Insulin helps control high blood glucose levels, but many people are reluctant to start insulin therapy because of the need for injections.
A new form of insulin that can be inhaled has been on the market for about a year. Although the Food and Drug Administration has approved inhaled insulin, little is known about the long-term safety and effectiveness of drugs that are inhaled.
What if there was a way to deliver insulin in a slow and steady trickle all day like a real pancreas does? That's the idea behind electronic insulin pumps. These wearable devices hold a one- or two-day supply of short-acting insulin that's dispensed continuously for basal coverage while providing a preprogrammed spurt of insulin at the touch of a button before meals. Pumps allow close control of blood sugar without the need for a lot of injections. Every two or three days, you need to change the site of the catheter that connects the pump to your body, which involves inserting a small needle just under the skin.
Automatic insulin pumps would seem ideal for children, but doctors tend to worry that kids aren't responsible enough to do extra blood testing and carefully program their doses to match their meals. Yet a 2002 study at Strong Children's Hospital, in Rochester, New York, found that, with only a couple of exceptions, 53 children under age 13 were safely able to achieve better glucose control with less hypoglycemia using pumps than they did with injections.
Insulin pumps are becoming more and more popular among people with type 1 diabetes (for whom they're mainly intended) because the instant adjustments allow a great deal of flexibility, they provide excellent glucose control, and their precise delivery often lets you use less insulin than with injections. What's more, new water-resistant pumps can be worn almost anytime, anywhere -- even when swimming. Pumps can also be quickly disconnected for, say, sexual activity. Fail-safe controls keep the unit from giving you an insulin overdose, beep if flow shuts down due to a clog, and signal when the batteries are running low.
For all their advantages, though, pumps aren't perfect. For one thing, they're pricey, costing between $4,000 and $6,000, and insurance doesn't always pick up the full tab. Some doctors are finding that the long-acting insulins glargine and detemir, with their rapid onset and steady action, can control basal glucose almost as well as a pump, at less cost. Problems like clogs and infections at the injection site can sometimes interfere with your insulin delivery, although patient education and practice can minimize these problems -- as can more frequent self-monitoring with blood tests, which you'll find are still necessary. Talk to your doctor to determine whether or not an insulin pump is a good idea for you.
Insulin infusers. Infusers are like an insulin pump -- without the pump. What's left is a catheter that remains in place at the injection site (usually the abdomen). You still need a needle to insert the catheter, but once the catheter's in place, you can leave it there for two or three days and administer insulin with a syringe through a self-sealing port. As with pumps, infections develop more easily at the injection site with this method, so you'll have to be diligent about keeping paraphernalia sterile, especially when you insert the catheter.
Pen injectors. These devices don't eliminate needles, but they make injections more convenient by prepacking the insulin, needle, and syringe into one small unit that looks like a fountain pen. In this case, the "ink" cartridge is a vial that contains insulin, which you inject using a needle at the pen's tip. When it's time to take your shot, you uncap the pen, choose your dose by turning a dial, then press a button to inject the insulin. The nondisposable pens generally cost $40 to $60.
Jet injectors. If you don't want to use needles at all, you might try a jet injector. These devices use a powerful burst of air to shoot a fine spray of insulin directly into your skin. Jet injections are not entirely pain-free: You'll feel a nip from the pressurized blast, and some people find that the jets cause bruising. But they can be a good option for children or anybody who'd rather not stick themselves with needles. Like pen injectors, jets can carry multiple doses at a time, and you can choose the amount of insulin you want by turning a dial. Jet injectors cost around $1,000, so price may be a barrier. Some units require thorough cleaning every two weeks by taking the unit apart and boiling the components or using germ-killing cleaners. If you're considering a jet injector, ask your doctor if you can arrange to test one before buying
The researchers wanted to examine a number of studies of inhaled insulin in order to get a more complete and reliable picture of the safety and effectiveness of inhaled insulin.
The studies included 4,023 adults who had type 1 or type 2 diabetes.
The medical literature and other databases were searched to find all randomized clinical studies of inhaled insulin that lasted at least 12 weeks. Sixteen studies were found. Two reviewers examined each study.
Injectable insulin reduced A1C (a long-term measure of blood glucose control) slightly better than inhaled insulin, but equal numbers of people on the inhaled and injectable formulations reached the A1C level of 7% recommended by the American Diabetes Association. People who inhaled insulin were more likely to have low blood glucose levels than those taking oral diabetes medication, but about the same as those who took injectable insulin. In general, people preferred inhaled insulin to injectable insulin.
The 12-week follow-up period may not be long enough to assess long-term safety of inhaled insulin. There could be subtle differences in the studies included in this project that affect the outcomes.
Inhaled insulin is a safe and effective alternative to injectable insulin for many people with diabetes. Longer-term studies are needed to see whether inhaled insulin remains safe if taken over a period of years
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