# Afrezza Inhaled Insulin for Diabetes Mellitus



## Northerner

This bulletin from the Canadian Agency for Drugs and Technologies in Health (CADTH) discusses investigational inhaled insulin, Afrezza, which consists of Technosphere insulin (TI) inhalation powder and a product-specific breath-activated inhaler. TI cartridges are used with an inhaler one minute before eating for managing type 1 and type 2- diabetes.

Findings from trials include the following:

? TI reduces postprandial glucose and HbA1c levels in type 2 diabetes patients taking oral antidiabetic drugs or concurrent insulin glargine (IG) compared with placebo.

? Patients with poorly controlled type 2 diabetes taking TI showed comparable reductions in postprandial glucose and HbA1c compared with biaspart insulin (BI) recipients.

http://www.nelm.nhs.uk/en/NeLM-Area...frezza-Inhaled-Insulin-for-Diabetes-Mellitus/


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## DeusXM

Yet another waste of money. We don't want a new and exciting way to take insulin, we want something that means that we don't have to self-manage our blood sugars. This stuff is like 'solving' a leaky pipe by putting a shinier bucket underneath it.


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## Northerner

DeusXM said:


> Yet another waste of money. We don't want a new and exciting way to take insulin, we want something that means that we don't have to self-manage our blood sugars. This stuff is like 'solving' a leaky pipe by putting a shinier bucket underneath it.



I don't know, it might be a better form of treatment for some people, perhaps if they have difficulties giving injections (not just needle phobia, but perhaps physical in nature). Wouldn't fancy it myself!


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## LeeLee

Deus, I see your point, however... given that my main aim is to do ANYTHING to avoid the need to inject myself, it gives me a little ray of hope.  I count myself very lucky that I can currently control my T2 without insulin, but I'm acutely aware that this blissful state may not last forever.  Bring it on!


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## Vicsetter

AFREZZA? (pronounced uh-FREZZ-uh), where does that name come from?

You might find this positive article interesting: http://klljinvestments.blogspot.co.uk/p/afrezza-paradigm-shift.html

And this page from a T1 who is part of the trial: http://www.tudiabetes.org/forum/top...rapid-acting-insulin-inhaled-insulin-onset-12


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## mcdonagh47

Northerner said:


> I don't know, it might be a better form of treatment for some people, perhaps if they have difficulties giving injections (not just needle phobia, but perhaps physical in nature). Wouldn't fancy it myself!



Inhalable insulin has been and gone 2006-7. It was called Exubera by Pfizer. It was basically rejected by the T2 community and only ever got about 1% of the market in the USA and even less in GB.
The main advantage of inhaled insulin is that it is going straight to the most efficient absorbable surfaces in the body - the alveoli in the lungs. So there was no 15 minutes or 40 waiting for it to come on stream as with injected insulins. If you inhaled 8 units it was there in the body working straight away.
That was one of the problems with exubera, it couldn't be fine tuned or exactly controlled . It was no good for T1s because the minimum dose was 8 units. It was designed for needle-phobic T2s. 
Exubera had to be sucked up from a long glass tube ( which some ladies found indelicate ).
Unless they have addressed the problems posed by Exubera, Alfrezza will probably go the same way.


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## Vicsetter

mcdonagh47 said:


> Inhalable insulin has been and gone 2006-7. It was called Exubera by Pfizer. It was basically rejected by the T2 community and only ever got about 1% of the market in the USA and even less in GB.
> The main advantage of inhaled insulin is that it is going straight to the most efficient absorbable surfaces in the body - the alveoli in the lungs. So there was no 15 minutes or 40 waiting for it to come on stream as with injected insulins. If you inhaled 8 units it was there in the body working straight away.
> That was one of the problems with exubera, it couldn't be fine tuned or exactly controlled . It was no good for T1s because the minimum dose was 8 units. It was designed for needle-phobic T2s.
> Exubera had to be sucked up from a long glass tube ( which some ladies found indelicate ).
> Unless they have addressed the problems posed by Exubera, Alfrezza will probably go the same way.


Follow the links in my previous post, it might help explain the difference to you, it doesn't work the same.


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## DeusXM

> Deus, I see your point, however... given that my main aim is to do ANYTHING to avoid the need to inject myself, it gives me a little ray of hope.



I know, but the issue is that so much has been spent on exciting new insulins or delivery methods or test strips in the last 15 years and we're no closer to a cure. Whereas if all that cash had been spent on cure research, we'd probably have a cure by now and then no-one would need to inject themselves.

I guess the way I see it is that the current things we have are just about enough to keep us ticking over. I'd rather wait 10-15 years with what we've got and then get a cure, rather than get a slightly more convenient insulin in 5 years' time and a cure in another 50.


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## Northerner

DeusXM said:


> I know, but the issue is that so much has been spent on exciting new insulins or delivery methods or test strips in the last 15 years and we're no closer to a cure. Whereas if all that cash had been spent on cure research, we'd probably have a cure by now and then no-one would need to inject themselves.
> 
> I guess the way I see it is that the current things we have are just about enough to keep us ticking over. I'd rather wait 10-15 years with what we've got and then get a cure, rather than get a slightly more convenient insulin in 5 years' time and a cure in another 50.



It's never going to happen though, is it, that money going to treatments could be translated to cure research? The treatment research money is intended to produce a commercial return for a company, and that is their incentive for investing the time and money. At the same time, there is lots of promising research being done into a possible cure, so they are not mutually exclusive.


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## trophywench

Oh Deus, the drug companies don't want a cure!

Take the Cold Sore.  Herpes Simplex.

Researchers at A University discovered in the 1970's that aciclovir stopped em dead in their tracks, if taken orally.  (can't cure it, being a virus you are stuck with once you have it)

What happened? - a drug company bought it off em.  Years later, Zovirax cream appeared.  It's still nearly the hardest thing in the world to get the tablets prescribed! 

That's why funding people like DUK or JDRF is important so they can try and direct money to where the proper research is being done.


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## DeusXM

Diabetes UK helping direct cash to cure research? Don't make me laugh. I looked at the research they're currently funding. Almost every single project is for either something that could lead to a regular treatment regime or something that helps understand why either type of diabetes happens. There is NOTHING going towards a cure and frankly the amount of translated literature they seem to produce suggests they're far more interested in making sure elderly ethnic minorities use a bit less fat in their cooking rather than drive real change.

JDRF, that's a different kettle of fish though.

As for the 'Big Pharma' argument...I'm not convinced that stacks up in Europe. Healthcare in most developed nations costs the state, not the individual. Treatments are expensive, therefore it's in the interest of almost all healthcare systems to fund their own research into cures rather than treatment. There's a reason why the UK, Canada and Australia are currently the leaders in cure research.

A smart pharmaceutical company would know it needs to get there before the government researchers do, otherwise they'll lose their entire market overnight.


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## Northerner

DeusXM said:


> Diabetes UK helping direct cash to cure research? Don't make me laugh. I looked at the research they're currently funding. Almost every single project is for either something that could lead to a regular treatment regime *or something that helps understand why either type of diabetes happens*. There is NOTHING going towards a cure and frankly the amount of translated literature they seem to produce suggests they're far more interested in making sure elderly ethnic minorities use a bit less fat in their cooking rather than drive real change.
> ...



You need to understand why something is happening in order to prevent or fix it, surely?


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## trophywench

Took the words right out of my mouth Alan !


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## DeusXM

And if you look at the research aims of all of the Diabetes UK projects, not a single one talks about being able to reverse diabetes in existing patients. All of them are entirely about improving existing medications or how to improve overall control without actual doing anything practical. 

Why waste ?14k on finding out how teenagers manage alcohol consumption with diabetes? Wouldn't it be far better to spend that cash on researching a cure so that no-one would ever need to know that information? 

Why spend ?40k on why people become more hypo-unaware from glucose-lowering therapies? Why not spend that cash on finding a way so people don't need glucose-lowering therapies ever again? 

Why waste ?127k on finding out high glucose level results in people mean they are lower in nitric oxide, so we can develop a medication that will restore nitric oxide function in people with high glucose levels? Why not spend that cash on something that means no-one will have high blood glucose levels? 

Seriously, some of the things on the Diabetes UK research list are the equivalent of those bathroom plug holders or atomic clocks you used to get in the Innovations catalogue - they're solutions that revolve around creating an additional problem rather than tackling the basic underlying one. The Diabetes UK mission statement doesn't even address the issue of curing diabetes, it's a woolly 'future free from diabetes and its complications' and 'research for a better life'. They're faffing around with this artificial pancreas option (oh and incidentally, according to the website and overnight home study 'WILL begin in Autumn 2012', time for them to update the website maybe?). Again, the artificial pancreas is yet another shiny-bucket-under-the-leaky-pipe - granted, an extremely shiny bucket. But can't we start looking into how we weld the leak shut instead?

Look, I appreciate that Diabetes UK do fulfil some useful functions for us, we need an advocacy group to give us access to needles and test strips, and I realise that therefore does require some research to prove the position on these points. But I just don't understand why they're even bothering to research things that won't even exist if you cure diabetes.


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## Northerner

DeusXM said:


> Look, I appreciate that Diabetes UK do fulfil some useful functions for us, we need an advocacy group to give us access to needles and test strips, and I realise that therefore does require some research to prove the position on these points. But I just don't understand why they're even bothering to research things that won't even exist if you cure diabetes.



Erm, because people have to live with it now and no-one knows when a cure might come? Should we stop trying to improve knowledge and treatments of all human ills in the (possibly mistaken) belief that a cure exists for everything and can be found if only we direct all resources to that end, and let everyone currently affected limp along on what we know up to now? There are all sorts of avenues for a cure being explored, but that doesn't mean we don't need the other stuff.

The only stuff I would question is the lower-level No S**t Sherlock and often endlessly duplicated common-sense stuff.


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## trophywench

Have you ever told DUK that's what you want them to research ?

Anyone can.

*Random thoughts*

Is there anyone who, given the funding, is ready to do this research?

Would a University see it as a useful project? 

How much funding would they need for how long? - could they even plan a programme for it?

How would they balance the books between the team doing the research and those researchers doing stuff which should hopefully provide an income stream?

I actually see quite a few Research Projects from Uni researchers, in the draft format before or after they go to 'Ethics' and thence to apply for funding.

Recently I plodded through no less than 8 A4 pages of close typed description from a very trusted D researcher.  Plus the notes and references.  We had already seen the whole outline plan of this (5+ years) research over 12 months ago; that wasn't anywhere near as detailed at that stage and this bit is just the first year.  This has been run past various funding sources, some of whom have expressed an interest to fund s/to meat on the bones.

But the main thing on the very first page is the bit where they have to say why they want to do it and what the benefits will be.  They have to quantify these - they can't just say 'I will get the Nobel Prize for Medicine, and anyway it's interesting'  or even 'People will feel better and it will save the NHS a bit'  They have to say exactly how/why people will feel better and how much ???? will actually be saved.  If the realistically predicted result won't be - at worst - cost neutral, then you are most unlikely to get funding for it ......

You can't put all your eggs in the one basket of finding a cure.  What about the millions of people who are stuck with it already, we have to find ways of helping them better, don't we?


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## DeusXM

> Should we stop trying to improve knowledge and treatments of all human ills in the (possibly mistaken) belief that a cure exists for everything and can be found if only we direct all resources to that end, and let everyone currently affected limp along on what we know up to now?



The issue is that any treatment regime is going to be greatly inferior to a proper cure. I'm actually all in favour of 'limping along'. The reason a cure is always theorised to be far away is because the balance of research is heavily in favour of treatments, rather than cures. On the face of it, Diabetes UK isn't even funding cure research. So that means by following their research model, we'll never develop a cure for diabetes. It's a very simple equation - if you divert the vast majority of research to a cure, maybe it'll come in 10 years. Maybe 100. But either way, it will come quicker than not funding it at all. That's what matters. 

My personal view is that given we already have a range of tools at our disposal that largely allow us to eat what we want, when we want, and do what we want, we're in a time of severely diminishing returns from finding new and exciting tablets to take every day. 



> But the main thing on the very first page is the bit where they have to say why they want to do it and what the benefits will be. They have to quantify these - they can't just say 'I will get the Nobel Prize for Medicine, and anyway it's interesting' or even 'People will feel better and it will save the NHS a bit' They have to say exactly how/why people will feel better and how much ???? will actually be saved. If the realistically predicted result won't be - at worst - cost neutral, then you are most unlikely to get funding for it ......



But that's the thing. There are already projects out there that would lead to a cure if properly funded. We already know islet cell transplants seem to actually work. Why isn't Diabetes UK a)funding a project that enables these cells to be grown and transplanted at a greater rate (clear benefit: we know this already works in T1 treatment, so it's a numbers game) and b)funding a project that finds a way to prevent these cells from being destroyed (clear benefit: we know the reasons these transplants fail is because the cells get destroyed). For the second part, there are already various projects using lisofyllene as a targetted immunosuppressant, and even chitin from shrimp as a protective shell around the cells. 

We also already know that combining lisofyllene with Exendin-4 (otherwise known as Byetta, a drug already on the market and used for treating T2) reverses diabetes in rodents. Why isn't Diabetes UK funding human trials? Yes, ok, I'm not a researcher and I'm not a scientist but even a cursory google search will find you several different avenues of cure research that still look reasonably solid on the science front but just haven't been tested. I did actually contact Diabetes UK about these. Unfortunately, their policy is they only fund British research (because of course, British diabetes is completely different from anything the Canadians or Australians have ) which means unless a British researcher magically stumbles on a new idea means we're pretty much stuck. Shouldn't Diabetes UK be doing a better advocacy job with UK researchers then? Shouldn't they be waving some big cheque around for a British researcher to work on a cure if they're going to be parochial about it?



> What about the millions of people who are stuck with it already, we have to find ways of helping them better, don't we?



But the only way to do that is to cure them! We've already got hundreds of tablets, test strips, insulins and god knows what else. Why do we need another pill to patch over the cracks caused by the fundamental break in the system? Isn't it better to strive for 20 years of ok-ish diabetes care and then an eternity of no diabetes, than 100 years of good diabetes care?


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