What if you could get insulin without needles?

Diabetes Advocacy Public Advocacy
#1

We tend to equate insulin delivery with needles: we have to! Even the best infusion sets available require inserting the cannula with the help of a needle.

But a type of insulin currently in review by the US FDA called Afrezza, if approved, will allow for insulin delivery without needles, in inhalable form.

You may remember a few years ago a failed attempt at insulin in powder form, called Exubera. The people at Mannkind (a company by Al Mann, the man who founded Minimed before it became a part of Medtronic) introduce the product as follows:

AFREZZA® (pronounced uh-FREZZ-uh) is a first-in-class, ultra rapid-acting mealtime insulin therapy being developed to improve glycemic control in adults with Type 1 and Type 2 diabetes mellitus. It is a drug-device combination product, consisting of AFREZZA Inhalation Powder single use dose cartridges, and the small, discreet and easy-to-use AFREZZA inhaler. - See more at: http://www.mannkindcorp.com/product-pipeline-diabetes-afrezza.htm#sthash.7HMJ5FQW.dpuf

I applied along with other diabetes patient advocates to speak at the FDA Advisory Committee meeting for Afrezza on April 1, and today we received confirmation about our 3 minutes to speak in front of the committee.

I want to take my opportunity to speak to bring the voice of TuDiabetes members to the committee members. Please share here HOW would a needled-free delivery system for insulin make a difference for you, whether you are currently on insulin or not... perhaps, even more so, if you are NOT on insulin but are considering it or talking with your physician about it.

FDA Approval of Afrezza inhaled quick -acting insulin
Afrezza An Ultra Rapid-Acting Insulin / Inhaled Insulin Onset 12 minutes!
#2

I would be very reluctant to inhale something several times a day for the rest of my life, as I'd be concerned about long-term damage to my lungs. And although I'm on a pump now, I had absolutely no problem with shots when I was on MDI.

Ruth

#3

Thanks for sharing this perspective, Ruth.

If you don't mind me asking, how old were you when you were diagnosed?

#4

I agree with Ruth's concerns but I have to admit that snorting lines of insulin on my desk @ work seems sort of crazy, in an amusing way...

#5

I believe we had a lengthy discussion of this topic not too long ago. My questions would be: How is this different than the previous failed attempt at inhaled insulin? and What about dosing? I believe when we discussed this last we were told that there were only gross choices of dosage such as 1 units or 5 units or 10 units which certainly would be no improvement on our current potential dosing on our pumps in increments of .025 units!

Most of us have adjusted easily to needles and/or infusion sets and an alternative delivery method is not nearly as important as the ability to narrow our dosage and timing.

#6

I second what Zoe posted !!

#7

On insulin, MDI. I am interested to see what the long term results of inhaled insulin would be however I do not want to be one of the early users. I can see how a less invasive method of delivery could persuade people who fear needles to consider insulin. Being as unnoticeable as possible when giving myself insulin is important to me. I want it to be a part of normal life, not something people make into a big deal. So however the insulin gets inhaled, it should be compact, portable, easy to administer, affordable, and quick.

#8

I was 38 at time of diagnosis...possibly T2 or 1.5. Unfortunately those tests were not done. I started on insulin a few years later. So, on insulin from 1989 to 2002, then got pump.

The other issue I think we discussed in the past has to do with the fact that we'd still have to do finger sticks and, for many of us, the finger sticks hurt more than the shots do, so there doesn't seem to be a major up-side to inhaled insulin.

Ruth

#9

Manny, I wish you all the best speaking at the FDA!
I personally would for sure not volunteer to test that drug, because i have heard of potential lung problems and other stuff those Inhalation Powders can cause. I also would not give up my extremely accurate dosage i can use with my pump to bigger increments.
Spray could not be bigger than those usual asthma sprays they use nowadays, or i wouldn't even use it later on.
As you see, i am extremely hesitant regarding this, but also understand that this could be an extreme help for people who fear needles or have high insulin resistance (as they don't need that small units).
I was diagnosed at age 8, if you need to know that.

#10

i have been t1 for two years and the injections are absolutely the EASIEST part of diabetes. i dont think i would want to be one of the first users of this because of potential side effects and i wouldnt trust the dosing!
i would be much more excited to see some kind of intelligent insulin that made itself ready for use when it was needed after injection.
good luck speaking!

#11

I have always been dreaming about intelligent insulin...
injection once every week, and it just becomes active if your bg rises and stops if it sinks...

#12

Err....

It's called an artificial pancreas (which is really just a smart pump running a closed or semi-closed loop). The results from the Boston and Cambridge trials are actually really encouraging. I will be disappointed if I am not using one within 5-10 years.

As far as insulin delivery is concerned, the ONLY criterion is how well it works. A smart two chamber pump delivering an even more rapid acting analog insulin (with say an DIA of < 2h) plus a 2nd glucagon reservoir will suit me just fine. I will happily put up with the double tubing/sets.

Joel

#13

+3!

#14

i think me and swiss chocolate are not talking about gadgets attached to us, just a quick injection of insulin that will know when to release!

#15

I’ve read a lot about afrezza and would definitely like it to come to market, I already told my doctor I’d like to try it when it does. My only BG issue currently is post prandial, I have very little first phase release. I have no problem with needles but my research indicates afrezza’s quick mechanism of action (and short duration of action) sounds like it would be much easier to control than current short acting insulins and would much more closely mimic meal-time insulin release. I am currently using prandin and recently trying metformin to try to regulate mealtime hyperglycemia. For someone like me, afrezza would be an opportunity to replace my missing first phase release in a much more controllable and measured way rather than using the prandon which stimulates my own insulin release. I’m in!

#16

Actually, there has been some exciting research recently with a glucose sensitive gel that releases insulin when blood sugar rises. it's very promising, and may lead to injectable nano-particle "smart" insulin that could be administered one a day or less.

#17

I would love an option for safe precise & effective delivery of inhaled insulin. I believe that an inhaled insulin may have the potential to peak faster and possibly eliminate higher blood sugars after meals. It’s not a comfortable idea for a Type1’s blood sugar to be acceptable at 180 3 hrs after a meal. Plus the highs make you feel tired and mentally less on your game. A medication that could target post prandial elevations & somatic discomfort associated would be an advantage in the immediate as well as in prevention of LTC.

#18

exactly, no gadget, but an injection, with an insulin deposit which releases insulin if needed and holds back if not needed.

#19

MDI here. Needles don't bother me, never have, so the fear of needles issue really isn't a motivator. I also share the concerns expressed in this thread about dosing flexibility and possible long term side effects, pulmonary and otherwise. For what it's worth, I also agree that finger sticks are much more annoying than injections.

All of that being said, I can easily see how this could be a boon for some people and it's certainly worth pursuing. The nature of R&D is that you can't know what you'll end up with until you actually do it.

However, I have no interest in being an early subject. "Pioneers often get arrows in their backs."

#20

I've been T1D for 53 years and currently on a pump. I would welcome an inhaled fast acting insulin but would only use it (assuming it's faster acting than Humalog) when my bg is unusually high and would be benefited more by a delivery method that may get my bg to respond more quickly. Otherwise my control is good and I'm slightly concerned about my lungs as others have voiced.