Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Inhaled Insulin Limited

Inhaled Insulin (Exubera)® is already receiving media attention despite the product not being launched yet.

It is likely that a great many patients will be disappointed when the product is launched because there are several contraindications and monitoring issues associated with this novel product.

Inhaled Insulin is a short acting insulin for the treatment of Type I and Type II diabetes however it is not recommended for use in the following patients:

  • Current smokers
  • Any who has smoked in the last 6 months
  • Patients with poorly controlled, unstable or severe asthma
  • Patients with severe COPD
  • Patients with Heart Failure and compromised lung function
  • Patients under the age of 18

Any patient who is initiated on inhaled insulin should also undergo a baseline assessment of lung function using spirometry to assess FEV1. This test should be repeated at 6 months in all patients and periodically thereafter depending upon the decline in lung function. Patients whose lung function is confirmed as having declined by 20% or more should have treatment stopped.

This insulin is also a short acting insulin and many patients will still need to inject an intermediate or long acting insulin. This removes the main advantage for needle phobic patients if injections will still be necessary.

Action: Inhaled insulin will be suitable for a relatively small number of patients given the contraindications and also comes with some intensive monitoring requirements. Uptake should be initiated and initially managed in a secondary care setting.

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