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Insulin Inhaler

L

livqrm

New Member
Relationship to Diabetes
Type 1
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I'm very new here, in fact the only reason I created this account was for this very post (but I'm finding a lot more cool perks about this) so forgive me but...
Yep, it exists. I don't know if this is a new thing for you, but I've certainly never heard of it before, so imagine my shock when I'm doom scrolling on instagram and see someone pull out an inhaler for their insulin! I'm like... am I seeing this right?! So I do some research, and I found that it is indeed a real thing - a type of insulin brand called Afrezza. An actual insulin inhaler. No needles, no cartridges, no pumps or catheters, no need to inject! This is pretty cool!
Knowing my luck, its obviously not on the NHS, nor is it even approved by NICE due to I think marketing issues. It was however FDA approved back in 2014 and currently still used in the USA.
Please, feel free to do your own research. I have looked on the official Afrezza website, the NICE website, and diabetes uk even have an article about it dated back 26/06/2024.
But I need help. I want this inhaler, and I want it bad! I'm 23, I've been T1 diabetic for 10 years, and I am sick of having bruises, lumps and painful injection marks all over my stomach and legs. I work in a GP surgery, and our head diabetic nurse was quite interested once I told her about it - she also had not heard about it before. One of our partners here is also a big overseer for the local area, and I didn't know but even has links to the secretary of health (!) This inhaler has good results, and I want to see what we can do to bring it here to the UK. I'm going to try and get my surgery on board, and see what we can do. I also want to message people, maybe NICE, maybe anyone else to get some more information or research about this. If anyone has any ideas about who I should speak to regarding this, or any other ideas, please let me know! Also, let me know if you're actually interested in this, and I can keep you all updated!
 
livqrm said:
I'm very new here, in fact the only reason I created this account was for this very post (but I'm finding a lot more cool perks about this) so forgive me but...
Yep, it exists. I don't know if this is a new thing for you, but I've certainly never heard of it before, so imagine my shock when I'm doom scrolling on instagram and see someone pull out an inhaler for their insulin! I'm like... am I seeing this right?! So I do some research, and I found that it is indeed a real thing - a type of insulin brand called Afrezza. An actual insulin inhaler. No needles, no cartridges, no pumps or catheters, no need to inject! This is pretty cool!
Knowing my luck, its obviously not on the NHS, nor is it even approved by NICE due to I think marketing issues. It was however FDA approved back in 2014 and currently still used in the USA.
Please, feel free to do your own research. I have looked on the official Afrezza website, the NICE website, and diabetes uk even have an article about it dated back 26/06/2024.
But I need help. I want this inhaler, and I want it bad! I'm 23, I've been T1 diabetic for 10 years, and I am sick of having bruises, lumps and painful injection marks all over my stomach and legs. I work in a GP surgery, and our head diabetic nurse was quite interested once I told her about it - she also had not heard about it before. One of our partners here is also a big overseer for the local area, and I didn't know but even has links to the secretary of health (!) This inhaler has good results, and I want to see what we can do to bring it here to the UK. I'm going to try and get my surgery on board, and see what we can do. I also want to message people, maybe NICE, maybe anyone else to get some more information or research about this. If anyone has any ideas about who I should speak to regarding this, or any other ideas, please let me know! Also, let me know if you're actually interested in this, and I can keep you all updated!
Click to expand...
If you type Afrezza into the search box, top tight of the screen (click the magnifying glass symbol and a drop down box appears) you’ll see there are lots of threads about it, a couple of useful ones from 2022 discussing pros and cons, and availability (or why it isn’t available).
One note of caution on the 'no more needles', it is only a very fast acting insulin, so you still need to inject a basal.
 
livqrm said:
But I need help. I want this inhaler, and I want it bad! I'm 23, I've been T1 diabetic for 10 years, and I am sick of having bruises, lumps and painful injection marks all over my stomach and legs.
Click to expand...
I suggest your best bet may be to be persistent about a pump. Some people seem to get more bruising from injections than others and you may just be one of those people and a pump may well work better for you. (Obviously try other needles too, maybe other insulins.) Regardless, keep complaining about the bruising and things because that matters (and not all of us have that).

I don't think Afrezza has MHRA approval so I think your chances of getting it any time soon are pretty low. (As @Robin notes, you'd still need need a basal.)
 
I admire your enthusiasm to change things and provide more choice for people needing insulin but It wouldn't interest me personally.
I don't really have enough of an issue with injecting to make an inhaler appealing and as someone who has used inhalers in the past for asthma, I don't find it an attractive option. I also consider my lungs as very much essential to life whereas a few bruises or lumps on my skin is not a big deal. My concern would be for that insulin and whatever carrier is required to take it into your lungs, to have some unseen long term effect and I am afraid I don't trust pharmaceutical companies enough to be confident of that. My Dad died of an acute asthma attack and I was with him and unable to save him, so I am perhaps more wary of compromising the lungs than the average person may be.
 
I presume that you have read the NICE July 2014 paper on Afrezza?

If inhaled insulin solved all known problems, then most diabetic persons in the US who currently inject insulin would have moved across to it.
That this has not happened over the past eleven years, and that you (and your surgery's diabetic nurse) have only just become aware of it, might indicate that it was an idea whose time came, and went.

One major problem is that inhaled insulin does not easily pass through the lungs to the blood stream, and one would need to inhale much more insulin to have the same effect as that which you currently inject. (I forget what the multiple was - it was a long time ago - but it could have been at least five times...)
Hence I agree strongly with @rebrascora 's views above.

I would suggest that the "once a week" insulin injection news (currently targetted at type 2s) sounds rather more promising...
 
I know one person in the US who uses Afrezza.
She uses it in combination with her pump as an ultra fast insulin when her BG creeps too high.

Before I started pumping, I would get a lot of bruises (although lumps and pain were very rare and would ease over a few hours). Unfortunately, my DSN was not very sympathetic - "you are obviously one of those people who bruise easily". Gee, thanks!
I found single use of the needle was very important - if I tried reusing it, I would definitely bruise - and some needle brands were gentler on me than others so that is certainly something to check out.
But eventually, it was having a pump that made the difference and it is available now.

There are other benefits of pumping such as the ability to dose very small amounts and change the basal every half hour or suspend it completely.

John Gray said:
I would suggest that the "once a week" insulin injection news (currently targetted at type 2s) sounds rather more promising...
Click to expand...
Any way to reduce the number of times you inject (such as using a twice daily mixed insulin or one a week basal) would be far too restrictive for most people with Type 1 who, unlike someone with type 2, has no insulin to "fill in the variations".
 
ISTR (but have to remember I'm old 🙂 ) that in the UK it was only ever used in cases of Diabetes Insipidus. I've never had that, it's always been D. Mellitus.
 
trophywench said:
ISTR (but have to remember I'm old 🙂 ) that in the UK it was only ever used in cases of Diabetes Insipidus. I've never had that, it's always been D. Mellitus.
Click to expand...
Diabetes Insipidus doesn't involve elevated BG levels or insulin, so I think you may have misremembered.
 
Yes there was a LOT of discussion about Afrezza some years ago. The marketers pushed very hard, and posts were often joined by new accounts with very florid language and wild claims for how amazing it was. I seem to remember that is was adopted temporarily by a major Pharma player (Sanofi?), but then dropped again, and became almost more of a crowd-funded type thing. I think lung problems were pretty common with it.

Commentary: Why Was Inhaled Insulin a Failure in the Market? - PMC

pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov
 
everydayupsanddowns said:
Yes there was a LOT of discussion about Afrezza some years ago. The marketers pushed very hard, and posts were often joined by new accounts with very florid language and wild claims for how amazing it was. I seem to remember that is was adopted temporarily by a major Pharma player (Sanofi?), but then dropped again, and became almost more of a crowd-funded type thing. I think lung problems were pretty common with it.

Commentary: Why Was Inhaled Insulin a Failure in the Market? - PMC

pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov
Click to expand...
Thanks for sharing that report. It is an interesting read.
One thing that jumped out is, while I enjoy the ability to dose 0.05 units on my pump, the smallest dose from Afrezza is 4 units! That would be a pretty carby meal for me.
 
helli said:
One thing that jumped out is, while I enjoy the ability to dose 0.05 units on my pump, the smallest dose from Afrezza is 4 units! That would be a pretty carby meal for me.
Click to expand...
The point I made in my earlier post was that one had to breathe in a considerably greater amount of insulin than you would have injected, because only a small proportion of the breathed-in insulin made it through to the bloodstream...
 
John Gray said:
The point I made in my earlier post was that one had to breathe in a considerably greater amount of insulin than you would have injected, because only a small proportion of the breathed-in insulin made it through to the bloodstream...
Click to expand...
I would assume that is "calibrated" in some way so that 4 "units" of Afrezza has the same impact as 4 units of injected insulin.
It is not reasonable to expect the patient to do that calculation and the report shared above would discuss it.
 
helli said:
I would assume that is "calibrated" in some way so that 4 "units" of Afrezza has the same impact as 4 units of injected insulin.
It is not reasonable to expect the patient to do that calculation and the report shared above would discuss it.
Click to expand...
There you have me! I didn't find anything about this is that report, on a quick scan.
I could counter-speculate that if the patient was new to Afrezza they would have to determine, from scratch, for their own body, how much Afrezza to inhale to achieve the desired blood glucose reduction effect, regardless of any previous insulin-injecting experience.
 
helli said:
I would assume that is "calibrated" in some way so that 4 "units" of Afrezza has the same impact as 4 units of injected insulin.
It is not reasonable to expect the patient to do that calculation and the report shared above would discuss it.
Click to expand...
If I remember correctly the accounts of it were that it behaved so differently that it wasn't sensible to try to compare doses between injected and inhaled insulins, so I'm not at all sure they intend the units to be comparable.
 
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