Monday Medical: Diabetes treatment breakthrough

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Inhaled insulin, a breakthrough in diabetes treatment, will be hitting the pharmacy shelves soon. Inhaled insulin, or Exubera (manufactured by Pfizer, Inc.), is a powder form of insulin, which is delivered by an inhaler device that is made specifically for this type of insulin. Exubera is taken prior to meals, in order to manage blood glucose levels during and after meals.

How does it work?

Exubera comes in "blister packs" in doses of 1 mg or 3 mg. Patients will work with their health care providers to determine the appropriate dose. The blister is inserted into the inhaler device and pierced so that a "cloud" of insulin enters the inhaler's chamber. Patients inhale the insulin cloud and the insulin enters their system through the lungs.

Inhaled insulin is taken 10 minutes before meals and starts working in 10 to 15 minutes. It is similar to rapid-acting insulin (Humalog, Novolog or Apridra), in that it starts working quickly and its peak effect occurs about 30 to 90 minutes after it is inhaled.

The effects of Exubera last longer, however, and therefore its duration of action is more similar to regular insulin (Humulin R or Novolin R). This means that Exubera can help manage blood glucose levels during and between meals.

How is it stored?

Exubera should not be stored in the refrigerator. It should be kept at room temperature in a dry place. It should not be allowed to get too hot or freeze, and should be kept away from extreme humidity.

Who can use it?

Exubera is a new diabetes management option for people ages 18 years and older who have type 1 or type 2 diabetes. It can be used in combination with a long-acting insulin such as Lantus or Levemir.

Because type 2 diabetes is a progressive disease, over time a large percentage of people with type 2 diabetes require insulin. Unfortunately, and for a variety of reasons, many people who need to take insulin wait several years to start. Some people believe that insulin causes the complications of diabetes, when in reality it is a failure to take insulin (if it is needed) that causes problems.

Who cannot use it?

People who smoke or who have quit smoking within the past six months cannot use Exubera. Neither can people who have unstable or poorly controlled lung disease.

Before starting Exubera, patients will be given a lung function test, which is repeated after six months and yearly after that. The lung function test is one that can be done at Yampa Valley Medical Center or in most physicians' offices.

When will it be available?

Exubera is due on pharmacy shelves in September. Talk to your health care provider if you think you are a good candidate for this medication.

Jane K. Dickinson, RN, PhD, CDE, is the Diabetes Education Program Director at Yampa Valley Medical Center.

Call Yampa Valley Medical Center's Diabetes Education Program at 871-2352 for more information about Exubera or any aspect of diabetes management. The Community Health Resource Center, a free lending library at YVMC, provides materials and internet searches on diabetes and other health issues and can be reached at 870-1173.

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