LifeAfterDx--Diabetes Uncensored

A internet journal from one of the first T1 Diabetics to use continuous glucose monitoring. Copyright 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014

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Location: New Mexico, United States

Hi! I’m William “Lee” Dubois (called either Wil or Lee, depending what part of the internet you’re on). I’m a diabetes columnist and the author of four books about diabetes that have collectively won 16 national and international book awards. (Hey, if you can’t brag about yourself on your own blog, where can you??) I have the great good fortune to pen the edgy Dear Abby-style advice column every Saturday at Diabetes Mine; write the Diabetes Simplified column for dLife; and am one of the ShareCare diabetes experts. My work also appears in Diabetic Living and Diabetes Self-Management magazines. In addition to writing, I’ve spent the last half-dozen years running the diabetes education program for a rural non-profit clinic in the mountains of New Mexico. Don’t worry, I’ll get some rest after the cure. LifeAfterDx is my personal home base, where I get to say what and how I feel about diabetes and… you know… life, free from the red pens of editors (all of whom I adore, of course!).

Friday, December 08, 2006

Guinea pig a.k.a. Exhubera Party

Floutas. (First cousin to the Taco). Check.

Salsa. Check.

Sour Cream. Check.

Guacamole. Check.

Glucagon Kit. Check.

Inhaler. Check.

Powdered insulin packets. Check. A 3mg packet and a 1mg packet; based on my weight.

So…Time to rock. Shuuuuunk! Snap! Poof! Ahhhhhhhhh….Tastes like chicken. Not really. Just kidding. I just tried Exhubera. On my self. What the hell. Why not?

We’re having a party of sorts in my office. A small party, but aren’t those the best kind? I’ve got my pharmacy tech (perky blonde about 12 years old….or so she seems from my side of the hill), the out-reach coordinator (and my right-hand-woman in the diabetes program), and my Pfizer Rep (who brought cookies from the Chocolate Maven).

Pfizer is really trying to push their Exhubera, with varying results. I’m keen to have any arrow in my quiver, but this is far enough out there on the ledge that I’m not going to recommend putting a patient on it until I’ve tried it for myself. Eager to please, Pfizer has provided me with some samples.

So the clock is ticking. We’ve got ten minutes to wait before we start chowing down. I check the Girl. My blood sugar is stable at 116.

By the way, the inhaler was a heck of a lot easier to use than I had imagined. I thought the multiple dosing would be a pain, but it was fast and easy. The inhaler telescopes inside itself to make it more compact. It has a finger ring you can use to pull it out to its full length, but a quick snap of the wrist will “unfold” the device. Makes you look cool and sophisticated in a James Diabetic Bond kind of way. That’s the Shuuuuuuuunk!

You slip a blister pack into the mouth of the device, cock the handle to pressurize the system, and pull the trigger. All of the training devices have empty packets, leaving me very curious to see how the insulin cloud would really look. Snap! I pull the trigger and Poof! The clear chamber is instantly filled with fog.

Three sets of eyes are riveted on me, unblinking. I exhale, turn the mouth piece around and breath in deeply. I briefly consider grasping my throat and collapsing to the floor, just to freak everyone out, but we only have a one-bay ER, and only one defibrillator, so we really aren’t well equipped to handle three simultaneous heart attacks.

I expect a slight burning sensation, like when I used to smoke. But it is no different than any other deep breath. I feel…..nothing. No taste. No tickle. No cough. I exhale, expecting to blow a smoke ring. Again, nothing. So simple and uneventful as to be almost disappointing.

WhatdiditfeellikeWhatdiditfeellikeAreyouOK? Don’t you hate it when three people talk at once? I de-brief the crew and take the second hit.

Ahh. Ten minutes have passed. Time to chow down. We eat, chat, check the girl, and chat some more. Continuous monitoring offers not only the ultimate in safety and control, but it allows you to safely play with new meds like this.

My BGL drifts downward, then levels out. It stays that way for nearly an hour. I begin thinking a hypo may be in my future. Then, in the space of half and hour it shoots up from 110 to 192, which is the peak for the day. For the next three hours my BG stays bizarrely flat between 190 and 184. It is like looking at the cardiac monitor of a dead person. Flattest, longest, BG graph I’ve ever seen on a bolus. After three hours after spiking (four hours into the experiment) it begins a gentle drift downwards and bottoms out at 136 five-and-one-half hours after taking the hit. By the way, I want you all to know that for the sake of science, I sacrificed the opportunity to have a Starbucks Iced Latte. I didn’t want to add in any carbs until the Exhubera ran it’s course. See how much I love you guys?

Now a gentle drift upwards begins. The insulin has run its course. Looks like we could have used a bit more powder or a few less carbs. It is promising enough that we all agree to have to have another party soon and try again with a little more insulin. Hey, that’s not an excuse for a taco party, this is serious science here! Really. I swear. Have I ever lied to you guys?

11 Comments:

Blogger MileMasterSarah said...

Wow. That is really cool! Would you ever consider using it as a consistent treatment for yourself?

10:19 AM  
Blogger Carey said...

Fascinating. Thank you!

10:36 AM  
Blogger George said...

Thanks Wil, that was very cool!

12:57 PM  
Anonymous AmyT of www.diabetesmine.com said...

Interesting. So are you "on it" now?

btw, isn't it Exubera (with no 'h')?

8:25 PM  
Blogger Scott K. Johnson said...

Wow! Sounds like it actually did pretty good!

And I know that skipping your Starbucks was a HUGE sacrifice - you are so dedicated!

12:25 AM  
Blogger Wil said...

Hmmmmmm…..that’s the trouble with the #$%&*! spell check programs: they can’t double check the spelling of new drugs. Amy’s right. No “h” in Exubera. For what it is worth I’m not the first to make that mistake, if you Google it both ways you’ll get a ton of hits either way.

Nope, I’m not “on” it at this time. I’m a pumper. I like trying new things; but so far, I’m yet to find anything that gives me the control POSSIBLE with a pump. That said, as we all know, even the best car won’t drive itself. Although I did see recently that the new Lexus will parallel park itself, but that’s nit-picking……

One thing I’ve been thinking about is LARGE carb load meals. I liked the profile I saw with this stuff. I’m going to do a few more experiments. I have a problem with meals of more than 30 carbs giving me huge spikes no matter how creatively I bolus or how early I pre-bolus. I may keep it around for big meals.

I see some problems with the inhaled insulin. No basal is the biggy for T-1s. I also have some concerns about the accuracy of the dosing, both from the device and the way it is dosed. So all of that said, it is not for me personally, however, I would not hesitate to recommend it for needle-phobic non-motivated T-2s who are having mainly post postprandial trouble. I think it would be better than orals (or nothing) for that crowd. For control freaks like me, the pump or MDI is still the best bet.

2:25 PM  
Blogger Bernard said...

Thanks for a really evocative description of the whole trip man.

Now I've started to use Symlin for big meals (not as much as I should). I wonder whether it's possible to use Symlin and Exubera together? I might be interesting.

Do they have a lot of different size dosages available? And what's the smallest one - would you use this for a correction bolus for example?

10:03 AM  
Anonymous Anonymous said...

I work in a nursing home and see people with lung diseases daily. There's no way I want this in my lungs or anyone else's lungs I care about. I admire your willingness to try it, but would caution you about what this may do long term. What's next, diabetic lung disease?

5:57 AM  
Anonymous Anonymous said...

Prescrire Int. 2006 Dec;15(86):203-9. Links
Inhaled human insulin: new drug. No short-term advantages, to many unknowns in the long term.[No authors listed]
(1) The standard treatment for type 1 diabetes is intensive insulin therapy, with at least 3 daily subcutaneous injections. Insulin is sometimes useful in type 2 diabetes, in which case the first-line treatment is an injection of isophane insulin at bedtime, in addition to ongoing oral antidiabetic therapy. (2) Pfizer has been granted marketing authorization in the EU for a powdered insulin product for pulmonary inhalation, for the treatment of adults with type 1 or type 2 diabetes. Two dose strengths are available (1 and 3 mg). (3) When inhaled, the insulin powder acts as rapidly as subcutaneous lispro insulin and lasts as long as a standard insulin injection. (4) Inhalation of 1 mg of insulin powder has similar glucose-lowering effects as 3 units of subcutaneous insulin, but inhalation of 3 mg is comparable to 8 units rather than 9 units of injected insulin. Three inhalations of 1 mg each have more glucose-lowering potency than a single inhalation of 3 mg. (5) None of the clinical trials published thus far have assessed the effects of inhaled insulin on clinical complications of diabetes. (6) In patients with type 1 diabetes, 7 randomised trials have compared inhaled insulin plus 1 or 2 subcutaneous injections of long-acting insulin with standard or intensive insulin therapy. They failed to show that intensive insulin therapy consisting of 3 insulin inhalations plus 1 or 2 injections of long-acting insulin reduced the HbA1c concentration or the frequency of hypoglycaemia more effectively than standard insulin therapy consisting of 2 daily subcutaneous insulin injections. (7) In type 2 diabetes, the addition of inhaled insulin has not been compared with the addition of injected insulin in patients whose glycaemia is not controlled by oral antidiabetic therapy. (8) In type 2 diabetes, 3 randomised trials have compared intensive insulin therapy based on inhaled insulin to subcutaneous insulin (2 to 4 daily injections), without oral antidiabetic drugs. The results suggest that glycaemic control is similar with both treatments. (9) The adverse effects of inhaled insulin have been assessed in fewer than 4000 patients participating in clinical trials, fewer than 600 of whom were treated for more than a year. During treatment lasting a few months, the most frequent short-term adverse effects (other than hypoglycaemia) seem to be mild respiratory adverse effects (cough, upper airway infections, etc.). (10) Treatment with inhaled insulin causes a gradual reduction in the peak expiratory flow rate (not convincingly shown to be reversible after the end of treatment) as well as a high incidence of anti-insulin antibodies. The possible long-term clinical consequences of these changes are unknown. The results of planned, long-term comparative trials should be available in 2014-2016. (11) The assessment of inhaled insulin in patients with respiratory disorders is inadequate. The effect of acute respiratory tract infections on the efficacy of inhaled insulin has not been adequately assessed. (12) Smoking (active or passive) and salbutamol, to a lesser extent, have important effects on the efficacy of inhaled insulin. (13) The insulin powder is very sensitive to high humidity, which can occur under normal conditions, leading to a risk of under-dosing. (14) The inhalation device is much larger than an injector pen. It does not permit precise insulin dose adjustment and delivers a maximum of 8 units per inhalation. (15) In practice, the many unknowns concerning the adverse effects of long-term treatment with inhaled insulin powder will probably not be resolved before 2016. In the meantime, subcutaneous injection remains the standard method of insulin delivery.

PMID: 17165235 [PubMed - in process]


Ellen

7:09 PM  
Anonymous Way said...

Why are these diabetic places always seem to be filled with strange folks.

Just looking for info on continuous glucose monitoring systems. The Guardian RT looks to be near the top of the heap. The prices are still stupid,... but maybe a little more competition, etc...
Want something for at night, while driving, and during hockey & soccer to keep my energy levels at peak.

7:53 PM  
Blogger Joe Hough Realtor said...

I have been on Exhubera trial for 4 years now. So far no adverse effects, nothing but praise for the product and the control it gives me. Very easy to use in public a lot better than trying to give yourself a needle or the epi-pen. The public still have a real stigma when it comes to giving yourself needles (what are you on!!). Would recomend this product to anyone who does not have lung problems.

9:59 AM  

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