For countless individuals living with diabetes in India, the prospect of daily insulin injections has been a significant psychological hurdle, often delaying crucial therapy. This barrier, commonly known as 'insulin inertia,' may now see a breakthrough with the introduction of Afrezza, a rapid-acting inhaled insulin, launched by pharmaceutical major Cipla.
Addressing the Fear of the Needle
Medical experts highlight that the fear of injections remains a primary reason patients resist starting insulin, even when it is medically necessary. "Fear of injections remains a major reason for delaying insulin therapy," explained Dr. Milind Patil, Assistant Professor, Department of Endocrinology, DPU Super Specialty Hospital, Pimpri, Pune. This avoidance can lead to poorly controlled blood sugar and increased risk of long-term complications.
Dr. Patil noted that for many, the needle itself becomes a psychological barrier. Others find the routine of injections inconvenient during work or travel. Dr. Vijay Negalur, HoD Diabetology, KIMS Hospitals, Thane, stated that inhaled insulin offers "a more convenient and patient-friendly alternative, helping improve adherence to insulin therapy."
How Does Inhaled Insulin Work?
Afrezza is not a new insulin molecule but a novel delivery system. It is a dry powder insulin delivered via a small, discreet inhaler using single-use cartridges (4, 8, and 12 units). Unlike subcutaneous injections, the insulin is absorbed through the lung epithelium into the bloodstream.
"It works like a fast-acting insulin but starts working faster than the conventional insulin and also leaves the body much faster," said Dr. Pranav Ghody, Consultant Endocrinologist and Diabetologist, Wockhardt Hospitals, Mumbai Central. Dr. Hetashvi Gondaliya from CK Birla Hospitals, Jaipur, added that it reaches the bloodstream faster than injectable rapid-acting insulins like lispro or aspart.
Patients typically use it three times a day before main meals—breakfast, lunch, and dinner—primarily to control post-meal blood sugar spikes. A critical prerequisite is a lung function test before starting therapy, with follow-up monitoring required.
Benefits, Limitations, and Who Can Use It
In terms of glycemic control, experts clarify that inhaled insulin is not superior to injections but offers significant lifestyle benefits. Dr. Negalur listed key advantages: better acceptance by those avoiding multiple injections, convenience for travel and work, and no need to carry needles or syringes.
However, Dr. Gondaliya pointed out a dosing nuance: "Dosing may require 1.5 times more units than injectable ones for equivalent effect due to bioavailability differences."
It is crucial to understand that inhaled insulin cannot completely replace injections. For patients with Type 1 diabetes, basal (long-acting) insulin, which is only available as an injection, remains essential. Dr. Rajiv Kovil, Head of Diabetology, Zandra Healthcare, also noted that the fixed cartridge dosing limits fine-titration of small doses compared to subcutaneous insulin.
Inhaled insulin is not suitable for everyone. It is contraindicated for patients with lung conditions like asthma or COPD, active smokers, and recent ex-smokers (quit less than 6 months ago). "If there is worsening of lung function while using inhaled insulin, the medicine has to be stopped," cautioned Dr. Ghody.
A Step Towards Patient-Centric Care
While not a universal solution, Afrezza represents a meaningful advancement in diabetes management. It aims to bridge the gap between medical necessity and patient acceptance for a select group. Dr. Patil concluded, "When prescribed carefully and used appropriately, it can help bridge the gap between medical necessity and patient acceptance of insulin therapy."
Experts unanimously advise that patients must consult their healthcare practitioner to determine if they are eligible candidates for this new form of insulin therapy, ensuring it aligns with their specific health profile and lifestyle needs.
