Exubera - First Inhaled Insulin

[VickyRN, MSN, DNP, RN]

inhaled insulin

the food and drug administration has approved an inhaled insulin for adults with type 1 or type 2 diabetes. called exubera, the drug is a powder form of recombinant human insulin that's inhaled orally. more than 5 million americans with diabetes inject insulin. with the approval of inhaled insulin, they have the first new delivery option since insulin was discovered in the 1920s.

in clinical trials, exubera acheived peak insulin levels more quickly than regular insulin given by injection (49 minutes versus 105 minutes). in patients with type 1 diabetes, it may be added to long-acting insulin as a replacement for short-acting insulin taken with meals. in type 2 diabetes, it may be used alone, with an oral antidiabetic drug, or with long-acting insulin.

ndhnow.com - news capsules - inhaled insulin

[Dabuggy]

Thank you, I know I'll see that on a test some time soon. What a giant step forward. One less syringe, cool.

Dabuggy

[Myxel67]

You should see the inhaler though--it's huge. Also requires pulmonary function tests before Rx. One of our endocrinologists says that although it starts quickly, it's action profile is more like regular insulin than like the fast acting insulin analogs.

THE LARGER VIEW IS THE PUMP AS ASSEMPLED FOR USE (smaller view does not have aerochamber attached)

[wincha]

I know some co-workers who were at a demonstration. Is for the person who will not take shots and will be complaint with this type of delivery. They are also working on a smaller version.

[NewGoalRN]

This has been discontinued. I know because I used it and found out that I can no longer script for it. Something about the manufacturer not making profit from less people than they anticipated using it. I loved it. It meant fewer injections...ah well. I can't believe that a diabetic would not prefer this over a needle. The explanation doesn't sit well with me.

[dansingrn]

Exubera had to be taken in doses of certain increments, the powdered insulin was premeasured and couldn't be adjusted precisely. It was a pretty large device, and was technique dependent.

Insulin administration has improved so much in recent years. There are a variety of insulin pens and extremely thin, well lubricated needles that make injections nearly, if not completely, painless. Using excellent technique (and there are many tricks) can reduce any discomfort even more.

Of course, insulin pump therapy eliminates injections altogether, and delivers insulin in extremely precise increments.

Exubera wasn't approved for pediatric use, but in my patient population I can't imagine a kid carrying around one of those things. Our 6 year olds are giving their own shots by themselves without pain, but the 60 year olds cry and refuse to take insulin!

[NewGoalRN]

I used Exubera and Iloved it. The size didn't bother me and I have to say that as a chronic diabetic I preferred it to needles and I am sure most kids would have as well. It can be carried in a backpack or pouch and all it required was to insert the tab, press down on the lever and inhaled. The only small side effect was that it sometimes irritated my throat a bit and I had to cough.

I have to take a shot everytime I eat and even with tricks and using short needles, I get hotspots. As someone who takes shots, taking needles is a pain and I am an adult, so I have to imagine that it is worse for kids. If you have not lived with being a diabetic and taking shots, I don't care what the medical field says, you still experience some discomfort from time to time and hotspots. I have used pens for Lantus and Byetta and while they are a bit better than the traditional needles, you still have to do a few more steps, dialing up, making sure that it is properly dialed etc

Regarding pumps, while their measures are more precise, you still have to deal with tubing etc so with all the methods of insulin delivery there are always 1 to 2 drawbacks. I don't know why Exubera wasn't approved for kids as I am an adult but I had to take a prelimnary cardio and breathing exam from another specialist before my Endocrinologist scripted me for it.

According to him and the manufacturer's website, it was pulled because they were not making money off it. Now, I am going back on a higher dose of Byetta as the 5mg didn't really help me so we'll see. So far, I do Lantus longterm 1x day and Novolog at every meal.

[blondy2061h, MSN, RN]

I thought Exubera was a stupid concept from day 1. An insulin that has uneven absorption, comes in a HUGE container, causes lung damage, and needed to be taken in increments of 3 units? Cool, where do I sign up? Or, uhm, not.

During my family health rotation they still had the demo units after it stopped being sold. I grabbed one cause I thought it would be cool to own a piece of diabetes history (can you say "dork" boys and girls?).

Here's the comparison between Exubera and my usual insulin delivery method.

Exubera can give increments of 3 units. The pump can give increments of 0.1 units. Exubera requires a needle at least once a day (long acting insulin). My pump required 1 stick q3 days. Exubera is dosed only before meals and based on weight. My pump lets me dose by what I'm eating, whenever I need to dose it be it to eat a snack or correct a high on the go. My pump won't cause lung damage. My pump just uses normal vials of insulin my insurance will pay for without an fights. My pump lets me adjust my basal insulin to meet my needs. My pump can be uploaded to a computer to view trends.

So yeah, I like my pump better.