Tag Archives: Insulin

FDA approved Inhaled Insulin Afrezza

Damion Edwards for Mannkind

The Food and Drug Administration (FDA) of America had just approved the new inhaled insulin Afrezza for patients with both types of diabetes. It can replace the short acting insulins but not the long acting ones, so patients with type 1 diabetes would still need to inject the basal insulin, but would then just need to inhale before meal times, effectively saving themselves 3 injections.

Afrezza, or technosphere insulin, has a short time to maximum blood concentration of 14 minutes, resulting in improved control of postprandial (after meal) blood sugars, less weight gain and lower risk of hypoglycemia (blood sugar level too low). Side effects include transient cough, and a small reversible reduction in forced expiratory volume in 1 second (FEV1) (a measure of a person’s ability to blow) by 37ml. An expected FEV1 calculated for a Chinese man measuring 174cm and 72kg was about 4 litres, making this a drop of less than 1%.

However, bronchospasm (airway narrowing) had occurred in patients with previous asthma and chronic lung disease, so Afrezza is contraindicated in those patients. FDA had also mandated post-marketing studies of the drug.

This is great news for patients who are currently injecting insulin multiple times a day, as inhaled insulin was much more acceptable to patients with type 2 diabetes.  This means that more patients with poorly controlled diabetes would be willing to be started on insulin, which no longer requires painful injections.

Nonetheless, the previous inhaled insulin Exubera had been withdrawn from the market before because of poor sales. The high price, and the huge size of the inhaler were cited as reasons of its failure.

Provided this is not priced too high, the fact that this inhaler is palm-sized should help Afrezza escape the fate of Exubera. Hopefully it will arrive in Singapore soon.

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The Artificial Pancreas – Hope for Type 1 Diabetes

The artificial pancreas has just been approved by the American Food and Drug Administration (FDA).

Patients with type 1 diabetes cannot make insulin because their pancreas has been damaged by their own immune system, and have to have external insulin supplied to them. An insulin pump can provide insulin constantly through a needle that is secured just under the skin and typically lasts for 3 days. The problem had always been that patients can get hypoglycemia, or low blood sugar, especially during the night or during vigorous exercise.

Now the FDA had approved a new Medtronic pump that also has a sensor which can switch off the pump when the patient’s sugar drops too low. This pump now behaves like our real pancreas: provide insulin when the sugar is high, stopping insulin when sugar is low. However, it is not fully automated: unlike our body which knows how much carbohydrates we have taken, the pump user still needs to enter the amount manually into the machine.

Nonetheless this is a much safer machine than the old ones. Hopefully it will be brought to Singapore soon!