbling block I see is the fixed dosages. The more sizes they choose to offer it in, the more of a market it's likely to find.