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This article was written by Amanda Ciprich, MS, RD. Last updated on 8/30/23.
Did you know that there is an alternative approach to insulin administration that eliminates the need for syringes, pens, and infusion sets? Inhaled insulin, developed by Mannkind, offers an alternative method by delivering insulin through lung inhalation. Despite being available for nearly a decade, there are individuals within the diabetes community who may have concerns regarding the safety and effectiveness of this particular form of insulin. Additionally, there are many who are unaware that such an option even exists. This article aims to provide a comprehensive review of inhaled insulin and evaluate its safety for diabetes management.
What is inhaled insulin?
Inhaled insulin is a powdered form of ultra-rapid acting insulin that is delivered to the lungs through an inhaler device. This administration method allows powdered insulin to quickly pass through the lungs into the bloodstream in less than a minute and begin lowering blood sugars in about 12 minutes. In comparison, injectable rapid-acting insulins that are typically administered subcutaneously often require more time to have a similar effect on blood sugar levels.
Currently, there is only one type of inhaled insulin available on the market called Afrezza.
Why would someone need inhaled insulin?
There are a few advantages to using inhaled insulin over injectable insulin that includes:
Convenience and Comfort:
The administration method of inhaled insulin can provide a more comfortable and accommodating experience when managing blood sugars. Inhaled insulin provides a needle-free alternative to insulin administration which can be beneficial for people with diabetes who may find insulin injections to be uncomfortable, inconvenient, or have limited dexterity. Maja Mirkovic, MPH, RDN, CDN, CDCES, BC-ADM, states that “with Afrezza, you can discreetly administer insulin in a restaurant or a friend's house by eliminating the need for mealtime injections.” The discrete nature of inhaled insulin could greatly impact the quality of life of people with diabetes.
Kylee Pedrosa, RD, LDN, CDCES states that inhaled insulin “can be helpful for those with type 1 diabetes because it starts working quickly and doesn’t last as long, which could make it more convenient to manage blood sugar levels.” The quick onset action of inhaled insulin can be beneficial for people with diabetes who struggle with consistent pre-bolusing. The quick onset of insulin action can allow people with diabetes to eat right when their food arrives without frequent spikes in blood sugar levels. Additionally, the shorter action period of inhaled insulin can be beneficial to athletes, including endurance athletes, who often encounter hypoglycemic episodes during physical activity. Inhaled insulin helps maintain a lower level of circulating insulin during exercise which can lower the risk of hypoglycemia.
Some people with diabetes may choose to utilize inhaled insulin as a supplemental form of insulin. Rachel Halverson, RN, BSN CDCES, explains that some people with diabetes may utilize inhaled insulin alongside their insulin pump or pens. This can be particularly helpful in correcting persistent high blood sugar levels or when blood sugar levels are significantly above target range. The rapid onset time of inhaled insulin may help bring blood sugar levels into target range more quickly compared to other rapid-acting insulins.
Is inhaled insulin safe?
According to the Federal Drug Administration (FDA), inhaled insulin is considered a safe and effective treatment for high blood sugars for people with type 1 and type 2 diabetes. Some of the common side effects from Afrezza include:
- Sore throat
Although uncommon, other more serious side effects include:
- Diabetic ketoacidosis
- Lung cancer
- Decreased lung function
- Severe allergic reactions
- Low potassium
- Heart failure
It is important to note that these side effects may vary for each individual. It is recommended to discuss any concerns or potential side effects with your doctor.
Who should not use Afrezza?
Pedrosa reports that Afrezza is considered a safe option for people with diabetes who do not have long-term lung issues such as asthma or chronic obstructive pulmonary disease (COPD).
How does inhaled insulin work?
Inhaled insulin is a mealtime replacement insulin that should be taken at the start of a meal. Here are step-by-step guide on how to use Afrezza:
- Select a cartridge option you need for your meal
- Load the cartridge by opening the mouthpiece and placing the cartridge inside. Once the cartridge is inside, lower the mouthpiece and close the inhaler. You should hear a click when it has been closed. Do not turn the inhaler upside down to avoid loss of the drug powder.
- Remove the mouthpiece cover and place the mouthpiece in your mouth. Close your lips around the mouthpiece and inhale deeply and hold your breath. Remove the inhaler from your mouth and exhale.
- Remove cartridge and discard
Dosing options with Afrezza
Afrezza differs from injected rapid-acting insulin as it comes in set doses of 4, 8 and 12 units. The dosing units with Afrezza are not the same as the units for injected insulin. One unit of injected rapid-acting insulin is about the same as 1.5 units of Afrezza. This means that the smallest cartridge of Afrezza (4 units) equals about 2.6 units of injected rapid-acting insulin.
If needed, Afrezza users can mix and match cartridges to take their prescribed dose. For example, two 8-unit cartridges provide a dose of 16 units of Afrezza. When transitioning to Afrezza, it may be helpful to use this starting dose conversion chart to help determine the appropriate amount of Afrezza. Since it works differently than injected insulin, you may need to adjust your dose, up or down, based on your blood sugar levels and how Afrezza works for you.
How much does Afrezza cost?
Inhaled insulin may be more expensive than injectable insulin, which can be a barrier for some people. According to GoodRx, the list price of Afrezza ranges between $470-2,313, the price depends on the cartridge dosage (units) and the number of cartridges in each kit. Similar to injectable insulin, insurance coverage for Afrezza will vary with each individual’s plan. If you are considering switching to inhaled insulin, it is important to check with your insurance provider to see if it is covered and what the out-of-pocket costs will be.
If you have commercial insurance, you could potentially be eligible for the Afrezza savings program, which can help reduce your out-of-pocket expenses. Qualified patients may pay as little as $35 per month, but there may be certain restrictions or limitations that may apply.