Inhaled Insulin is Here Again. Will it Stick Around?

Injecting insulin is no fun. The prospect of inhaling insulin into the lungs, instead of injecting it under the skin, is appealing to many diabetic patients. The first delivery system for inhaled insulin (Exubera) was available in 2006-2007 before it was discontinued due to poor sales. The inhaler was bulky and dosing was complicated. 

The U.S. Food and Drug Administration approved Afrezza Inhalation Powder in June 2014, and it became available through some U.S.

pharmacies in January 2015. Success of this new treatment option will depend on a number of features. 

Key features

Afrezza is a rapid-acting inhaled insulin for adults with type 1 or type 2 diabetes. Since it is rapid acting, it is designed for use at the beginning of a meal.

Afrezza is packaged as single-use, color-coded plastic cartridges containing 4 units or 8 units of powdered insulin. Multiple cartridges can be used to reach the prescribed insulin dose. For example, a patient who is supposed to have 16 units of insulin with a meal would use 2 of the 8 unit cartridges. The inhaler should be replaced every 15 days.

The patient places the cartridge into the inhaler device, places the device into his or her mouth, and inhales the insulin through the device into the lungs. The powdered insulin is aerosolized into the tiny particles and absorbed through the lungs into the bloodstream.

The Afrezza inhaler is much smaller than the Exubera inhaler.

This may play a significant role in acceptance by patients.

Important limitations

Afrezza is only for adults with diabetes. It has not been studied in individuals younger than 18 years of age. 

Afrezza cannot replace long-acting insulin like insulin glargine or insulin detemir. It must be used in conjunction with long-acting in patients with type 1 diabetes.


Even though it acts rapidly, Afrezza is not suitable for treatment of diabetic ketoacidosis, a medical emergency which requires intravenous insulin and fluids, and intensive monitoring of glucose and electrolyte levels. 

Afrezza is not recommended for individuals who smoke, recently stopped smoking within the last 6 months. It also not recommended for individuals with lung cancer.


Afrezza can cause acute bronchospasm in patients with asthma or chronic obstructive pulmonary disease, and therefore it shouldn't be used by patients with chronic lung disease.

In fact, health care providers are urged to evaluate a patients' lung function with a medical history, physical exam, and spirometry testing before prescribing Afrezza, after 6 months of treatment, and every year thereafter. If lung function declines during treatment with Afrezza, then it may not be safe to continue.

Like any insulin product, the most common side effect of Afrezza is hypoglycemia (low blood sugar). Other side effects include cough and throat pain or irritation 

The FDA is requiring the post-marketing studies for Afrezza to evaluate the following:

  • Pharmacokinetics, safety, and efficacy in pediatric patients
  • Risk of lung cancer
  • Risk of heart disease
  • Long term effect on lung function


Afrezza offers an alternative insulin delivery method which many diabetic patients may prefer over injections. Its compact size and convenient dosing appear to be advantages over it's defunct predecessor (Exubera). However, Afrezza can't replace injected insulin as a whole, and safety concerns still need to evaluated over a longer period of time.

[Mention of a commercial product or service does not constitute an endorsement.] 


U.S. Food and Drug Administration. FDA Approves First Ever Inhaled Insulin Combination Product for Treatment of Diabetes. January 27, 2006. Accessed on January 31, 2015.

U.S. Food and Drug Administration. FDA approves Afrezza to treat diabetes. June 27, 2014. Accessed on January 31, 2015.

Afrezza® Prescribing Information. Accessed on January 31, 2015.

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