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Insulin puffers story

Question:

Any news story that refers to Type II diabetes as "a milder form" deserves to be immediately sent to the trash can. "Mild" diabetes is like "mild" pregnancy.   If a journalist can’t get that right, then how can you trust any of the rest of the piece?

Griff? I hate to tell you this, but it is in fact milder. It’s the difference between nearsighted and flat-out blind. Us Type 1’s don’t have *any* insulin to work with, at least after the honeymoon phase.

Response:

Any news story that refers to Type II diabetes as "a milder form" deserves to be immediately sent to the trash can. "Mild" diabetes is like "mild" pregnancy.   If a journalist can’t get that right, then how can you trust any of the rest of the piece? Griff? I hate to tell you this, but it is in fact milder. It’s the difference between nearsighted and flat-out blind. Us Type 1’s don’t have *any* insulin to work with, at least after the honeymoon phase.

This is the case, but the insulin resistance in Type 2 can require far more to handle it than plain Type 1’s need.  At this time, we do not know that much about insulin resistance. It is even possible to be both. — This address is for information only.  I do not claim that these views are those of the Statistics Department or of Purdue University. Herman Rubin, Department of Statistics, Purdue University

Response:

Any news story that refers to Type II diabetes as "a milder form" deserves to be immediately sent to the trash can. "Mild" diabetes is like "mild" pregnancy.   If a journalist can’t get that right, then how can you trust any of the rest of the piece? Griff? I hate to tell you this, but it is in fact milder. It’s the difference between nearsighted and flat-out blind. Us Type 1’s don’t have *any* insulin to work with, at least after the honeymoon phase.

nico?  i hate to tell you this, but griff is right and you are wrong and there’s a sizeable subset of the T1s who have small amounts of endogenous insulin. biggs is my main source on this, not to mention that i e-mailed t1 charly coughran on this issue about 5 years ago and his response was that he’s never seen anything on it one way or the other bill t1 since ‘57

Response:

Insurance Companies sure see a difference between Type 1 and 2. They specifically ask the question "Do you have Type 1 – Insulin Dependent Diabetes" on all applications for life insurance. There are no questions such as this regarding "Type 2". JavaScript Includes In a previous issue of the tips and tricks newsletter we discussed Server Side Includes (Virtual Includes) as a method of creating single files for multi-page components such as headers, footers, navigation menus, etc. Bravenet Member Christian Hess Araya mailed in with an alternative using JavaScript Includes. Here’s how it works. Rather than using a server-side solution, we can employ JavaScript Includes to save our HTML code as a series of "document.write" statements in a .js file, then include it in our main page via a <SCRIPT tag. For example, suppose we want the following code: Click <A HREF="http://www.bravenet.com"here</A to visit Bravenet. to appear in several different html pages on a site. We simply create a .js file (bravenet.js as example) with the following contents: <!– document.write(‘Click <A HREF="http://www.bravenet.com"here</A to visit BraveNet’); — Note that we have omitted the "script" tag. We then save this .js file and then link to it at the appropriate places (within the BODY tags, not in the document HEAD) of our file(s) like this: <SCRIPT LANGUAGE="javascript" TYPE="text/javascript" SRC="bravenet.js"</SCRIPT This has the effect of displaying the code from our .js source file wherever we place this script tag. If we have a menu of links, for example, we can put that on all pages of our site using the included file; if we save a change to that file, all other pages that reference it will change as well.

– Hide quoted text — Show quoted text – Any news story that refers to Type II diabetes as "a milder form" deserves to be immediately sent to the trash can. "Mild" diabetes is like "mild" pregnancy.   If a journalist can’t get that right, then how can you trust any of the rest of the piece? Griff? I hate to tell you this, but it is in fact milder. It’s the difference between nearsighted and flat-out blind. Us Type 1’s don’t have *any* insulin to work with, at least after the honeymoon phase.

Response:

Bill, The puffers are relatively big. Here is a link to the Nektar/Aventis/Pfizer inhaler. http://www.nektar.com/content/inhalers The top one labeled "Nektar Pulmonary Inhaler" is the one for insulin. It is shown in its *collapsed* state. When expanded it is about 80% longer. The pens are definitely smaller. Here is a link to the Aradigm/Novo device. http://www.aradigm.com/tech/delivery.html and it’s strips http://www.aradigm.com/tech/packet.html Cheers, William C Biggs, MD

– Hide quoted text — Show quoted text – I’m a Type 2 using Lantus and Humalog, and I think I would be more excited about testing without finger sticks than I am about reducing the number of injections. Given today’s smaller needles I don’t have a problem with the injections. Would the inhalers be smaller and easier to carry about than today’s Humalog pen? Bottom line for me is better control….not just avoidance of injections. Although I admit that before I went on insulin I would have been very interested in an inhaled insulin.  Having been there, the injections are not that big a deal. Bill Nico, IMHO, the reason we don’t see inhaled insulin on the market today is not dosage, but the two related concerns. First, one patient (out of thousands tested) developed pulmonary fibrosis. People can develop pulmonary fibrosis spontaneously, and this could be coincindence. But this prompted a call for additional testing. Second, there is the issue of antibodies. The titer of insulin antibodies in the blood is higher in inhaled insulin vs injected insulin. At the last ADA meetings in New Orleans, there was a symposium about these issues.  The take home message was a) nobody else has had fibrosis  and b) the antibodies don’t appear to be a manifestation of any harm. Once the additional testing is complete, if there are no additional cases of fibrosis and if there are no new adverse effects noted, then the FDA should approve this. As far as the dosing issue, it’s actually not as bad as you describe. In fact, inhaled insulin has some of the best times to peak of any delivery method, allowing the dose to be given during or just after a meal. It is also cleared rapidly, reducing the hypo risk pre-meal. Assuming no new adverse effects on the clinical testing underway, I predict that 5 years from now the majority of type 2’s converting to insulin will use a basal insulin like glargine or detimir plus inhaled insulin. Cheers, William C Biggs MD : Thought the following might be of interest … : : Insulin puffers as effective as injections : : Trials with experimental insulin inhalers show they are as effective : as injections – and that diabetics much prefer them, an analysis of : existing studies has found. : : http://www.abc.net.au/science/news/stories/s909977.htm all I gotta say… "what a crock of crap!" I found several incorrect statements in that article. RK They’ve never been FDA approved, despite many years of research. The problem seems to be dosage. Posted Via Uncensored-News.Com – Still Only $9.95 –

http://www.uncensored-news.com – Hide quoted text — Show quoted text –       <<<<<<<   The Worlds Uncensored News Source <<<<<<<<

Response:

Any news story that refers to Type II diabetes as "a milder form" deserves to be immediately sent to the trash can. "Mild" diabetes is like "mild" pregnancy.   If a journalist can’t get that right, then how can you trust any of the rest of the piece? — Griff Griffith T2 since December 1990 Basal/bolus insulin & Metformin since May 2003 – Hide quoted text — Show quoted text – Thought the following might be of interest … Insulin puffers as effective as injections Trials with experimental insulin inhalers show they are as effective as injections – and that diabetics much prefer them, an analysis of existing studies has found. http://www.abc.net.au/science/news/stories/s909977.htm

Response:

Senkise, I think you misread the posting. There were six STUDIES. Three STUDIES with type 1 patients, and three STUDIES with type 2 patients. Not three patients. Actually, the Cochrane paper stated "Six randomised controlled trials were found and the overall number of participants was 1191.". "Six trials have been done on giving short-acting insulin by inhalation instead of injection. Much of the evidence has not yet been published in full. The results so far suggest that inhaled insulin gives similar levels of glycated haemoglobin; overall the incidence of hypoglycaemia also appears similar, but patients prefer inhaled to injected. The quality of evidence is not great – only two studies appeared to use the same basal insulin in the inhaled and injected groups. We need longer studies to see if there are any side-effects in the lung. More insulin has to be given by inhaled than by injection to achieve the same effect, and the cost-effectiveness remains to be assessed." Cheers, William C Biggs, MD

 Trials with experimental insulin inhalers show they are as effective YES, they have tried it on *THREE* (sic) patients…  as injections – and that diabetics much prefer them, an analysis of  existing studies has found.  http://www.abc.net.au/science/news/stories/s909977.htm — Senkise Vagyok

                                   To get to real sender replace nemo with

me

Response:

I’m a Type 2 using Lantus and Humalog, and I think I would be more excited about testing without finger sticks than I am about reducing the number of injections. Given today’s smaller needles I don’t have a problem with the injections. Would the inhalers be smaller and easier to carry about than today’s Humalog pen? Bottom line for me is better control….not just avoidance of injections. Although I admit that before I went on insulin I would have been very interested in an inhaled insulin.  Having been there, the injections are not that big a deal. Bill – Hide quoted text — Show quoted text – Nico, IMHO, the reason we don’t see inhaled insulin on the market today is not dosage, but the two related concerns. First, one patient (out of thousands tested) developed pulmonary fibrosis. People can develop pulmonary fibrosis spontaneously, and this could be coincindence. But this prompted a call for additional testing. Second, there is the issue of antibodies. The titer of insulin antibodies in the blood is higher in inhaled insulin vs injected insulin. At the last ADA meetings in New Orleans, there was a symposium about these issues.  The take home message was a) nobody else has had fibrosis  and b) the antibodies don’t appear to be a manifestation of any harm. Once the additional testing is complete, if there are no additional cases of fibrosis and if there are no new adverse effects noted, then the FDA should approve this. As far as the dosing issue, it’s actually not as bad as you describe. In fact, inhaled insulin has some of the best times to peak of any delivery method, allowing the dose to be given during or just after a meal. It is also cleared rapidly, reducing the hypo risk pre-meal. Assuming no new adverse effects on the clinical testing underway, I predict that 5 years from now the majority of type 2’s converting to insulin will use a basal insulin like glargine or detimir plus inhaled insulin. Cheers, William C Biggs MD : Thought the following might be of interest … : : Insulin puffers as effective as injections : : Trials with experimental insulin inhalers show they are as effective : as injections – and that diabetics much prefer them, an analysis of : existing studies has found. : : http://www.abc.net.au/science/news/stories/s909977.htm all I gotta say… "what a crock of crap!" I found several incorrect statements in that article. RK They’ve never been FDA approved, despite many years of research. The problem seems to be dosage.

Posted Via Uncensored-News.Com – Still Only $9.95 – http://www.uncensored-news.com       <<<<<<<   The Worlds Uncensored News Source   <<<<<<<<

Response:

 Trials with experimental insulin inhalers show they are as effective

YES, they have tried it on *THREE* (sic) patients…  as injections – and that diabetics much prefer them, an analysis of  existing studies has found.  http://www.abc.net.au/science/news/stories/s909977.htm

–                                    To get to real sender replace nemo with me

Response:

- Hide quoted text — Show quoted text – Nico, IMHO, the reason we don’t see inhaled insulin on the market today is not dosage, but the two related concerns. First, one patient (out of thousands tested) developed pulmonary fibrosis. People can develop pulmonary fibrosis spontaneously, and this could be coincindence. But this prompted a call for additional testing. Hmm. I can certainly see where this would be an important cause for additonal testing. I wonder what else they were sniffing, or if there were other complicating factors? trials are carefully controlled and the companies do everything they can to downplay any negative stuff that comes up during the trail once this "puffed" insulin stuff is put on the open market (note: i’m assuming it’ll be a script item and NOT OTC) it’ll be open to a *lot* more variability

Yeah, but it’s hard. I’ve spent *years* doing human testing, and determining what factors and what are insignificant are very, very difficult, especially when there’s no chance of doing a double blind (such as in this case, unless we give them nose sprays *and* injections, which could be quite hazardous if they lose and need to replace a bottle or a nose spray).

Response:

Nico, IMHO, the reason we don’t see inhaled insulin on the market today is not dosage, but the two related concerns. First, one patient (out of thousands tested) developed pulmonary fibrosis. People can develop pulmonary fibrosis spontaneously, and this could be coincindence. But this prompted a call for additional testing. Hmm. I can certainly see where this would be an important cause for additonal testing. I wonder what else they were sniffing, or if there were other complicating factors?

trials are carefully controlled and the companies do everything they can to downplay any negative stuff that comes up during the trail once this "puffed" insulin stuff is put on the open market (note: i’m assuming it’ll be a script item and NOT OTC) it’ll be open to a *lot* more variability Second, there is the issue of antibodies. The titer of insulin antibodies in the blood is higher in inhaled insulin vs injected insulin. *Hmmm*. That’s interesting. I don’t think that’s an important issue for most of us Type 1’s.

wanna bet? bill t1 since ‘57

Response:

- Hide quoted text — Show quoted text – the story accurately reflects the aversion of the large majority of people to syringe shots the site’s positive spin on inhaled insulin is a good example of big pharma marketing money at work.  :( is it any wonder that Aventis and Novo have spent millions on new 1x background insulins (glargine/Lantus in the case of Aventis) that they can get new patents on I’m a bit confused.

i don’t think so.  :) First the story was that big pharma prevents new treatments to milk their current products.

not by me Now the story is that big pharma is spending big money on new products to replace old.

that’s what i said above.  :) Which is it?

see above.  :) And where can I buy stock in big pharma.

if anyone here’d know, it’d be you.  :) but what’ll you buy? the puffer company(s)? or Lilly or Novo? i mean, if Lilly or Novo (or another of the big synthetic insulin makers) supplies the base insulin and/or base insulin technology to the "puffer" companies (i.e. if they get a "cut" based on insulin sales volume), then maybe Lilly and/or Novo would be the better buy? i mean, their insulin volume may soon quintuple since it’s my understanding that puffed insulin delivery is *extremely* wasteful.  so given our wacky 3rd party pay system in the USA, synthetic insulin sales could easily soon be at 5x current levels and one more good reason why we’d all be better off, if everyone in the USA paid out of pocket for health care and meds, coz that’s the only way we’re ever gonna get any real restraint in our bloody health care system one other though is that since T2s presently use about 90% of all insulin sold, we’ll soon have T2s using 98+% of all insulin sold.  iow, one more good reason for T1s with brains to start sweating on the subject of remaining available insulin suitable for use by T1s bill t1 since ‘57, ex 8-yr pumper, beef-L 1x, simple MDI/DAFNE

Response:

RK Is it as beneficial as pumping?

Inhaled insulin has been tested in type 1’s but there has not been any head to head comparison vs a pump.  I’m sure that eventually it will be tested against a pump, but obviously it wouldn’t be a double blind type of study. What about long term damage?

That is the exact question the FDA has. They want to know if any other patients ever develop fibrosis, and if there is any relevance to an increased insulin antibody titer.  Studies are still underway, but appear to look good so far. How would dosing be adjusted? Like a squirt per unit?

Depends upon the manufacturer. I have seen the devices from Nektar (formerly Inhale) and from Aradigm. Nektar’s device is about 1 -2 years ahead of Aradigm in development. Nektar is working with Aventis and Pfizer to market the device. Nektar has done the research, the insulin is manufactured by Aventis, and Pfizer & Aventis will market it. The Nektar system is dry powder. When I saw it about 3 – 4 years ago they had little foil packages of insulin that were the equivalent of 3 or 6 units of insulin. I am not sure how they will be dosing the packages for final release. I would think the best would be a binary like assortment….1 , 2, 4, 8, and 16 unit packages, or simply have all different doses available prepackaged. The device spins the insulin into an air chamber, and you then suck in a deep breath from the air chamber. Aradigm is working with Novo. The Aradigm system uses wet insulin packaged in tiny little blisters on a paper strip. A hammer like device strikes the paper, rupturing the blisters which then are ejected into the air.  The hammer won’t trigger off unless you are sucking enough air to get a good mix and a good inhalation into your lungs. The device even has a little green light telling you the best time to trigger the dose. I haven’t seen the dosing details on this one. BTW, one of the curious things presented at the ADA meeting was the effect of cigarette smoking on inhaled insulin. Rather than reducing the effect, cigarettes actually made the insulin absorb more completely and more quickly. They documented some problems with former smokers on inhaled insulin, relapsing into smoking, and triggering hypos as a result. Best wishes, William C Biggs, MD

Response:

Nico, IMHO, the reason we don’t see inhaled insulin on the market today is not dosage, but the two related concerns. First, one patient (out of thousands tested) developed pulmonary fibrosis. People can develop pulmonary fibrosis spontaneously, and this could be coincindence. But this prompted a call for additional testing.

Hmm. I can certainly see where this would be an important cause for additonal testing. I wonder what else they were sniffing, or if there were other complicating factors? Second, there is the issue of antibodies. The titer of insulin antibodies in the blood is higher in inhaled insulin vs injected insulin.

*Hmmm*. That’s interesting. I don’t think that’s an important issue for most of us Type 1’s. At the last ADA meetings in New Orleans, there was a symposium about these issues.  The take home message was a) nobody else has had fibrosis  and b) the antibodies don’t appear to be a manifestation of any harm.

Cool. Once the additional testing is complete, if there are no additional cases of fibrosis and if there are no new adverse effects noted, then the FDA should approve this.

Again, cool. But there are other big if questions. I’d like to see the papers myself on dosage, especially for overnight use for people like me. As far as the dosing issue, it’s actually not as bad as you describe. In fact, inhaled insulin has some of the best times to peak of any delivery method, allowing the dose to be given during or just after a meal. It is also cleared rapidly, reducing the hypo risk pre-meal.

Dose != speed of onset. I’m using Humalog, and successfully taking my insulin at meal time. But overnight is a bit tricky, as is the time between lunch and my rather late supper. If it clears more quickly, then I’m screwed at about 5pm. And taking *another* dose at that time of a really fast-acting insulin seems a bit awkward. Assuming no new adverse effects on the clinical testing underway, I predict that 5 years from now the majority of type 2’s converting to insulin will use a basal insulin like glargine or detimir plus inhaled insulin.

I dunno, I’ve been seeing claims like that for 10 years now. One guy I played paintball with about 5 years ago (at my bachelor party!) was working on it and claiming they’d have FDA approval within six months. It took me a while to stop laughing: maybe he said something that silly just to ruin my aim, but I still shot him…..

Response:

the story accurately reflects the aversion of the large majority of people to syringe shots the site’s positive spin on inhaled insulin is a good example of big pharma marketing money at work.  :( is it any wonder that Aventis and Novo have spent millions on new 1x background insulins (glargine/Lantus in the case of Aventis) that they can get new patents on

I’m a bit confused. First the story was that big pharma prevents new treatments to milk their current products. Now the story is that big pharma is spending big money on new products to replace old. Which is it? And where can I buy stock in big pharma.

Response:

the story accurately reflects the aversion of the large majority of people to syringe shots the site’s positive spin on inhaled insulin is a good example of big pharma marketing money at work.  :(

??? Now wait a minute. If workable, it is in fact an exciting possibility. The developers do keep publishing very promising articles and papers about it. They just don’t seem able to get enough control over dosage in vivo to actually use the stuff. is it any wonder that Aventis and Novo have spent millions on new 1x background insulins (glargine/Lantus in the case of Aventis) that they can get new patents on

That’s a very separate matter….

Response:

- Hide quoted text — Show quoted text – : Thought the following might be of interest … : : Insulin puffers as effective as injections : : Trials with experimental insulin inhalers show they are as effective : as injections – and that diabetics much prefer them, an analysis of : existing studies has found. : : http://www.abc.net.au/science/news/stories/s909977.htm

all I gotta say… "what a crock of crap!" I found several incorrect statements in that article. RK They’ve never been FDA approved, despite many years of research. The problem seems to be dosage.

the problem(s) appear to me to go beyond "dosage" Correct. Even injections give wide variations in absorbtion. The inhaler   can meter the dosage as accurately as a syringe, but the respiratory tract is too variable and unpredictable a site.

the story accurately reflects the aversion of the large majority of people to syringe shots the site’s positive spin on inhaled insulin is a good example of big pharma marketing money at work.  :( is it any wonder that Aventis and Novo have spent millions on new 1x background insulins (glargine/Lantus in the case of Aventis) that they can get new patents on bill t1 since ‘57

Response:

: Thought the following might be of interest … : : Insulin puffers as effective as injections : : Trials with experimental insulin inhalers show they are as effective : as injections – and that diabetics much prefer them, an analysis of : existing studies has found. : : http://www.abc.net.au/science/news/stories/s909977.htm all I gotta say… "what a crock of crap!" I found several incorrect statements in that article.

As soon as I read that some users suffered from lung fibrosis as a result of inhaling, my thought was "Stick with the needle Beav, you KNOW it makes sense":-) Beav

Response:

: Thought the following might be of interest … : : Insulin puffers as effective as injections : : Trials with experimental insulin inhalers show they are as effective : as injections – and that diabetics much prefer them, an analysis of : existing studies has found. : : http://www.abc.net.au/science/news/stories/s909977.htm all I gotta say… "what a crock of crap!" I found several incorrect statements in that article. RK

Response:

- Hide quoted text — Show quoted text – : Thought the following might be of interest … : : Insulin puffers as effective as injections : : Trials with experimental insulin inhalers show they are as effective : as injections – and that diabetics much prefer them, an analysis of : existing studies has found. : : http://www.abc.net.au/science/news/stories/s909977.htm all I gotta say… "what a crock of crap!" I found several incorrect statements in that article. RK

They’ve never been FDA approved, despite many years of research. The problem seems to be dosage.

Response:

- Hide quoted text — Show quoted text – : Thought the following might be of interest … : : Insulin puffers as effective as injections : : Trials with experimental insulin inhalers show they are as effective : as injections – and that diabetics much prefer them, an analysis of : existing studies has found. : : http://www.abc.net.au/science/news/stories/s909977.htm all I gotta say… "what a crock of crap!" I found several incorrect statements in that article. RK They’ve never been FDA approved, despite many years of research. The problem seems to be dosage.

Correct. Even injections give wide variations in absorbtion. The inhaler   can meter the dosage as accurately as a syringe, but the respiratory tract is too variable and unpredictable a site.

Response:

Nico, IMHO, the reason we don’t see inhaled insulin on the market today is not dosage, but the two related concerns. First, one patient (out of thousands tested) developed pulmonary fibrosis. People can develop pulmonary fibrosis spontaneously, and this could be coincindence. But this prompted a call for additional testing. Second, there is the issue of antibodies. The titer of insulin antibodies in the blood is higher in inhaled insulin vs injected insulin. At the last ADA meetings in New Orleans, there was a symposium about these issues.  The take home message was a) nobody else has had fibrosis  and b) the antibodies don’t appear to be a manifestation of any harm. Once the additional testing is complete, if there are no additional cases of fibrosis and if there are no new adverse effects noted, then the FDA should approve this. As far as the dosing issue, it’s actually not as bad as you describe. In fact, inhaled insulin has some of the best times to peak of any delivery method, allowing the dose to be given during or just after a meal. It is also cleared rapidly, reducing the hypo risk pre-meal. Assuming no new adverse effects on the clinical testing underway, I predict that 5 years from now the majority of type 2’s converting to insulin will use a basal insulin like glargine or detimir plus inhaled insulin. Cheers, William C Biggs MD

– Hide quoted text — Show quoted text – : Thought the following might be of interest … : : Insulin puffers as effective as injections : : Trials with experimental insulin inhalers show they are as effective : as injections – and that diabetics much prefer them, an analysis of : existing studies has found. : : http://www.abc.net.au/science/news/stories/s909977.htm all I gotta say… "what a crock of crap!" I found several incorrect statements in that article. RK They’ve never been FDA approved, despite many years of research. The problem seems to be dosage.

Response:

Since I am long past needle phobia I will not participate in these changes in my time that is left. I have had several incidents in my life with new meds and methods that had very negative effects. My doc says that it is best to wait a while on any new item and see what works out. Lantus was my last early entry because of the acute insulin program I was on.  So far no problems there. Had to do some sorting of fact from fiction. Seems to me some drugs are approached with tunnel vision and sometimes have ignored side effects. One of the problems with private money drugs that if a problem is found it is a major loss to drop it, (unless the failure is gross).                                                 Guy. – Hide quoted text — Show quoted text – Dr. Biggs, What about those of us that are T1’s. You said about 5yrs we’ll see T2’s using it. Is it as beneficial as pumping? What about long term damage? How would dosing be adjusted? Like a squirt per unit? RK : Nico, : : IMHO, the reason we don’t see inhaled insulin on the market today is not : dosage, but the two related concerns. : : First, one patient (out of thousands tested) developed pulmonary fibrosis. : People can develop pulmonary fibrosis spontaneously, and this could be : coincindence. But this prompted a call for additional testing. : : Second, there is the issue of antibodies. The titer of insulin antibodies in : the blood is higher in inhaled insulin vs injected insulin. : : At the last ADA meetings in New Orleans, there was a symposium about these : issues.  The take home message was a) nobody else has had fibrosis  and b) : the antibodies don’t appear to be a manifestation of any harm. : : Once the additional testing is complete, if there are no additional cases of : fibrosis and if there are no new adverse effects noted, then the FDA should : approve this. : : As far as the dosing issue, it’s actually not as bad as you describe. In : fact, inhaled insulin has some of the best times to peak of any delivery : method, allowing the dose to be given during or just after a meal. It is : also cleared rapidly, reducing the hypo risk pre-meal. : : Assuming no new adverse effects on the clinical testing underway, I predict : that 5 years from now the majority of type 2’s converting to insulin will : use a basal insulin like glargine or detimir plus inhaled insulin. : : Cheers, : William C Biggs MD : : : : Thought the following might be of interest … : : : : Insulin puffers as effective as injections : : : : Trials with experimental insulin inhalers show they are as effective : : as injections – and that diabetics much prefer them, an analysis of : : existing studies has found. : : : : http://www.abc.net.au/science/news/stories/s909977.htm : : all I gotta say… "what a crock of crap!" : : I found several incorrect statements in that article. : : RK : : They’ve never been FDA approved, despite many years of research. The : problem seems to be dosage. : : :

Response:

Dr. Biggs, What about those of us that are T1’s. You said about 5yrs we’ll see T2’s using it. Is it as beneficial as pumping? What about long term damage? How would dosing be adjusted? Like a squirt per unit? RK : Nico, : : IMHO, the reason we don’t see inhaled insulin on the market today is not : dosage, but the two related concerns. : : First, one patient (out of thousands tested) developed pulmonary fibrosis. : People can develop pulmonary fibrosis spontaneously, and this could be : coincindence. But this prompted a call for additional testing. : : Second, there is the issue of antibodies. The titer of insulin antibodies in : the blood is higher in inhaled insulin vs injected insulin. : : At the last ADA meetings in New Orleans, there was a symposium about these : issues.  The take home message was a) nobody else has had fibrosis  and b) : the antibodies don’t appear to be a manifestation of any harm. : : Once the additional testing is complete, if there are no additional cases of : fibrosis and if there are no new adverse effects noted, then the FDA should : approve this. : : As far as the dosing issue, it’s actually not as bad as you describe. In : fact, inhaled insulin has some of the best times to peak of any delivery : method, allowing the dose to be given during or just after a meal. It is : also cleared rapidly, reducing the hypo risk pre-meal. : : Assuming no new adverse effects on the clinical testing underway, I predict : that 5 years from now the majority of type 2’s converting to insulin will : use a basal insulin like glargine or detimir plus inhaled insulin. : : Cheers, : William C Biggs MD : :

: : Thought the following might be of interest … : : : : Insulin puffers as effective as injections : : : : Trials with experimental insulin inhalers show they are as effective : : as injections – and that diabetics much prefer them, an analysis of : : existing studies has found. : : : : http://www.abc.net.au/science/news/stories/s909977.htm : : all I gotta say… "what a crock of crap!" : : I found several incorrect statements in that article. : : RK : : They’ve never been FDA approved, despite many years of research. The : problem seems to be dosage. : : :

Response:

Thought the following might be of interest … Insulin puffers as effective as injections Trials with experimental insulin inhalers show they are as effective as injections – and that diabetics much prefer them, an analysis of existing studies has found. http://www.abc.net.au/science/news/stories/s909977.htm

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