[seacomp]

Two leading endos published a letter to the editor today in the Wasington Post indicating that are not altogether thrilled by the new inhaled insulin. One, of the doctors, Kenneth Burman, is Director of Endocrinology at the Washington Hospital Center in Washington, DC and once
treated George Bush, the father for thryroid problems. The letter is at:
http://www.washingtonpost.com/wp-dyn...020500797.html

[David]

"A last important consideration is that fine-tuning of insulin doses before meals is not possible with the current delivery system of inhaled insulin. At present the inhaler can dispense insulin only in increments of three or nine units. Clearly, if the patient needs a different dose, this would not be possible with the inhaler."

[rzrbks]

Two Leading Endos pan Inhaled Insulin


You mean they're going out and panning it like the Gold Miners used to?

KUUL

[bac4uw]

Holy **** I had no idea that the inhaled insulin device could only deliver doses of 3 and 9 units! Wow. That's not useful.

Bryan

[duck]

Originally Posted by bac4uw

Holy **** I had no idea that the inhaled insulin device could only deliver doses of 3 and 9 units! Wow. That's not useful.

Bryan

LOL, it's kinda like saying "One size fits all!" The real question is, "But how well?"

You have to wonder what these two endos were paid to say such nice things about inhaled insulin considering you can only take it in two sizes?

[bac4uw]

Originally Posted by duck

LOL, it's kinda like saying "One size fits all!" The real question is, "But how well?"

You have to wonder what these two endos were paid to say such nice things about inhaled insulin considering you can only take it in two sizes?

Well, they weren't entirely nice:

The article also skimmed over the potential long-term side effects of inhaled insulin.

But they weren't entirely critical either...

You're right - it'd seem like they would have really harped on the silliness behind only being able to give two discrete dose levels. In an era where we aim to get better and better at delivering continuous and finely tuned doses of insulin, here Pfizer gives us a product that not only does not advance that goal - it goes in the complete opposite direction: delivering less finely-tuned doses of insulin at discrete times during the day.

[JediSkipdogg]

The doses are actually 1 and 3 mg. I believe if I remember correctly, it is about 1/2 to 1/3 that of regular insulin. It all depends on how well your lungs are and how well you react to the inhaled insulin. So if you took 10 units of humalog, you would take 1 3 mg dose of exubera. However, the catch is....1 mg of exubera IS NOT 1/3 of the 3 mg dose. And it's not a simple number either. Therefore your doctor has to come up with two action plans for you on each dosage and you can't easily mix dosage levels. Control????? What control??????????

[seacomp]

Originally Posted by bac4uw

Well, they weren't entirely nice:

But they weren't entirely critical either...

You're right - it'd seem like they would have really harped on the silliness behind only being able to give two discrete dose levels.

These two are big time players, what they said from their position is damming.

[zookeeper671]

Am I the only one who thinks the creation of this insulin "bong" or "dysfunction looking" device is a waste of time and money? I really wish they had put the money into finding a cure. If not a cure, then maybe a practical CGM device. Anything but this.

[seacomp]

The dosage problem with this are so bad that there really can be no question of it being used to replace injected insulin for those who need it. The dosage issue is probably worse than has been brought out, I would strongly suspect that there is a wide variation in the amount of insulin delivered per use for the same dose. That is when you take their 3 unit dose, you might get 2.2 units one time, 3.7 units the next, etc. As I said this is what I strongly suspect; I don't have any actual figures to back it up, but there are indications to this effect.
But in any case, these dosage problems are not deliberate. I'm sure that Pfizer would provide unit doses in a consistant manner, if they could. But they can't, it's in the nature of what they are trying to do that you can't get good dosage control.
Pfizer's error, and even more so the popular press's, is playing this up as a replacement for those painful "needle sticks". There is a potentially a very large role that inhaled insulin could play, but not where it's now positioned.

[sydneya]

I had no idea the inhaled insulin was so limited. Good grief, I hope they plan on doing a little fine tuning. It doesn't seem like it's much good now.

[seacomp]

What inhaled insulin could do. There are many Type II diabetics on various oral medications who are either at maximum dose and/or are not getting adeqaute control. These people would benefit from geting additional, exterior supplied insulin as a supplement, and there are many who do using injecting insulin. But there are many who do not, mostly for "fear of the needle". With my own experience, I think they are wrong, but their fear is perfectly understandable.

Inhaled insulin can be a godsend to this particular group of patients. Since the insulin they would benefit by taking is only a supplement to their natural insulin, they do not have to exactly match the extra insulin to amount of food they are eating. Thus if the supplement insulin is 30% of what they need, then the body will make up the other 70%, and likewise if they take 74% of what is required. This type of dosage flexibility is something that inhaled insulin can meet.

Also since the supplementation of normal insulin is useful, but not required at every meal, the size of the inhaler becomes less of a problem. If it will be a problem, leave the thing home. Use it when it makes sense to.

However, whether inhaled or injected, insulin is a very potent and dangerous drug. Lows can kill. Users of inhaled insulin are almost as liable to hypo problems as insulin-dependant diabetics, if they take the drug too lightly.
All the precautions, training etc. that are part of injected insulin use will be reuired for the inhaled product.

[seacomp]

Originally Posted by sydneya

I had no idea the inhaled insulin was so limited. Good grief, I hope they plan on doing a little fine tuning. It doesn't seem like it's much good now.

That's the problem, they can't "tune it". They would have, if they could have.