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    New Methods May Mean Fewer Insulin Shots for Diabetics


    Arthur Krosnick, MD, a researcher involved in early tests of the device, says patients tell him they like it because it's easy to use. "Time and again, they have said, 'If I had my druthers, I would rather have this device than a needle,'" he says.

    Although it has only been tested in adults, Krosnick, a diabetologist and clinical associate professor at Robert Wood Johnson Medical School in Princeton, N.J., says the spray inhaler is simple enough that kids should be able to use it, if studies show it works as well for them.

    The spray device has been tested in about 300 patients in the U.S. and other countries. In Canada, long-term trials -- the final step before drug approval -- recently began. The U.S. equivalent of those studies is expected to begin within the next two or three months, Krosnick says.

    But a few hurdles must be cleared before the devices are approved for use. One potential problem is that, unlike injections that are precisely measured, inhaled doses may not be exactly the same each time people take them. Another concern is that taking particles deep into the lungs could cause breathing problems in some people, or lead to unhealthy changes in lung cells.

    Skyler says some patients have been on the inhaled insulin for at least three years with no apparent lung problems. He adds that animal studies do not support the idea that insulin causes unhealthy cell changes in the lung. In human studies, testing of lung function has shown no changes among insulin inhalers, according to Inhale Therapeutic Systems, one of several companies that are developing inhaled insulin products.

    Although an insulin pill might be easiest of all to use, insulin is currently only taken by injection. That's because it is a protein, which can be broken down in the stomach, like food, before it starts to work on blood sugar. Insulin injections get the drug into the bloodstream fast, and are typically taken before eating and before going to bed. The challenge for researchers has been to convert the insulin into a form that can be absorbed in a way that bypasses the stomach's acids.

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