Inhaled insulin

[sharishine]

Has anyone had any experience with inhaled insulin yet? If so, what were the results? Do most insurance companies pay for it? Thanks!

[marked]

I was on inhaled insulin for a month. My control slipped because Exubera at the time had only provided insulin packets in 1 or 3mg dose.
The margin for error was too great for my liking. I understand that now they are making it also in 2 and 4mg so maybe that fact is mute now. Plus carrying around the inhaler was humbug. Too big and bulky for my liking. My insurance did cover it. I think they are really targeting the Type 2 market for this thing for those who do not want to inject.
Mark

[SharpTail]

I just found this forum and have not posted before. I may have missed it but I have seen no discussion about inhaled insulins. For about a year now I have been involved in a clinical trial for Technosphere insulin. This is a "dry powder" inhaled insulin that replaces the fast acting insulins like Humalog. This has been working great for me. My A1c reading at the beginning of the study was 6.8 and the last test was 6.3. The great thing about this is the inhaler which is not much bigger than a cell phone.
I can elaborate on this if anyone is interested.
Pat

[xMenace]

Please do, and welcome to the forum.

[JediSkipdogg]

There is some talk on here on Exubera but for the most part it's negative talk. The problem with Exubera is the inhaler is anything but small so it's not easy to be carried and far from discreet (which they somehow push as a plus to it.) The other problem with Exubera is the dosing amount. It only comes in 1 and 3 mg blister packs adn 3 1 mg packs DOES NOT equal 1 3 mg pack. Not to mention, it's not a 1 for 1 unit comparison. I think it's 7 units of shot insulin is not possible on Exubera due to the way the combo packs are, therefore you have to either take 1 extra or 1 less unit.

So I guess my quesitons are.....

What are the dosing amounts? Can you dose every in say 1/2 units of insulin (like a shot)?

Have you been sick at all during the trial with a cough or chest congestion? I just wonder how being sick works with the rate it's absorbed.

Anymore info I'd love to hear. I dislike Exubera for numerous reasons but see alto of promise on in the future for inhaled insulin.

[kgm0612]

HI Pat & Welcome to the forum.


Karen

[Alice]

Welcome...I'm new also.
The drug companies have a really hard time selling the inhaled insulin to me. I don't see the purpose in all that research money when injections are easy, painless to most and more portable. (Pen needles are what I use...and love, even over the ease of a pump)

To be honest, I wish the research money had gone elsewhere. My opinion was that the inhalers were developed to market to the people who are "traumatized by needles"...which is ridiculous. Again, diabetes management is always sensationalized in the news. My friends can't even see the tiny needle on my pens.

But since you took place in the trials, I'm sure you are more knowledgeble about the outcome and I would love to hear your experiences. The inhaler I saw on the news was huge and looked like a giant plastic tube. (Once again, the news doesn't usually show the true story, so clue us in on this small inhaler).

Another concern is putting a new drug into my lungs. I've used an asthma inhaler (now on advair and rarely use the Albuterol)...I really don't like inhaling anything!

My choice is somethings small that fits into my purse...insulin pen. Also, wouldn't it be difficult to dose with an inhaler?

[SharpTail]

You can Google Technosphere Insulin (TI) and find out a lot of information about it including photographs of the inhaler. The inhaler is about 4" x 2" x 1" in dimensions, small enough to put in a shirt pocket. It can easily be carried into a restaurant and be very indiscrete to use.

I believe there are about 2000 patients worldwide in this phase of the study. I will participate for 2 years and am half way through it. This is a prandial insulin to take care of the blood sugar levels after a meal. Most of what I have to say is anecdotal and as with a lot of medications their effects vary among individuals. This insulin seems to start to work within about 10 minutes after being inhaled and most of its action is complete in about an hour. I believe one of the primary points of study for this trial is to test for possible effects on the lungs. Personally I have not detected any decline in my breathing and in fact my last Pulmonary Function Test (about 1 month ago) seemed to go better than the first such tests taken for this study. At the beginning of this trial I found some sensitivity to the inhaling of the insulin and sometimes caused me to cough. However, this has completely gone away.

Like a lot of insulin therapy there is a learning curve to figure out the dosages and how to use it correctly. The action of the TI insulin has been very predictable for me. Of course I also take a split doses of injected basal insulin (Lantus). There are two different dosages 30 units and 15 units. I was told at the beginning that the conversion for injected Humalog was 1/3. In other words 30 units TI should work like 10 units of Humalog. However, for me the conversion should be closer to 1/5 or 1/6. The 30 units are more like 5-6 units of Humalog. I can understand that this may present a problem for individuals who micro manage their dosages in 1/2 or 1 unit increments. It seems for me that the estimation of dosages has been very forgiving and that the very small dosages have not been necessary.

A really positive thing that has happened is extremely infrequent occurrances of low blood sugars. Since being diagnosed with Type 1 in 1981 I have worked hard to tighten my control. I found as my control became tighter I seemed to be on the edge and at more risk of hypooglycemia. With the TI insulin I have narrowed the range of the blood sugars and almost completely eliminated the low blood sugars. The TI insulin seems to be really "gentle" in its action as the blood sugar comes down.

I was told at the beginning of this trial that the insulin had to be refrigerated except what was being used within 48 hours. However, when I recently looked on the internet I noticed a claim that it could be kept safely at room temperature for up to 2 months.

Something I have found out that users should be aware of it the increase in action of the TI insulin if you participate in an aerobic activity within an hour of inhaling. I have estimated that breathing hard in this situation almost doubles the action of the insulin.

Realistically this is primarily a different delivery system for insulin and frequently monitoring of sugar levels are required just like other therapies. I suspect the trials will show that blood sugar control with the TI insulin will be comparable to that with injected insulin and may even be a little better. I would think that for newly diagnosed Type 1 diabetics if given a choice would likely chose inhaled insulin if it is convenient to use. My better control may have resulted from a willingness to take the insulin more frequently, and thereby taking care of small "blips" in my sugar levels.

Pat

[Injecto]

Has anyone had any experience with inhaled insulin yet? If so, what were the results? Do most insurance companies pay for it? Thanks!

Well, I didn't do it on purpose but once I put a reservoir full of insulin near my nose to smell it and I accidently inhaled it....man I coughed and snotted for 5 minutes. That was it, I figured I'm NEVER going on inhaled insulin...EVER.

:T

[marked]

Please click one of the Quick Reply icons in the posts above to activate Quick Reply.

[marked]

oops sorry about that post.
I think it depends on the person and their diabetes. A friend of mine is on Exubers and finds the same results as you, for me the control was not to my liking. My average blood sugar was in the 130's Too high for my taste. If I took another 1mg, I it would only lower it to the 120's and if I took 3mg I would go low. But it sounds like a much better size than the Exubera,that thing was hauling around a suitcase.
Mark

[barko]

Exubera has already been denied full reimbursement coverage by UK and German authorities.

The general consensus in the bio-tech investment arena seems to be that Pfizer (and associates) over-estimated the demand for this type of therapy.

One perspective: Inhalable insulin may be a 'flop', says report (http://www.in-pharmatechnologist.com/news/ng.asp?n=71656-pfizer-exubera-inhalable-insulin)

And another ;-)

A Few Lessons From Exubera - Seeking Alpha (http://biotech.seekingalpha.com/article/32657)

And my favorite -lol

"Pfizer Taking Some Hits Over Billion-Dollar Bong"

Pfizer Taking Some Hits Over Billion-Dollar Bong (http://www.brandweek.com/bw/news/recent_display.jsp?vnu_content_id=1003550265)

[SharpTail]

barko: Wow! I haven't seen all the negative press on the Exubera product but it really sounds like it is a bust for Pfizer. It seems most of the criticism is based on the device required to deliver the insulin. I can certainly understand that. I doubt that that will even be talked about with the Technosphere device and the important aspects of whether the medication works will prevail in any discussions. I suspect the meager sales of Exubera may suffer even more when Technosphere is approved unless Pfizer improves their device.
Pat

[LoriAnne]

I was supposed to get Excubera but my wonderful ~sigh~ insurance would'nt cover it. I'm sort of glad they did'nt, I've been hearing that it can effect your lung function & with my family's history of lung probs, I think I'll stay clear. I also been told you have to have a lung function test every 6 months & have seen the informational dvd & it seems like a whole lot of hassle with the cleaning & also have to replace components like every six months. Could run into alot of expense, no wonder the insurance companies are trying to avoid covering it. If you're afraid of needles, I guess it would be a good alternative. I'm not afraid of needles, I hate "popping" my finger to test, can they find an inhalable way of testing blood sugar? LOL I'd be allllll over that. :)

[LantusFiend]

I was thinking about it but it's not on the formulary for my insurance... they cover it way less than they do liquid insulin.
So no go.
My insurance is Blue Cross Blue Shield Illinois PPO