And Now for Something Completely Different

Some things I remember very clearly. Like the moment the doctor told me that I had to take injections for the rest of my life. This news bothered me horribly. But what if he had told me I could inhale the insulin instead? I would have been on cloud nine.

Well, now we have it: In late January, the FDA approved the inhalable insulin Exubera (made by Pfizer, Inc.), and every newspaper in the country ran big headlines about the end of injections for diabetes. But as is always the case, there is more to it than that.

Inhalable insulin might be a boon for many type 2s who need to go on insulin but who are afraid of injections. But what about type 1 teens? I was 17 when I started on insulin. Exubera has been approved for type 1 adults but it has not yet been approved for children. Any doctor, however, will be able to prescribe it for kids if he or she wants to. Type 1s will still have to inject long-acting insulin every day anyway, so this new product will not eliminate injections entirely.

Will We Pay More to Inhale?

Exubera is expected to cost four times as much as insulin injections, according to BusinessWeek. Will insurance companies be willing to pay for it? Pfizer is hoping that insurers will compare the cost of Exubera to that of oral meds for type 2, because those pills are quite expensive. Even though diet and exercise remain the only known cures for type 2, pharmaceutical treatments for it have been reaping billions in profits in the past few years.

Patients with needle phobia will benefit from the advent of inhalable insulin, but there is currently no evidence that Exubera is better for your health than traditional insulin therapy.

We recently asked 165 of our insulin-using readers if they were planning to try the new inhalable insulin. Eighty percent of them told us no. You can read some of their comments in this month’s article (“Take a Deep Breath”).

Is Injecting All That Bad?

Now that we have the option of inhalable insulin, it begs the question: Is injecting insulin with a syringe really all that bad?

After I had been injecting insulin for a few weeks after my diagnosis, I realized it wasn’t so bad. The injections were actually the easy part! The hard parts were the low BGs and deciding how much insulin to take and when. After a while, injecting myself with a syringe became as routine as shaving or making scrambled eggs for breakfast.

As a diabetic, I applaud Pfizer and other companies for developing and introducing new products that make managing diabetes easier and more effective. But this much-anticipated product, as some experts point out in the article (“Take a Deep Breath”), is good news mainly for the needle-phobic type 2 with the financial means to afford it.

Scott King
Type 1, 31 years (and counting)

Please send me your comments and suggestions via e-mail through our Web site.

In July 2001, we reported that in one Exubera trial, one out of 1,000 patients who used it developed pulmonary fibrosis, a potentially fatal disease in which scar tissue replaces the air sacs in the lungs.

Pfizer had hoped to gain approval for Exubera that year, but more safety studies needed to be done.

At press time, Pfizer spokesperson Rebecca Hamm told me that since then, “An extensive evaluation was undertaken (chest X-rays of more than 1,000 patients over two years and High Resolution CT scans of 144 patients over two years) and no association of Exubera with pulmonary fibrosis was found. There was no change in the product.”

It is estimated that only 6 to 10 percent of the insulin released through the inhaler gets absorbed by the bloodstream, posing the question of what happens to the balance of the insulin.

Researcher William Cefalu, MD, in 2001, said “There may be some loss to the device, some loss to the upper airway or it could be broken down.”

We also reported in 2001 that patients who took a combination of injected and inhaled insulin produced more antibodies to the drug than patients who only injected insulin. Whether this is still a concern is unknown.

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