Inhaled Insulin

For those who take insulin or for those whose healthcare provider has suggested that taking insulin may be necessary at some point in the future, the approval by the FDA of inhaled insulin seems very positive. If you have type 1 diabetes, you may be able to use inhaled insulin in place of meal-time injections of rapid-acting insulin, but you will still need to take injections of long-acting insulin or basal (background) insulin. If you have type 2 diabetes, you may be able to use inhaled insulin as an alternative to diabetes pills or meal-time injections or you may be able to take it in combination with diabetes pills or longer-acting injectable insulin.  

What is it? How does it work?

Inhaled insulin is a dry powder that comes in small foil packages called blisters. These blisters are loaded into a special device — the inhaler. The insulin in inhaled insulin is a rapid-acting or “bolus” insulin, so it is very important to make sure you eat within 10 minutes after taking it. It works hardest about 2 hours after you take it, but it can keep working for up to 6 hours.

Whether you have type 1 or type 2 diabetes, if you use inhaled insulin you still need to check your blood glucose regularly.

Helpful Hints

• Write the date you first use the inhaler at the bottom of the handle. This will remind you to replace it in one year.
• Stand or sit. Do not use while lying down.
• If you take more than one blister for any dose, insert only one pack at a time.
• Once you release the cloud of insulin, you must inhale the insulin right away. Don't set the inhaler aside to take it later.
• After you inhale, hold your breath for 5 seconds.
• Do not use if you smoke, even occasionally. Do not use if you've smoked within the last 6 months.
• If you get a cold or feel sick, you'll need to check your blood glucose more often. Call your provider.

Is inhaled insulin safe for anyone to use?

Inhaled insulin is approved for use by adults with type 1 or type 2 diabetes who have no history of lung problems. Before starting this medicine, you will need to have a “pulmonary function test” to measure how well your lungs are working. This test will be repeated 6 months after you start using inhaled insulin and then once a year after that to make sure your lungs are staying strong and healthy. You can not use it if you smoke or if you have smoked within the last 6 months.

Are there any risks to using inhaled insulin?

Insulin works very well to lower blood glucose. However, like injectable insulin, inhaled insulin can also bring blood glucose levels too low if you do not eat enough, if your insulin dose is too high or if you take too much, or have too much or unplanned activity. It is important to know how to treat a low blood glucose level and to check your blood glucose often using a blood glucose meter to see how the insulin is working. Write the numbers down in a log book and discuss them with your provider if they are not in your target range. Your provider may suggest the dose be changed. Have a low blood glucose action plan and keep carbohydrate or sugar treatments at home, work and in the car in case your glucose goes too low.

Other possible side effects include low blood glucose, dry mouth, chest discomfort and decreased lung capacity. You will need to make sure you have the lung function tests ordered by your provider.

Talk with your healthcare provider about whether inhaled insulin might be appropriate for you.

What should I do if I forget to take a dose?

If you forget to take it before your meal but remember while you are eating, you can take it within a few minutes of finishing your meal. However, if more time has passed, it is best to just skip that dose and continue with your next dose at your next meal as usual. Don't double up at the next does. If you check your blood glucose before the next meal, you  may notice it is higher than usual. You might find it helpful to get an extra inhaler to keep at work or as a back-up in case you forget it somewhere.

How do I care for my inhaler and insulin?

Clean your inhaler at least once a week. Wash the chamber and mouthpiece using mild soap and a soft cloth. Wipe the basin, but keep it away from water.

• Keep the inhaler and insulin blisters at room temperature in a dry place away from excess moisture. Keep them away from humid places such as a bathroom. Do not refrigerate.
• Replace the insulin release unit every 2 weeks. Replace the entire inhaler every 12 months.

Additional Action Plan:

• Have a low blood glucose treatment plan: If my blood glucose falls below 70 (or ______), I will take 15 grams of carbohydrate such as 1/2 cup juice or non-diet soda or 3-4 glucose tablets. What I'll use:______ Where I'll keep it:______
• Ask your provider for information on "Sick Days", "Low Blood Glucose", "Monitoring Blood Glucose" and "Meal Planning" if you are not sure what to do.