| INSULIN HUMAN INHALED
Classifications: hormone; antidiabetic agent; insulin; Therapeutic:hormone; antidiabetic; insulin
Prototype: Insulin injection
Pregnancy Category: C
1 mg and 3 mg blister packs with powder for inhalation; 1 mg is equivalent to 3 units of regular SC insulin; 3 mg is equivalent
to 8 units of regular SC insulin
Inhaled insulin hormone regulates carbohydrate, fat, and protein metabolism. Insulin lowers plasma glucose concentration
by facilitating uptake of glucose into muscle and adipose tissue, as well as by inhibiting hepatic glucose production by
both glycogenolysis and gluconeogenesis.
Inhaled insulin lowers plasma glucose level and improves glycemic control as indicated by a lowering of postprandial plasma
glucose and HbA1C levels.
Treatment of type 1 and type 2 diabetes mellitus.
Hypersensitivity to inhaled human insulin; diabetic ketoacidosis; coma; hyperosmolar hyperglycemic state; tobacco smoking;
poorly controlled pulmonary disease; moderate to severe COPD; cystic fibrosis; asthma; upper respiratory infection; pregnancy
(category C). Safety and efficacy in children have not been established.
Hepatic disease, renal impairment; renal failure; thyroid disease; infection; surgery, trauma; emesis, diarrhea.
Route & Dosage
Adult: Inhaled 23 times daily no more than 10 min a.c. Initial doses: 3039.9 kg, 1 mg; 4059.9 kg, 2 mg; 6079.9 kg, 3 mg; 8099.9 kg, 4 mg; 100119.9 kg, 5 mg; 120139.9 kg, 6 mg. Initial premeal dose calculation: body weight (kg) x 0.05 mg/kg = premeal dose (mg) rounded down
to the nearest whole milligram
- Give no sooner than 10 min a.c.
- Supplied in 1 mg and 3 mg blisters. The least number of blisters per dose should be used. To give a 4 mg dose, use one 1 mg and one 3 mg blister rather than four 1 mg blisters.
To give a 5 mg dose, use two 1 mg blisters and one 3 mg blister. To give a 6 mg dose, use two 3 mg blisters.
- Do not substitute three 1 mg blisters for one 3 mg blister because consecutive inhalation of three 1 mg blisters provides much
greater insulin exposure than one 3 mg blister. If 3 mg blisters are temporarily unavailable, use two 1 mg blisters for
a 3 mg dose and monitor blood glucose closely.
- Store at 15°30° C (59°86° F).
Adverse Effects (≥1%)[See INSULIN (REGULAR)] Body as a Whole:
Chest pain. GI:
Dry mouth. Respiratory: Asthma
, cough, dyspnea
, epistaxis, laryngitis, pharyngitis, respiratory disorder, respiratory tract infection, rhinitis, sinusitis,
sputum increase. Special Senses:
Diagnostic Test Interference
See INSULIN INJECTION (REGULAR).
See INSULIN INJECTION (REGULAR)
. Herbal: Garlic
and green tea
may potentiate hypoglycemic effects.
1020 min. Peak:
3090 min. Distribution:
Throughout extracellular fluids. Metabolism:
Primarily in liver with some metabolism
in kidneys. Elimination:
<2% in urine. Half-Life:
Biologic, up to 13 h.
Assessment & Drug Effects
- Monitor for hypoglycemia (see Appendix F) at time of peak action of insulin. Onset of hypoglycemia (blood sugar: 5040
mg/dL) may be rapid and sudden.
- Lab tests: Periodic postprandial blood glucose and HbA1C. Test urine for ketones in new, unstable, and type 1 diabetes; if patient has lost weight, exercises vigorously, or has
an illness; whenever blood glucose is substantially elevated.
- Notify physician promptly for presence of acetone with sugar in the urine; may indicate onset of ketoacidosis. Acetone without
sugar in the urine usually signifies insufficient carbohydrate intake.
Patient & Family Education
- Follow directions for taking the drug (see Administration).
- Read the Medication Guide provided with the medication. Ensure that you have the correct dosage forms from the pharmacy
(i.e., correct number of 1 mg and 3 mg blister packets to provide the right dose as outlined in the Medication Guide).
- Change the release unit of the inhaler every 2 wk and change the inhaler 1 y after first use.
- Do not use inhaled insulin if you currently smoke or have smoked within the last 6 mo. Failure to follow this guideline may
result in serious hypoglycemia.
- Note: Hypoglycemia can result from excess insulin, insufficient food intake, vomiting, diarrhea, unaccustomed exercise, infection,
illness, nervous or emotional tension, or overindulgence in alcohol.
- Respond promptly to beginning symptoms of hypoglycemia. Take 4 oz (120 mL) of any fruit juice or regular carbonated beverage
[1.53 oz (4590 mL) for child] followed by a meal of longer-acting carbohydrate or protein food. Failure to show
signs of recovery within 30 min indicates need for emergency treatment.
- Carry some form of fast-acting carbohydrate (e.g., lump sugar, Life-Savers, or other candy) at all times to treat hypoglycemia.
- Avoid OTC medications unless approved by physician.