The Pharmaceutical Journal
Vol 277 No 7412 p153
5 August 2006

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Fast-acting inhaled insulin available from this week

Certain patients with type 1 or type 2 diabetes may no longer need insulin injections now that the first inhaled product has become available from Pfizer this week.

Exubera, a fast-acting insulin, is inhaled into the lungs within 10 minutes before starting a meal. Unlike the parenteral insulins already on the market, which are dosed in international units, the inhaled insulin powder is dosed in milligrams — determined individually by the physician and adjusted according to response and lifestyle — using a combination of 1mg and 3mg unit dose blisters.

The recommended starting dose is 0.15mg/kg of body weight per day, divided into three pre-meal doses. It should be noted that consecutive inhalation of three 1mg blisters yields a higher insulin dose than inhaling one 3mg blister (see Panel for dosing guidance).

Exubera is contraindicated in patients who smoke or have smoked in the six months before treatment, due to a risk of hypoglycaemia. Patients with poorly controlled, unstable or severe asthma, and those with severe chronic obstructive pulmonary disease are also not eligible for inhaled insulin treatment.

The National Institute for Health and Clinical Excellence is in the process of formalising technology guidance on the product. In its preliminary consultation, NICE recommended that inhaled insulin not be used for the routine treatment of people with type 1 or type 2 diabetes, and only be used in patients who have a HbA_1c level of 9 per cent or higher despite other therapeutic interventions and adequate educational support, and who are unable to start or continue with insulin injections because of proven needle phobia or severe injection site problems.


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