I was just reading a free diabetes magazine and there was an interesting article. Apparently in June the FDA approved Afrezza, a rapid acting inhaled insulin for type 1 or 2 diabetics. Anyone hear of this and anyone tried it?
Afrezza is not available yet. Mannkind, the company that developed Afrezza, partnered with Sanofi, the large pharmceutical. to bring Afrezza to market. Sanofi's last statement as to the actual release of Afrezza is the first quarter of 2015.
I'm very interested in Afrezza as a therapy in addition to insulin. It's action profile is super fast and is similar to the speed of insulin in the metabolism of a non-diabetic. It peaks in 12 minutes and is mostly gone in an hour or two. I look for it to correct high BGs and as an addition to mealtime insulin.
It is not indicated for people with asthma or other lung problems.
I just went to see my endo this morning and she is ready to prescribe it for me as soon as it comes out. I hope it lives up to my expectations!
The action profile looks extremely promising.
On the downside, it seems to cause at least modest lung impairment (albeit below a threshold where this would be a more significant concern for those who don't have preexisting lung conditions--but personally, I'm not looking to sign up for any lung impairment). And the dosing is very crude, pumps are widely heralded for allowing incredibly precise dosing (tiny fraction of a unit) compared to insulin pens (1 unit or 0.5 for kiddie pens), and Afrezza goes in the other direction with only a few doses (4 and 8 units).
Here's some informed commentary from well-regarded bloggers, the former is more positive, the latter pretty negative:
http://diabetesupdate.blogspot.com/2014/06/afrezza-new-fast-acting-inhaled-insulin.html
http://integrateddiabetes.com/new-inhaled-insulin-smokescreen-or-a-real-gas/
The last inhalable insulin was taken off the marker for causing pulmonary fibrosis. While I'm sure Afrezza was tested more thoroughly because of this, I'd still be extremely skeptical of using it on a long-term basis.
That being said, I might be tempted for very high BGs if it's only once in a while. I wouldn't give up my lung function for an inhaled insulin.
Lastly, if it peaks that fast, I'd be extremely worried of lows, because if you use the wrong dose, those lows will hit hard and fast, and will more likely than not be impossible to manage by yourself.
Even though I have asthma, Id' be interested in using it very intermittently to bring down extreme highs. (Although I think a super bolus could accomplish the same thing for those of us using pumps; I haven't experimented with this yet.) But I've read that it can't be fine-tunred (that it can only be given in units of 2 or 3), which would make it very hard for Type 1s to use for correcting highs.
Especially if you have asthma, why do something that impedes your lung capacity?
Super bolus won't help with the slow action of subcutaneously injected insulin, but if you want faster action, just do an intramuscular injection--yes, it'll hurt a little, but less than an asthma attack!
Afrezza will be offered in 4 and 8 unit doses initially. There are apparently plans to add a 2 unit dose in future. Even if that comes along, the dosing is still extremely crude, especially for anyone who's not manifesting significant insulin-resistance.
Does it actually say it impedes lung capacity? Or are they just worried it might? My lung capacity is completely normal aside from when I'm having asthma symptoms.
If I recall correctly, a very significant percentage of patients demonstrated reduced lung capacity, though the reductions were modest enough that they were considered acceptable for those without other lung impairments.
But with that plus the incredibly crude dosing, I personally don't understand why this has generated as much excitement as it has, especially when we have alternatives like intramuscular injections if we really need to speed up the action of our insulin.
But down the road we'll have more data on how safe this is, and likely also the ability to dose it more precisely, so perhaps my skepticism will prove unwarranted. And that requires guinea pigs to use it in the interim, I just don't want to sign up to be one of those guinea pigs myself!
Actually, niccolo brought up a good point--if inhaled insulin causes an asthma attack (and I have little doubt that it will), it's probable that the insulin will be trapped in the lungs and not all of it will enter the bloodstream quickly. If the insulin isn't degraded during its time hanging around in the lungs, it will probably cause lung damage then, as well as slowly releasing insulin for an unknowable amount of time.
Good point... I actually didn't even think about the insulin triggering an asthma attack. I was thinking more long-term damage.
It's been out a few weeks now and some users are reporting, sounds exciting, I found them by googling. There's also a youtube from Adam Lasher from American Idol is using it, also SamP here on Tudia is. It's for T2's. Seems to be mostly good things so far, I've got a quick call in to my PCP and he says he's ok with it and will get some if I want. Says it acts like natural insulin, because that's basically what it is, very little risk of hypos which is kind of a good feature, you take it right when you start eating, adjustable dose in case you miscalculate the carbs (like I do, especially with dried fruit which just always seems to have more carbs than I realize), takes up really fast and exits your system very quickly. There are some details if you have extremely high degree of insulin insensitivity or have to be on way high units. My doc says the thing on smokers is they have a tendency to eventually risk lung cancer because of their smoking, but the studies found no more than normal rate of lung cancer even in smokers. It's really just insulin as a monomer (very small molecule) delivered by a very slick gadget. Sounds like a different animal from that exubera entirely. The guy who created it actually invented insulin pumps by the way. Looking forward to getting a trial and seeing what people say. I'm pretty hopeful.