A BREATH OF INSULIN !

Will insulin injections soon be a thing of the past? Researchers say an inhaler device containing insulin in powder form is as effective as an insulin injection. That means people who need to take insulin before meals may soon be able to easily inhale it instead of giving themselves painful and inconvenient shots. When the insulin powder is put into the inhaler, it is transformed into a cloud of vapor. The diabetic person then inhales once or twice and the insulin travels into the lungs. From there it passes quickly into the bloodstream.

Inhaled insulin therapy is an option for type 1 diabetics and appears to be just as effective as insulin injections in controlling blood glucose levels, according to a report published in the February 3rd issue of The Lancet.

Dr. Jay S. Skyler, from the University of Miami, and colleagues assessed the efficacy of inhaled insulin therapy by randomizing 72 type 1 diabetic patients to receive preprandial inhaled insulin plus a bedtime ultralente injection or their usual insulin regimen of two to three injections per day.

The authors found no significant differences between the groups regarding changes in HbA1c, changes in fasting and postprandial glucose concentrations, and occurrence and severity of hypoglycemia. In addition, inhaled insulin appeared to be well tolerated and did not affect pulmonary function, the researchers note.

There is good news even for those with Type II diabetes who may require insulin. Inhaled insulin therapy is well tolerated in type 2 diabetic patients and achieves improved glycemic control with no adverse pulmonary effects, according to a report published in the February 6th issue of the Annals of Internal Medicine.

Dr. William T. Cefalu, from the University of Vermont College of Medicine in Burlington, and colleagues assessed the safety and efficacy of inhaled insulin therapy by evaluating the pulmonary function and glycemic control of 26 type 2 diabetic patients who received 3 months of preprandial inhaled insulin therapy plus bedtime ultralente injections. Patients performed home glucose monitoring and had weekly adjustments of their insulin dose to achieve a target preprandial glucose level of 100 to 160 mg%.

Glycemic control was significantly better after 3 months of therapy than at baseline, the authors state. There were no serious hypoglycemic events.

At the same time, one must add a word of caution. Dr. Edwin A. M. Gale, from the University of Bristol, in the UK, points out that inhaled insulin does not abolish the need for long-acting insulin injections and "it is also much too early to conclude that inhaled insulin is as good as conventional injections." Moreover, as Dr. David M. Nathan, from Massachusetts General Hospital in Boston, points out, "other studies of insulin therapy that have used only one or two daily injections, or have combined injections with oral hypoglycemic agents, have achieved substantially better hemoglobin A1c results and less frequent hypoglycemia than the study of Type II patients."

He, as well as others are concerned about the effect of high levels of insulin in the lungs. Insulin is a growth factor and may cause problems in the lungs. Would we be exchanging the benefits of not taking an insulin injection for some as yet unknown complication in diabetes? And using the inhaler, which contains short-acting insulin, doesn't completely eliminate the need for the shots. People with type 1 diabetes still need long-acting insulin, so they have to take an injection of it before going to bed.

Although Dr. Skyler agrees with many of these fears, he feels that having the inhaled insulin available as an option may make some people who dislike the idea of needles feel a little better about having to use insulin therapy. Anything which increases compliance needs to be explored. Of the people in the study who were offered the inhaler instead of their before-meal injections, 82% liked it so much they chose to continue using it after the study had ended.