After decades of trial and error, researchers have brought an inhalable insulin to the market that may improve the lives of people with diabetes. The new drug, Afrezza, comes in a whistle-sized inhaler. Designed to be rapid-on, rapid-off , it works faster than injectable insulin, but also dissipates more quickly to help diabetics avoid blood sugar highs and lows. Diabetics, the manufacturer and shareholders are all hoping Afrezza is a win.
The pancreas is responsible for making insulin, which helps turn glucose into energy. After eating, carbohydrates break down to glucose, causing a rise in blood sugar. This triggers the pancreas to release insulin, which moves through the blood and alerts cells to open and allow glucose in. Once glucose is converted to energy, the body can use it immediately or store it for later.
For people with type 1 diabetes, the body produces insufficient insulin. Type 2 means the body has become resistant to letting insulin into cells. Either way, glucose stays in the blood, causing a rash of health problems. Diabetics usually deal with this problem by injecting insulin two to four times a day, according to a schedule set with their doctor. Depending on the type and severity of their diabetes, Afrezza could replace the need for injections, or at least cut down on their frequency.
Dr. Caroline Messer, an endocrinologist in New York, N.Y., regularly prescribes Afrezza to her patients. “I find it especially useful for patients who need a faster-acting mealtime insulin than is currently on the market in an injectable form,” she says. “I also find it incredibly helpful for patients with autoimmune diabetes who require multiple daily injections.”
Researchers pondered the idea of inhalable insulin for decades, imagining needles being replaced by something akin to an asthma inhaler. In 2006, the Food and Drug Administration approved Exubera, the first inhalable insulin to hit the market. However, it was a $2.8 billion flop, according to a Wall Street Journal article. The most glaring problem was the enormous delivery system that resembled a bong. Needles were more discreet and less embarrassing than hauling the contraption out in public. Patients also found the dosages confusing. Pfizer pulled Exubera from the market in 2007.
Afrezza, made by California-based MannKind Corp., became available to consumers in early 2015. The size is right and the color-coded dosages are easier to understand. Although many early adopters rave about Afrezza, the product hasn’t caught on like MannKind hoped, and its marketing and distribution partner cut them loose after disappointing sales. MannKind is now laboring to make Afrezza a success without a Big Pharma partner.
Risks and Roadblocks
Afrezza isn’t for everyone. It hasn’t been approved for people under 18, and smokers, asthmatics or anybody else with lung problems should give it a pass. Patients must take a pulmonary function test before starting Afrezza. “My only concern is for long-term lung function, but so far the data is reassuring,” Messer says.
Some doctors are wary of inhalable insulin after the Exubera fiasco, and some patients have had trouble getting their insurance companies to reimburse them for Afrezza. Like all medications, Afrezza comes with possible side effects, including low blood sugar, diarrhea, coughing, sore throat, fatigue and nausea. Lung spasms and an elevated risk of heart and lung disease are more serious but less common side effects.
While the long-term effects are unknown, many patients appreciate Afrezza so far. Felice Guimont, a New Orleans nurse who has type 1 diabetes, says “the ease of use is one of the biggest advantages, especially in public settings. There’s no stigma attached to using an inhaler as opposed to injections.” The fast-acting insulin also allows her more flexibility with when she eats.
Gustavo Basualdo chronicles his experiences as a diabetic triathlete online as “Diatriguy.” After initial struggles figuring the right dosage for his athletic lifestyle, he got the hang of Afrezza and was able to take off his insulin pump.
“I was pump free!” he wrote in a blog post titled “An open thank you letter to MannKind and the people behind Afrezza.” “I really don’t miss having a beeper stuck to my butt 24 hours a day, that’s for sure. Now I can have both non-diabetic numbers and a mostly non-diabetic life.”