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This Insulin is Changing Diabetics’ Lives

When he was just 10 years old, Eric Fenar was diagnosed with type 1 diabetes. By the time he was 12, he relied on an insulin pump to function.

“I never thought in my wildest dream I would be ditching my insulin pump,” one user said.

After searching online for alternatives, Fenar, now 33 and living in Buffalo, New York, found a new one: Afrezza, an inhaled insulin. It didn’t require a pump and claimed to work faster than traditional insulin.

Fenar liked that, because he always knew that high blood sugar was damaging his body until the pump could deliver insulin. That could take several minutes and came with uncomfortable symptoms.

In 2014, he headed down to Washington, D.C., with his family to speak at a meeting in favor of granting Food and Drug Administration approval to the drug. He was one of the first people to take the drug when it came on the market.

When Fenar started on inhaled insulin, his A1C level was 7.5 percent. A1C is a blood test that provides information on average levels of blood glucose, or blood sugar. Anything less than 5.7 percent is considered normal; anyone with an A1C of 5.7 to 6.4 is considered pre-diabetic — and 6.5 percent or more and a person is diagnosed with diabetes.

Two months later, Fenar said his A1C was at a 6.1 — a result he was never able to get on his own after decades of closely monitoring his diabetes. “There’s been no looking back,” Fenar said. “I never thought in my wildest dreams I would be ditching my insulin pump.”

Being able to inhale the medication is what he appreciates most — it works quickly and effectively. “[It’s] ultra-rapid insulin that just happens to be inhaled,” he said.

Some Common Side Effects
Afrezza isn’t the only inhaled insulin drug. Ten years ago, Pfizer’s Exubera hit the market as a “mealtime” insulin to lower blood glucose levels after a person consumed carbohydrates. Anyone who needed consistent basal insulin would have to use it along with injectable insulin. The drug was a flop, though, mostly because of its bulky device.

Afrezza peaks within 12 to 15 minutes and is out of a person’s system within an hour.

In many ways, however, it opened the door for Afrezza, which is known for its small, whistle-sized device. It’s a fast-acting insulin in powder form but can be delivered in the arterial blood system instead of the capillary system, so it performs differently.

Afrezza peaks within 12 to 15 minutes and is out of the system within an hour. Other fast-acting insulin can take at least 20 minutes to kick in, then peak after two to three hours and be in the body for as long as five hours.

The most common side effects were found to be coughing, hypoglycemia, and throat pain or irritation, Dr. David C. Klonoff, a doctor with Mills-Peninsula Health Services in San Mateo, California, noted in a 2014 Journal of Diabetes Science and Technology report. As part of its approval, the drug manufacturer had to note on the box that patients with asthma and chronic obstructive pulmonary disease experienced asthma attacks.

“The rapid onset and offset of this insulin may well prove to be a great advantage in minimizing glucose fluctuations without much of the risk of late post-injection hypoglycemia,” he said in the report.

A 2015 report in JAMA noted that 27 percent of patients experienced coughing on inhaled insulin, and that was the most popular reason why people quit. It also noted the drug shouldn’t be used by patients who smoke or who stopped smoking within six months — stating it was “only modestly effective” at reducing A1C.

Dr. Michael Haller, a leading endocrinologist in juvenile diabetes at University of Florida Health, said in a 2015 interview with Seeking Alpha he is not yet convinced the drug is much quicker than current methods. He added that more studies and real-world use will determine that.

"If the rapid onset and clearance of Afrezza is seen in real-world use — then, to me that would make it a far superior rapid-acting insulin in comparison to current options," he said.

"I would be comfortable prescribing it for now in adults with type 1 as long as patients were clearly informed of risks [unknown and otherwise] and patients agreed to the recommended pulmonary function testing," he added. "I would not prescribe it [outside of a study] for kids yet."

Patients prefer inhaled insulin, especially with the smaller design of Afrezza, said Dr. Michael Miller, a professor at the University of Maryland School of Medicine and author of the book "Heal Your Heart." Miller is concerned that some research has tied Exubera to lung cancer, though.

"We need long-term safety studies to ensure that insulin inhalers do not cause or promote cancer," he said.

Any patient who wants to consider inhaled insulin should have lung testing performed. Those who smoke, have an abnormal test, or have a history of lung disease or cancer are not good candidates for Afrezza, Miller said.

Catching On
Fenar said most people he speaks to have never heard of the drug and doctors have been reluctant to prescribe it — but he's never had a problem.

Mike Hoskins, 37, of Detroit, Michigan, is a type 1 diabetic who runs DiabetesMine, a diabetes news website. He said he is concerned about long-term effects on his lung function, but is giving it a shot.

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Hoskins has been on an insulin pump for 14 years, but recently took a break from it to take Lantus basal insulin twice a day, along with Novolog fast-acting medication and Afrezza.

"Mainly, I have been using Afrezza mostly for higher carb and quicker corrections, but sticking with Novolog for lower carb and smaller doses," Hoskins told LifeZette. "I love it, from the convenience of just being able to inhale instead of injecting, to the better blood glucose [numbers] that I see as a result."

Hoskins also noted that the dosing isn't always consistent — but in the first month of using it, he was able to drop his A1C by nearly a full percentage point.

"I am so grateful it exists and hope it continues being around for those who want it," he said.