COMMENTARY

Inhaled Insulin: How to Teach Patients

Anne L. Peters, MD

Disclosures

May 21, 2015

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Note: In the video, Dr Peters demonstrates how to teach patients to use inhaled insulin.

Today I am going to give you a short demonstration on how to teach patients to use inhaled insulin. They need two things to do this: the inhaler device and the cartridges.

These cartridges are for demonstration use, so they are red. The cartridges your patients will be using are blue and green. The blue cartridges correspond to 4 units, and the green cartridges correspond to 8 units.

In advance, you are going to tell a patient how much inhaled insulin to take. Hopefully you have helped the patient figure out how many cartridges will be needed before a meal. If you are starting a patient on inhaled insulin who is not on prandial insulin, you are going to start with 4 units, in most cases. That is one blue cartridge.

It is very simple. They hold this inhaler device level and put the cartridge in. Then, they close this lever over it until it clicks, and now it's ready to go. They are not supposed to tip the device, because you don't want the powder to come out of the cartridge. They take off the guard. They exhale, and then they breathe it in and hold it in their lungs. That was one cartridge.

If a patient needs to take more than one cartridge, they open this up, take out the used cartridge, dispose of it, and then put in another cartridge. They inhale as many units of insulin as they need before each meal.

Because this form of inhaled insulin is new to most of us and to our patients, it's important that we carefully read the package insert and the user guide so that we can help patients understand that this is, in fact, insulin, and then teach them how to use it. It's particularly important for patients who have already been on prandial insulin to use the conversion table that is provided, to be sure that they switch appropriately and receive the right dose of insulin.

Patients also need to realize that this can still cause hypoglycemia. It's absorbed much more rapidly than injected insulin, so patients need to be aware that they should take this just before they eat because they are going to get a fairly rapid response. They can still develop hypoglycemia, so they need to be aware of how to use this and how to prepare for any side effects that may occur.

This should be refrigerated. It can be kept out of the refrigerator for 10 days in the foil packet. Once the foil packet is opened, it will last for 3 days. Patients are encouraged to take it out of the refrigerator, however, for at least 10 minutes before using it so that they aren't inhaling a cold powder.

When using inhaled insulin, be sure that patients have pulmonary function testing before they start, and don't use it in patients with lung disease or in those who are smokers.

In terms of patients who might be interested in this, there is a subset of patients who are needle-averse or who are unwilling or unable to give mealtime insulin injections; they might be candidates for this drug.

It's not yet on most formularies, but we will need to see what happens as more people have access and get an understanding of the role that it will play in the management of type 2 and type 1 diabetes.

This has been Dr Anne Peters for Medscape. Thank you.

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