What are the uses and dosages of inhaled insulin and can it be an alternative to injections

Inhaled insulin is considered one of the modern treatment options that can help control blood glucose levels without the need for injections for mealtime insulin doses. It is characterized by ease of use and rapid absorption into the bloodstream, making it an interesting option for some people with diabetes.But can inhaled insulin completely replace insulin injections? In which cases is it used, and what are the appropriate doses? In this article on Dalili Medical, we explore the uses of inhaled insulin, how to use it and determine its dosage, its main benefits and side effects, and when it may be used as an alternative to injected mealtime insulin.

What Is Inhaled Insulin?

Inhaled insulin is a type of rapid-acting insulin that is administered by inhaling powdered insulin into the lungs using a specialized inhaler device. It is primarily used to help control increases in blood glucose levels associated with eating and is therefore generally taken around mealtimes.

Can Inhaled Insulin Replace Insulin Injections?

Inhaled insulin cannot replace insulin injections in all cases. People with type 1 diabetes need to receive the insulin their body requires through basal insulin, whether long-acting insulin or another appropriate treatment method. Inhaled insulin may then be used to cover mealtime insulin requirements.

For people with type 2 diabetes, inhaled insulin may be an appropriate treatment option for some patients, depending on their health status, blood glucose levels, and the treatment plan determined by their healthcare provider.

Is Inhaled Insulin Rapid-Acting?

Yes. Inhaled insulin is classified as a rapid-acting form of insulin and is characterized by a relatively rapid onset of action. It is therefore used to help control blood glucose elevations associated with meals.

Can Inhaled Insulin Be Used Instead of Rapid-Acting Injected Insulin?

Inhaled insulin may be an appropriate alternative to injected rapid-acting insulin for some patients, particularly for covering insulin requirements during meals. However, patients should not make this substitution on their own. The dosage and absorption of insulin can differ between inhaled and injected formulations, so a healthcare provider should determine the appropriate dose and treatment plan based on the patient's individual condition.

Is Inhaled Insulin Suitable for Children?

The use of inhaled insulin in children and adolescents depends on factors such as age, type of diabetes, overall health, and the specific product being used, as well as its approval by the relevant health authorities in the country. Therefore, inhaled insulin should only be used in children or adolescents under medical supervision and according to the approved instructions for the specific product.

Who May Not Be Suitable for Inhaled Insulin?

Inhaled insulin may not be suitable for people with certain lung conditions, such as asthma and chronic obstructive pulmonary disease (COPD), because of its potential effects on respiratory function. People who currently smoke or have recently stopped smoking should also inform their healthcare provider and undergo the necessary evaluation before starting treatment.

Does the Patient Need a Lung Function Test Before Using Inhaled Insulin?

Yes. A healthcare provider may recommend a lung function test before starting treatment with inhaled insulin to determine whether it is appropriate for the patient's respiratory health. The provider may also recommend monitoring lung function during treatment, depending on the patient's condition and the instructions for the specific product being used.

Can Inhaled Insulin Cause Low Blood Sugar?

Yes. Like other forms of insulin, inhaled insulin can cause low blood glucose levels (hypoglycemia). The risk may increase when a dose exceeds the body's needs or when the patient does not consume enough food. Therefore, it is important to follow the prescribed dose and monitor blood glucose levels regularly.

Does Inhaled Insulin Cause Weight Gain?

Insulin therapy may be associated with weight gain in some people. However, the extent of weight change varies from person to person and may be influenced by several factors, including the insulin dose, diet, physical activity, and other medications used to manage diabetes. Weight and blood glucose levels should therefore be monitored with the healthcare provider during treatment.

Can Inhaled Insulin Be Used During a Cold?

If a person develops a cold accompanied by coughing or other respiratory symptoms, they should inform their healthcare provider before using or continuing inhaled insulin, as certain respiratory conditions may affect whether the treatment is appropriate. Patients should not adjust their insulin dose or stop treatment on their own. Instead, they should consult their healthcare provider to determine the appropriate course of action.

Is Inhaled Insulin Suitable for People with Asthma?

Inhaled insulin is generally not recommended for people with asthma because of its potential effects on lung function and the increased risk of bronchospasm. People with asthma should therefore discuss alternative treatment options with their healthcare provider.

Can Inhaled Insulin Be Used with Other Diabetes Medications?

Yes. Inhaled insulin may be used as part of a treatment plan that includes other diabetes medications. However, the appropriate medications depend on the type of diabetes, blood glucose levels, overall health, and other medications the patient is taking. A healthcare provider should determine the appropriate treatment regimen and dosage for each individual case.

Can Inhaled Insulin Be Stopped Suddenly?

Inhaled insulin should not be discontinued or its dose changed without consulting a healthcare provider. This is particularly important for people with type 1 diabetes, who require continuous insulin to meet the body's basic needs. If inhaled insulin needs to be discontinued, the healthcare provider should determine the appropriate alternative treatment.

Is Inhaled Insulin Better Than Injected Insulin?

Inhaled insulin cannot be considered better than injected insulin for everyone, as each option has its own advantages and limitations. One of the main benefits of inhaled insulin is that it provides a non-injectable way to administer rapid-acting mealtime insulin. However, it may not be suitable for certain people, particularly those with certain lung conditions.

The most appropriate treatment depends on the type of diabetes, overall health, blood glucose control, individual treatment needs, and patient preferences.

Is Inhaled Insulin Available in All Countries?

Inhaled insulin is not necessarily available in every country, and approved products and access may vary from one country to another. Therefore, patients should check whether the specific product is available and approved by the relevant health authorities in their country or ask their healthcare provider or pharmacist about the available options.

How Long Should Inhaled Insulin Be Used?

There is no fixed duration for using inhaled insulin. The length of treatment varies from person to person depending on the type of diabetes, the body's insulin requirements, blood glucose levels, response to treatment, and the treatment plan established by the healthcare provider.

1. Inhaled Insulin for Type 1 Diabetes

People with type 1 diabetes require insulin continuously because their bodies do not produce enough insulin. Inhaled insulin may be used to cover mealtime insulin requirements, while patients generally need another source of basal insulin to meet their body's ongoing insulin needs.

Therefore, inhaled insulin or basal insulin should not be discontinued or have their doses changed without consulting a healthcare provider.

2. Inhaled Insulin for Type 2 Diabetes

The use of inhaled insulin in people with type 2 diabetes may vary depending on their response to treatment and how well their blood glucose levels are controlled. A healthcare provider may recommend continuing treatment, adjusting the treatment plan, or switching to another option based on changes in the patient's needs.

3. Can Inhaled Insulin Be Stopped When Blood Glucose Levels Improve?

Inhaled insulin should not be stopped simply because blood glucose readings have improved, as this improvement may be the result of effective treatment. Stopping insulin without medical supervision may cause blood glucose levels to rise.

If the healthcare provider determines that the patient no longer needs inhaled insulin or that another treatment option would be more appropriate, they can determine the safest way to adjust or replace the treatment.

4. How Does a Healthcare Provider Determine Whether Treatment Should Be Continued?

A healthcare provider considers several factors when evaluating the need to continue inhaled insulin, including:

• Regular blood glucose readings.

• Hemoglobin A1c (HbA1c) levels.

• The frequency of high or low blood glucose levels.

• The patient's response to the prescribed doses.

• Other medications the patient is taking.

• Any changes in health status or lifestyle.

• Whether blood glucose targets are being achieved.

5. Is Inhaled Insulin a Temporary Treatment?

Not necessarily. Inhaled insulin may be part of an ongoing treatment plan for some patients, while others may need their treatment changed over time because of changes in their health or insulin requirements.

Therefore, the duration of inhaled insulin treatment varies from person to person. A healthcare provider determines how long treatment should continue based on regular follow-up and the patient's response to therapy.

How Does Inhaled Insulin Work?

Inhaled insulin is a rapid-acting form of insulin administered as a powder that is inhaled into the lungs using a specialized inhaler device. Once it reaches the lungs, the insulin is absorbed into the bloodstream and works in a similar way to naturally produced insulin by helping regulate blood glucose levels.

1. Inhaling the Insulin Dose

The inhaler contains a specific dose of powdered insulin. When the device is used correctly, the insulin powder reaches the lungs, which have a large surface area that facilitates absorption of the medication into the bloodstream.

2. Movement of Insulin From the Lungs Into the Bloodstream

After reaching the lungs, the insulin is absorbed into the bloodstream relatively quickly. This contributes to the rapid onset of action of inhaled insulin compared with some other forms of insulin.

3. Binding of Insulin to Its Receptors

Once insulin enters the bloodstream, it travels to different tissues throughout the body and binds to insulin receptors located on the surface of cells. This activates a series of signals inside the cells that help them use glucose from the bloodstream.

4. Increasing Glucose Uptake Into Cells

Insulin helps increase glucose uptake, particularly in muscle and fat cells, allowing glucose to be used for energy or stored for later use.

In this way, inhaled insulin helps lower elevated blood glucose levels, particularly after meals.

5. Reducing Glucose Production by the Liver

Insulin does not only increase glucose uptake by cells. It also helps reduce the liver's production and release of glucose into the bloodstream when the body does not need additional glucose.

This contributes to maintaining more stable blood glucose levels.

6. Why Is Inhaled Insulin Used With Meals?

After eating, carbohydrates are broken down into glucose, which causes blood glucose levels to rise. When the body does not produce enough insulin, it may not be able to manage this increase effectively.

Therefore, inhaled insulin is used as a rapid-acting mealtime insulin to cover the body's insulin requirements associated with meals and help control the rise in blood glucose that occurs after eating.

7. What Happens After Its Effect Wears Off?

Inhaled insulin has a relatively rapid onset of action and a relatively short duration of effect. Therefore, it does not provide the basal insulin that the body needs throughout the day.

When continuous basal insulin is required, the patient may need another form of basal insulin, such as long-acting insulin, in addition to inhaled insulin to cover mealtime requirements, according to the treatment plan established by the healthcare provider.

What Are the Benefits of Inhaled Insulin?

Inhaled insulin is a rapid-acting form of insulin administered as a powder that is inhaled into the lungs using a specialized device and then absorbed into the bloodstream. It is primarily used to help control meal-related increases in blood glucose levels in some people with diabetes.

1. Rapid Onset of Action

One of the main advantages of inhaled insulin is its rapid absorption through the lungs, which allows it to begin working relatively quickly. This makes it useful for controlling blood glucose elevations associated with eating.

2. Helps Control Blood Glucose After Meals

Rapid-acting insulin helps manage the expected rise in blood glucose levels after meals. Therefore, inhaled insulin may be an appropriate option for some patients who require mealtime insulin doses.

3. Reduces the Number of Mealtime Insulin Injections

For patients who require rapid-acting insulin before meals, inhaled insulin provides a non-injectable way to receive their mealtime insulin dose, which may reduce the need for frequent injections.

4. Provides a Non-Injectable Option for Some Patients

Some patients may find using an inhaler more comfortable than receiving frequent injections, particularly those who experience discomfort or anxiety around needles. In this way, inhaled insulin provides an alternative method of administering rapid-acting insulin.

5. Relatively Rapid Onset and Shorter Duration of Action

Inhaled insulin has a rapid onset of action and a relatively shorter duration of effect, making it suitable for covering mealtime insulin requirements in patients for whom it has been prescribed.

6. Provides Greater Flexibility in the Treatment Plan

Inhaled insulin may give healthcare providers an additional option when developing a diabetes treatment plan, allowing the method of insulin administration to be selected according to the patient's needs, health status, and response to treatment.

7. May Be Suitable for People Who Have Difficulty With Injections

Some patients may find frequent injections difficult or may feel uncomfortable using needles. When medically appropriate, inhaled insulin can provide these patients with a non-injectable option for receiving rapid-acting insulin.

8. Does Not Mean That All Types of Insulin Can Be Discontinued

It is important to emphasize that inhaled insulin does not replace all forms of insulin. In some cases, patients require basal insulin to meet the body's basic insulin needs throughout the day, while inhaled insulin is used to cover mealtime requirements, according to the treatment plan established by the healthcare provider.

What Is Inhaled Insulin Used For?

Inhaled insulin is a rapid-acting form of insulin used to help lower elevated blood glucose levels. It is administered as a powder that is inhaled into the lungs using a specialized device rather than being injected under the skin.

Main Uses of Inhaled Insulin

Controlling Meal-Related Blood Glucose Elevations

Inhaled insulin is primarily used to cover the body's insulin requirements during meals and help control the rise in blood glucose levels that occurs after eating.

Treating Type 1 Diabetes

Inhaled insulin may be part of an insulin treatment plan for some people with type 1 diabetes to cover mealtime insulin requirements. However, patients generally need a source of basal insulin to meet the body's ongoing insulin needs between meals and overnight, according to the treatment plan established by their healthcare provider.

Treating Type 2 Diabetes

Inhaled insulin may be used in some people with type 2 diabetes when other treatments do not provide adequate blood glucose control and the healthcare provider determines that adding rapid-acting insulin to the treatment plan is appropriate for the patient's condition.

Providing a Non-Injectable Option for Rapid-Acting Insulin

Inhaled insulin may provide a non-injectable option for some patients who require mealtime insulin. It may be particularly suitable for people who wish to reduce their reliance on frequent injections, provided there are no contraindications to its use.

Helping Control Blood Glucose After Eating

Because of its relatively rapid onset and shorter duration of action, inhaled insulin is primarily used to control meal-related increases in blood glucose rather than to provide the body's basal insulin requirements throughout the day.

How Is Inhaled Insulin Used?

Inhaled insulin is not taken by mouth. Instead, it is administered by inhaling powdered insulin into the lungs using a specialized inhaler device. The exact method of use varies depending on the specific product, so patients should follow the instructions provided by their healthcare provider, pharmacist, and the medication's package insert.

General Instructions for Using Inhaled Insulin

Use the Dose Prescribed by Your Healthcare Provider

Only use the dose prescribed by your healthcare provider. Do not determine or adjust the dose on your own. The appropriate dose varies from person to person depending on blood glucose levels, insulin requirements, meals, and the overall treatment plan.

Injected insulin should also not be replaced with inhaled insulin without medical supervision, as insulin doses and absorption can differ between formulations.

Prepare the Inhaler Device

Use the inhaler device specifically designed for the prescribed product and make sure to use the correct dose unit or cartridge according to the manufacturer's instructions.

Use It According to Mealtime Timing

Inhaled insulin is rapid-acting and is generally used around mealtimes according to the timing recommended by the healthcare provider or stated in the medication instructions.

If a dose is missed, do not attempt to compensate for it or change the timing on your own. Instead, follow the product-specific instructions or consult a healthcare provider or pharmacist.

Inhale the Dose Correctly

Position and use the inhaler as described in the package instructions or as demonstrated by the healthcare provider or pharmacist. Follow the recommended breathing technique to ensure that the dose is delivered properly.

Do not swallow the insulin powder or use the inhaler in a way that differs from the instructions provided with the medication.

Monitor Blood Glucose Levels

It is important to monitor blood glucose levels according to the plan established by the healthcare provider, as inhaled insulin can cause hypoglycemia, just like other forms of insulin.

Patients should learn to recognize the possible symptoms of low blood glucose and understand how to manage them according to the medical guidance they have received.

What Should You Do If You Miss a Dose?

If you miss a dose of inhaled insulin, do not use a double dose to make up for the missed dose. Follow the specific instructions for the product or consult your healthcare provider or pharmacist about what to do, particularly if the dose is associated with mealtime.

Important Points Before Using Inhaled Insulin

Inhaled insulin is not suitable for everyone. A healthcare provider may need to evaluate lung function before starting treatment and monitor it during treatment, depending on the specific product and the patient's condition.

There are also special precautions for people who currently smoke or have recently stopped smoking. Therefore, patients should inform their healthcare provider about their smoking history before starting treatment.

Inhaled insulin should not be started, discontinued, or have its dose changed without medical guidance.

What Are the Alternatives to Inhaled Insulin?

Several treatment options may be used instead of inhaled insulin, particularly when it is not appropriate for the patient or is not available. The most suitable alternative depends on the type of diabetes, the patient's age, blood glucose levels, insulin requirements, and the treatment plan established by the healthcare provider.

Main Alternatives to Inhaled Insulin

Alternative	Method of Administration	Use
Rapid-acting injected insulin, such as lispro, aspart, and glulisine	Injection or insulin pen	Used to cover mealtime insulin requirements
Ultra-rapid-acting insulin	Injection or insulin pen	Used with meals and characterized by a rapid onset of action
Insulin pump	Continuous subcutaneous insulin delivery	Provides basal insulin, with the option of additional doses around meals
Automated insulin delivery (AID) systems	Insulin pump combined with a continuous glucose monitor	Helps adjust insulin delivery based on glucose readings
Short-acting insulin (Regular insulin)	Injection	May be used to cover mealtime insulin requirements, but generally has a slower onset than newer rapid-acting insulins
Premixed insulin or NPH-based regimens	Injection	May be appropriate for some patients, but generally provide less flexibility than some newer treatment approaches

Rapid-Acting Injected Insulin

Injected rapid-acting insulin is one of the most direct alternatives to inhaled insulin. It can be used to cover the rise in blood glucose associated with meals. Examples include insulin lispro, insulin aspart, and insulin glulisine.

Insulin Pump

An insulin pump is another option for some patients. It delivers insulin continuously rather than relying on repeated injections. Additional doses can also be administered to cover the body's insulin requirements around meals.

Automated Insulin Delivery Systems

These systems combine an insulin pump with a continuous glucose monitoring device and can automatically adjust insulin delivery based on glucose readings. They are particularly used by some people with type 1 diabetes, depending on the healthcare provider's assessment and whether the system is appropriate for the patient.

Can Inhaled Insulin Be Replaced With Injected Insulin?

Yes. Injected rapid-acting or ultra-rapid-acting insulin may be used as an alternative to inhaled insulin to cover mealtime insulin requirements in some patients. However, patients should not make this substitution or convert doses on their own, as doses can differ between inhaled and injected insulin.

In type 1 diabetes, treatment generally involves more than mealtime insulin alone. Patients also require continuous basal insulin, which may be provided through long-acting insulin, an insulin pump, or another appropriate treatment approach.

Therefore, the healthcare provider determines the most appropriate alternative based on the type of diabetes, the patient's insulin requirements, level of blood glucose control, and overall health.

What Is the Difference Between Inhaled and Injected Insulin?

Inhaled insulin has a rapid onset of action and is absorbed into the bloodstream through the lungs. Its duration of action is also relatively shorter than that of some rapid-acting injected insulin products. Therefore, it is primarily used to cover mealtime insulin requirements.

However, inhaled insulin is not a complete substitute for basal insulin. In people with type 1 diabetes, treatment generally requires a component that provides the body's basal insulin needs in addition to insulin used to cover meals.

There are also important restrictions regarding the use of inhaled insulin in people with certain lung conditions, such as asthma and chronic obstructive pulmonary disease (COPD). Therefore, patients may need lung function testing before starting treatment and monitoring during treatment according to their healthcare provider's recommendations.

What Are the Side Effects of Inhaled Insulin?

Inhaled insulin can cause side effects, as can other forms of insulin. These effects vary from person to person. Some are related to insulin's effect on blood glucose levels, while others may be associated with administering insulin through inhalation and its effects on the respiratory system.

1. Low Blood Glucose

Low blood glucose (hypoglycemia) is one of the most important potential side effects of inhaled insulin because of its glucose-lowering effect.

Symptoms of low blood glucose may include:

• Sweating.

• Shaking or trembling.

• Hunger.

• Dizziness.

• Headache.

• Rapid heartbeat.

• Confusion or difficulty concentrating.

• Weakness or fatigue.

Hypoglycemia should be managed according to the treatment plan provided by the healthcare provider, while severe hypoglycemia requires urgent medical attention.

2. Cough

Cough is a common side effect associated with inhaled insulin and may occur as a result of inhaling the medication powder into the respiratory tract.

The cough may be temporary in some people but may persist in others. Patients should inform their healthcare provider if the cough is severe or persistent.

3. Throat Irritation

Some patients may experience throat irritation or discomfort after inhaling insulin. This may be related to inhaling the medication powder or to the way the inhaler is used.

4. Changes in Lung Function

The use of inhaled insulin may be associated with changes in lung function in some patients. Therefore, a healthcare provider may recommend lung function testing before treatment and monitoring during treatment.

Patients should inform their healthcare provider if they develop new shortness of breath or notice a significant change in respiratory symptoms.

5. Respiratory Problems in Some Patients

Inhaled insulin may not be suitable for people with certain lung conditions. Therefore, it is important to inform the healthcare provider about any history of respiratory disease before starting treatment.

Assessing respiratory health is important to determine whether inhaled insulin is a safe and appropriate option for the patient.

6. Low Blood Potassium Levels

Like other forms of insulin, inhaled insulin may, in some cases, cause low blood potassium levels (hypokalemia). Mild reductions may not cause noticeable symptoms, while severe reductions can lead to weakness or abnormal heart rhythms.

7. Weight Gain

Some people may experience weight gain during insulin treatment due to insulin's effects on glucose utilization and storage in the body. The extent of weight change varies from person to person and may be affected by insulin doses, diet, lifestyle, and other treatments.

8. Allergic Reactions

In rare cases, an allergic reaction to insulin or one of the ingredients in the product may occur. Symptoms may include a skin rash, swelling, or respiratory symptoms.

If difficulty breathing or swelling of the face, tongue, or throat occurs, urgent medical attention should be sought.

Tips for Using Inhaled Insulin

To use inhaled insulin safely and correctly, follow the healthcare provider's instructions and consider the following recommendations:

1. Use only the prescribed dose: Do not change the dose or timing of inhaled insulin on your own, even if blood glucose levels improve or increase.

2. Use the inhaler correctly: Follow the healthcare provider's instructions or the instructions provided with the device, as proper inhalation technique helps ensure that the prescribed dose reaches the lungs.

3. Follow the recommended timing: Inhaled insulin is generally used around meals according to the prescribed treatment plan. Do not delay or repeat a dose without medical guidance.

4. Monitor blood glucose levels regularly: Monitoring helps assess treatment effectiveness and identify high or low blood glucose levels. Report significant changes to your healthcare provider.

5. Do not use it as a substitute for basal insulin when basal insulin is required: Inhaled insulin may replace mealtime insulin injections in some patients, but it does not replace basal insulin in people who require it, such as many people with type 1 diabetes.

6. Inform your healthcare provider about lung conditions: Inhaled insulin may not be suitable for people with certain lung diseases, such as asthma or COPD. Lung function testing may therefore be recommended before and during treatment.

7. Avoid smoking and inform your healthcare provider if you currently smoke or have recently stopped: Smoking can affect the safety and effectiveness of inhaled insulin.

8. Be aware of symptoms of low blood glucose: These may include sweating, shaking, dizziness, intense hunger, or difficulty concentrating. If they occur, follow the hypoglycemia management plan provided by your healthcare provider.

9. Store the inhaler and insulin as instructed: Use cartridges or other medication components correctly and do not use expired products.

10. Attend regular follow-up appointments: Your healthcare provider may need to monitor lung function and blood glucose levels and adjust the treatment plan based on the results.