4.5.6.0 In­haled In­sulin

In­haled in­sulin is avail­able for pran­di­al use with a lim­it­ed dos­ing range; stud­ies in peo­ple with type 1 di­a­betes sug­gest rapid phar­ma­coki­net­ics (20). A pilot study found ev­i­dence that com­pared with in­jectable rapid-‍act­ing in­sulin, sup­ple­men­tal doses of in­haled in­sulin taken based on post-‍pran­di­al glu­cose lev­els may im­prove blood glu­cose man­age­ment with­out ad­di­tional hy­po­glycemia or weight gain, al­though re­sults from a larg­er study are need­ed for confirma­tion (82).

In­haled in­sulin is con­traindi­cat­ed in pa­tients with chron­ic lung dis­ease, such as asth­ma and chron­ic ob­struc­tive pul­monary dis­ease, and is not rec­om­mend­ed in pa­tients who smoke or who re­cently stopped smok­ing. All pa­tients re­quire spirom­e­try (FEV1) test­ing to iden­ti­fy po­ten­tial lung dis­ease prior to and after start­ing in­haled in­sulin ther­a­py.