Inhalable Insulin Plans Brighten

Wednesday, September 20th 2000, 12:00 am
By: News On 6

JERUSALEM (AP) — Prospects that inhaled insulin may one day allow some diabetics to live without needles looked brighter Wednesday when researchers reported that inhaling seems to work for at least two years.

Until now, scientists had only studied how safe and effective it is to inhale insulin for three months. Early tests were encouraging, but it wasn't known what would happen if people took it for a longer time.

The results, the first examination of the long-term effects of inhaled insulin, indicated inhaling is as effective as injecting, and it doesn't damage the lungs. The next, final stage of research will have to prove it.

The findings were presented at a conference of the European Association for the Study of Diabetes in Jerusalem.

Experts say some diabetics, such as those whose bodies do not make insulin, known as Type I diabetes, may not be able to live without needles, but could be able to reduce their daily injections.

Eleazar Shafrir, a professor of biochemistry at Hadassah University Hospital in Jerusalem, who was not connected with the research, said he doubted inhaled insulin could entirely replace injections.

``It's not going to be effective for long-range treatment of patients,'' Shafrir said, adding that an alternative to injections would be most useful for children who are likely to develop Type I diabetes.

Some children have diabetes antibodies and a genetic predisposition to developing Type I diabetes and studies have indicated that insulin shots can head off the disease.

Inhalers could also provide an alternative to injections for diabetics who need a rapid boost of insulin in an emergency, Shafrir said.

About 150 million people — 2 percent of the global population — have diabetes. Experts expect the number of cases to exceed 250 million by 2025 as obesity and unhealthy lifestyles take their toll.

There are two types of diabetes. Type I occurs suddenly as a result of an immune system problem which destroys the body's ability to make insulin, a hormone that takes sugar in the blood to tissues to be used for energy. It usually strikes in childhood and afflicts about 15 million people, who now need regular insulin injections for the rest of their lives.

Type II diabetes develops gradually and accounts for about 90 percent of all diabetes. It happens when the body doesn't use insulin properly. It is strongly linked to obesity and is increasingly found in adolescents and children. About 40 percent of those with Type II diabetes eventually have to take regular insulin injections.

The study, involving 114 patients, found that Type I diabetics were able to reduce their daily injections from two or three to one.

People with Type II who were already taking insulin got the same benefit from the inhaler, also replacing all but one of their daily injections, the study found.

A third group, people with Type II diabetes who were not doing well on pills and would otherwise need injections, were able to avoid needles altogether.

Measurements of sugar in the blood and the dose of insulin needed were comparable for injected and inhaled insulin and remained constant over the two years, said the study's lead investigator, Dr. William Cefalu, a professor of medicine at the University of Vermont College of Medicine.

Lung performance remained the same during the two years and tests showed no abnormalities, he added.

``Right now, inhaled insulin does not appear to have adverse effects on the lungs, and it works, and it appears to be sustained,'' he said.

However, some experts challenged the inhaled insulin's performance and questioned its safety, saying it should bring blood sugar levels lower and the study could not measure lurking lung damage.

Cefalu said the next phase of research into the drug, made by Pfizer and Aventis, will tackle those issues, but he believed any lung damage would likely have surfaced by now.

Other alternatives to injections being investigated include nasal inhalers, mouth sprays, patches with mini-needles, implantable insulin pumps and transplants of cells that make insulin.