Inhaled Insulin: Is Afrezza Ready for Prime Time?

With David Kendall, MD

Technosphere human inhaled insulin, a type of ultra short-acting insulin, is intended for use in place of a mealtime bolus injection.1 When it is inhaled at the beginning of a meal, it works quickly to manage postprandial glucose levels, leading to better glucose control.

“Many individuals have become used to [receiving] insulin subcutaneous injections, and despite numerous advances in how insulin can be delivered under the skin, we know that delivery through the lung can provide almost immediate access to medications including insulin to the circulation,”2 David Kendall, MD, chief medical officer at MannKind Corporation, tells EndocrineWeb during the American Diabetes Association (ADA) 78th Scientific Sessions in Orlando, Florida.

Late Breaking Data Presented at the ADA Annual Meeting

Since experiencing hypoglycemia is the greatest fear for someone with diabetes, and even the worrying that it might happen is something that would be wonderful to escape.

As if in response, a team of researchers conducted a post hoc analysis of data from the AFFINITY-1 trial to evaluate the incidence and severity of hypoglycemic events experienced by diabetic patients, comparing those using Afrezza and others using Aspart.4

Patients experienced a 26% reduction in hypoglycemic events, particularly during the initial hours (2-5 hours) following meals when compared to patients using aspart,4 according to Lawrence Blonde, MD, director of the Diabetes Clinical Research Unit at Oschner Medical Center in New Orleans, Louisiana who presented the data at ADA.

What Is Different About Inhaled Insulin?

“One unique feature of using the lung as the delivery system is that it changes the time-action profile of insulin so that it actually approaches that of normal, physiological insulin,”3says Dr. Kendall.

“In fact, insulin that is inhaled through the Afrezza inhaler device is absorbed into the circulation within seconds and acts exceedingly quickly—within about 12 minutes—on the organs that control blood glucose,”3,5 he adds.

“Compare that to the timing for lispro (Humalog) insulin which takes up to 125 minutes to reach maximum effect, and to the fastest acting injectable insulin, Fiasp, which takes 30 minutes to be absorbed and two hours to reach the peak effect and then lingers for about 5-6 hours,”says Dr. Kendall.

"These differences in the time for injectable insulin to effect and how long it hangs around helps to explain the reason why so many people typically underdose their bolus insulin and struggle with good glucose control around mealtime needs," Dr. Kendall tells EndocrineWeb.

“This means that the way insulin acts on the liver, muscle, and fat cells is very much in a pattern that mimics that of the body’s normally released insulin. The result of this is rapid delivery, rapid absorption, and rapid clearance of insulin out of the system,” he explains.

“We believe [technosphere inhaled insulin] creates the opportunity to revolutionize how mealtime postprandial glucose can be controlled, and we are continuing to do studies to better understand both the safety but more importantly the dosing and effectiveness of using Afrezza for mealtime therapy,” says Dr. Kendall, “and we hope to establish that inhaled insulin will become one of the standards of care for mealtime glucose control in diabetes.”

A Closer Look at the Facts About Afrezza

Get better glucose control at meals without the need to inject your insulin.

Taken from the manufacturer's product label,1 you should be aware of the pros and cons of Afrezza to be fully informed. Of course, you will want to discuss with your diabetes provider whether this type of insulin may be a good choice for you.

Advantages:

  • Reduces the need for a mealtime injection, which can add up to at least 1,000 fewer needle sticks a year.
  • Makes it easier to receive “bolus” insulin whenever the mealtime occurs, which is helpful for unexpected or unanticipated changes to your schedule.

Disadvantages:

  •  Most common side effects are: hypoglycemia (drop in blood sugar), cough, and sore throat.
  • Possible side effects include low potassium, shortness of breath or lung spasms, edema, risk of diabetic ketoacidosis, and possible weight gain.
  • Not indicated for people with chronic lung conditions such as asthma, or chronic obstructive pulmonary disease (COPD), or lung cancer who are at risk for acute bronchospasm.
  • Should not be used if you are taking a thiazolidinedione (TZD).
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