Inhaled insulin: a clinical perspective with emphasis on EXUBERA.

There is a Type 2 diabetes epidemic; however, unfortunately, even though insulin is an effective therapy, it is mostly used late and as a last resort. Type 1 diabetics find it difficult to administer extra insulin injections when needed owing to the inconvenience and, although most cope well, many dislike injecting themselves so frequently. The newly approved EXUBERA inhaled insulin should help counteract the resistance of patients and physicians in instituting insulin in the Type 2 diabetic, and the Type 1 diabetic can take more than 1000 fewer injections per year, making their diabetes easier to live with. Pulmonary function tests have demonstrated clinically insignificant changes after years of monitoring. The increases of insulin antibodies found in those who use inhaled insulin have not affected diabetes control. Side effects of inhaled insulin are insignificantly different from injectable insulin except for a couple of mild coughs after an inhalation, which decrease quickly with time. The two dosage forms of EXUBERA insulin are 1 and 3 mg (equivalent to approximately 3 and 8 U of U-100 insulin, respectively), are adaptable to most regimens for both types of diabetes, and inhaled insulin is preferred by a significant majority of patients. Inhaled insulin should be cost effective if it allows earlier institution in the Type 2 diabetic thus improving diabetic control and lowering the expensive complications of diabetes.