Exubera Inhaled Insulin

I had two patients who participated in the clinical trial for inhaled insulin.
Neither had adequate control of their diabetes. Of course they were not the most compliant patients.
Not sure if it is administered via a MDI like you have pictured. If it is, then I doubt many patients will be controlled because there are few patients who can use MDIs appropriately.
Color me skeptical.

I was a participant in the test arm of a 30-month Exubera trial; I completed participation 2weeks ago. (I am not a physician.) The delivery device IS NOT a MDI as pictured; it is a much larger device, perhaps 12 inches long when extended for use. I found the device less convenient (I have injected insulin for 35 years), although not unpleasant. Dosing Exubera requires more time than injecting, depending on the dose required. I may have achieved marginally better control during the trial but this is difficult to assess.

Following the Advisory Committee's positive recommendation on Exubera, I see news comment on pulmonary function complications, but none on the other factor noted with Exubera use: creation and/or elevation of insulin antibodies. I understand from my PI that many/most participants develop elevated levels of antibodies after a period of time on inhaled insulin; the direct result is that the dosing requirements become elevated. As my antibodies rose, I required about 3 times as much Exubera as initially to maintain control. Unanswered qestions persist: I was never aware of antibodies with injected insulin, and neither was my ENDO. I am told that testing for them is extremely costly, and never done in clinical practice -- so I am unaware of whether injected insulin commonly produces antibodies, or whether these are specific to the route of delivery. My PI has also indicated that in "most people," the antibody level ultimately turns over and declines; mine has yet to do so. I have been off Exubera for approx 6 months after completing the active phase of the trial, and declined to enroll in a follow-on trial. I assume that, if nothing else, dose elevation as a result of antibody development will have significant cost implications for the use of Exubera -- which I hardly expect to be comparable in cost to injectable insulin to begin with. I would be interested in seeing other information or experiences related to the antibody issue.