II. Indications
- Bolus Insulin in Diabetes Mellitus when intollerant to SQ Injection
III. Contraindications
- COPD
- Asthma
- Chronic lung disease
- Lung Cancer
- Tobacco use
IV. Mechanism
V. Medications: Afrezza
- Background
- Released in 2014, as a Bolus Insulin (Short-Acting Insulin) substitute
- Does not replace Basal insulin (Long-Acting Insulin)
- Not approved for use in children
- Supplied
- Delivered in 4, 8 or 12 units/cartridge
- Convert Insulin unit for unit, and round dose up to nearest 4 unit cartridge
- Dosing: Insulin Naive
- Start: 4 units inhaled immediately before meals
- Dosing: Switching from Bolus Insulin (Short-Acting Insulin)
- Convert unit for unit of prior Bolus Insulin to Inhaled Insulin, rounding to nearest 4 units (4 to 24 units)
- Dosing: Switching from Pre-mixed Insulin (e.g. 70/30 or 50/50)
- Inhaled Dose: Divide 50% of total daily premixed Insulin equally over 3 meals
- Give Inhaled Insulin dose, rounding to nearest 4 units (4 to 24 units), immediately before meals
- Cost
- Twice the cost of Bolus Insulin
- Activity
- Onset of activity is similar to SC injected Bolus Insulin
- Duration is shorter than SC injected Bolus Insulin
VI. Medications: Exubera (off market as of 2007)
- Historical information only
- Off U.S. Market as of October 2007 (based on business decisions, not on recall)
- Dosing
- Preparations
- Starter: Inhaler/parts, 180 packs 1 mg, 90 packs 3 mg
- Refill 12: 90 packs 1 mg, 90 packs 3 mg (990 units)
- Refill 15: 180 packs 1 mg, 90 packs 3 mg (1260 units)
- Cost: Expensive (twice the cost of SQ Insulin)
- Starter: $190
- Refills: $140-180
VII. Efficacy
- Similar to SC Bolus Insulin
VIII. Safety
- Unknown safety in pregnancy
- Unknown safety in Lactation
IX. Adverse Effects: Exubera
- Hypoglycemia (esp. when used with Oral Hypoglycemics)
- Bronchospasm
- Cough (<5%)
- Chest Pain (<5%)
- Dyspnea (<5%)
- Dry Mouth (<5%)
X. Monitoring: Pulmonary Function Tests
- Schedule: Baseline, 6 months and annually
- Stop Inhaled Insulin if FEV1 with >20% decline from baseline