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INSULIN HUMAN INHALED

Medical Diagnosis and Drugs, Medications
INSULIN HUMAN INHALED
(in'su-lyn)
Exubera
Classifications: hormone; antidiabetic agent; insulin;
Therapeutic:hormone; antidiabetic; insulin
Prototype: Insulin injection
Pregnancy Category: C

Availability

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

Action

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.

Therapeutic Effect

Inhaled insulin lowers plasma glucose level and improves glycemic control as indicated by a lowering of postprandial plasma glucose and HbA1C levels.

Uses

Treatment of type 1 and type 2 diabetes mellitus.

Contraindications

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.

Cautious Use

Hepatic disease, renal impairment; renal failure; thyroid disease; infection; surgery, trauma; emesis, diarrhea.

Route & Dosage

Diabetes
Adult: Inhaled 2–3 times daily no more than 10 min a.c. Initial doses: 30–39.9 kg, 1 mg; 40–59.9 kg, 2 mg; 60–79.9 kg, 3 mg; 80–99.9 kg, 4 mg; 100–119.9 kg, 5 mg; 120–139.9 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

Administration

Inhaled
  • 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, bronchitis, cough, dyspnea, epistaxis, laryngitis, pharyngitis, respiratory disorder, respiratory tract infection, rhinitis, sinusitis, sputum increase. Special Senses: Otitis media.

Diagnostic Test Interference

See INSULIN INJECTION (REGULAR).

Interactions

Drug: See INSULIN INJECTION (REGULAR). Herbal: Garlic and green tea may potentiate hypoglycemic effects.

Pharmacokinetics

Absorption: Rapid pulmonary absorption. Onset: 10–20 min. Peak: 30–90 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.

Nursing Implications

Assessment & Drug Effects

  • Monitor for hypoglycemia (see Appendix F) at time of peak action of insulin. Onset of hypoglycemia (blood sugar: 50–40 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 [1.5–3 oz (45–90 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.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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