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Inhale your diabetes medicine

By | June 25, 2010, 8:24 AM PDT

Instead of injecting yourself with insulin you may soon be able to inhale it, the way asthmatics take their medicine.

That’s just one of the headlines at this weekend’s Americans Diabetes Association meeting in Orlando, expected to draw 15,000 scientists, and an accompanying special issue of England’s The Lancet.

The inhaled insulin is called AFREZZA, and while it failed to win FDA approval early this year, creator Mannkind Corp. is claiming its solution provides better glucose control for serious cases than the twice-daily injections now being used. (Image from Mannkind, founded by philanthropist Al Mann.)

There is also good news about a drug called dapagliflozin, which works independently of insulin. It could be a replacement for metformin when that drug does not work.It’s considered flexible and a “good add-on” by scientists interviewed at the Orlando meeting.

The biggest headline may be a Lancet editorial, more of a rant really, which calls Type II diabetes “a public health humiliation.”

The phrase was chosen because the disease is easily preventable through proper diet and lifestyle choices, yet 285 million people now have it, most of them poor people who will never benefit from treatments like those being described this week.

Instead, the magazine says, a societal approach is needed. The editorial praises the Administration’s Let’s Move campaign but shows barely-contained rage toward multinational food corporations:

To help Americans make better choices more easily, the US Department of Agriculture released updated dietary guidelines on June 15 that aim to shift consumption towards more plant-based foods. By contrast, on the same day in Brussels (and amid intense lobbying by multinational food corporations), the European Parliament rejected plans to aid consumers by labelling food with a health traffic-light system.

The editorial also suggests that urban planners in the developing world insist on space for, and advocacy of, physical fitness. “The focus on youth in a disorder that is age-related might seem paradoxical; but the age of diabetes onset is falling and it is in young people that diet and exercise habits are formed.”

The diabetes fight shows in microcosm the real problems in health reform. Critics may call what The Lancet advocates a “nanny state.” But the present path of medication is financially self-defeating.

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Dana Blankenhorn

About Dana Blankenhorn

Dana Blankenhorn was a contributing editor for SmartPlanet from 2009 to 2010.

Dana Blankenhorn

Dana Blankenhorn

Contributing Editor, Healthcare

Dana Blankenhorn has written for the Chicago Tribune, Advertising Age's "NetMarketing" supplement and founded the Interactive Age Daily for CMP Media. He holds degrees from Rice and Northwestern universities. He is based in Atlanta.

Follow him on Twitter.

Dana Blankenhorn

Dana Blankenhorn

Dana Blankenhorn has been a technology reporter since 1982, a business reporter since 1978, and a writer for as long as he can remember. His Schwab IRA has a few tech stocks in it, most notably some Intel and Applied Materials bought over 10 years ago. But the vast majority of his tiny fortune (emphasis on the word tiny) is invested in mutual funds. He presently writes for no one else but ZDNet, SmartPlanet and himself. But if you've got an opportunity let him know. If he takes the gig he"ll first add it to this disclosure page.

He writes for SmartPlanet and is not an employee of CBS.

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RE: Inhale your diabetes medicine
Why didn't the FDA like the inhaled insulin?
Posted by jsindle@...
25th Jun 2010
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RE: Inhale your diabetes medicine
Hi Dana!

Just finished Diabetes Rising by by Dan Hurley, which kind of diminishes The Lancet's point of view. Great datapile. Still trying to figure what to do with it.
Posted by dickdavies
25th Jun 2010
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RE: Inhale your diabetes medicine
>> easily preventable through proper diet and lifestyle choices

While this is believed by many, there is no scientific evidence for
it. It's wonderfully tempting to believe that those with Type II
diabetes "deserve" it - believing this scratches a very
fundamental itch - but the truth is that people of all body shapes,
sizes and lifestyle choices get Type II diabetes.
Posted by aureolin
25th Jun 2010
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Re: Type-II "easily preventable", ADA, and the FDA's concern.
I strongly, STRONGLY agree with Aureolin, for several reasons. First, there a plenty of overweight, fast-food chugging people who don't have D; and, as, Aureolin pointed out, plenty of low-BMI people who do have it. And second, these "easy" diet and lifestyle choices are anything BUT easy -- how many women want to lose a few pounds? Nearly every single one I know. And guys too.

Anyway, the ADA's "recommended" diet is to eat the same food pyramid as everyone else: carbohydrate-heavy, in spite of the fact that your body can't manage carbohydrate properly. Why do they "recommend" this?

Just look at some of their Corporate Contributors: General Mills (makers of Count Chocula, Fruit Gushers, and Lucky Charms). Kraft (Cheez-Whiz, Fig Newtons, Mac and Cheese dinners... all "proper diet and life style choices".) I feel that ADA is nearly ALL about promoting a tangled web of business interests, consuming a vast amount of money. That money would be spent more effectively, for research and treatment, if it were given to other organizations. (JDRF, for example-- when insulin is being used used T1 Persons with Diabetes and T2 PWD's actually have a lot in common.)

Now -- back to the FDA's issue: It's about breathing the carrier powder on a chronic basis. PWD's using inhaled insulin for year and years could (perhaps) end up sort of like asbestos workers, or Beryllium miners: After many years of dissolving these chemicals, their alveoli might become severely damaged, or cancers could develop.

There have been several studies showing this insulin to be effective and reliability in creating predictable, safe concentrations of insulin in blood, and controlling Glucose levels properly. (The company has been pushing this product for several years, it's NOT new.) But it's very difficult to demonstrate the long-term safety of the dissolving powder "carrier". You breath this stuff in DEEP, and your tiniest lung tissues are responsible for making the exchange into blood. They're sensitive, and cases of COPD seems to getting more common in the USA already. Do PWD's really want to throw more chemicals into their lungs, spending the rest of their lives as "test subjects" to see if it's really OK to use?

It couldn't be exactly like Asbestosis, because there wouldn't be actual CHUNKS left behind by this powder. (It dissolves.) If there were a problem, it would more likely be similar to Besnier-Boeck disease (i.e., granulomas occurring all over, but without particular bits of identifiable stuff in them), or chronic bronchitis. So, even if it IS approved, I'm not going to go anywhere near this stuff. I don't want to risk damaging my lungs as if I'd been a heavy smoker, pushing around an oxygen tank and wheezing whenever I get off the couch.

(I'm insulin dependent, and use a pump.)
Posted by Rick S._z
25th Jun 2010
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Causes of diabetes
Overweight and lack of exercise greatly increases the chance of
Type II diabetes. Fact. The numbers of those with the condition
has risen right alongside our percentage of overweight and
obese. Also fact.

This doesn't guarantee that if you're overweight you'll become
diabetic. Of course not. It increases your chance of becoming
diabetic. Just as obesity increases your risk of heart disease and
some types of cancer.

As more children have become obese, we're seeing more Type II
diabetes. As more Mexican-Americans have become obese, same
thing.

Pretending that since it hasn't happened to you there's no
correlation is foolish. Basing public policy on your superstition is
dangerous.
Posted by DanaBlankenhorn
26th Jun 2010
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RE: Inhale your diabetes medicine
And furthermore BMI is a load of bollocks, my wife has preached it too me for years and I still can't make any sense of it's benefit other than to categorize and label people by a relatively arbitrary scale...
Posted by IgnorantBugger
27th Jun 2010
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RE: Inhale your diabetes medicine
May I suggest that the company does long term trials & if necessary manufacture the drug in third world country's out of the jurisdiction of the FDA. This may seem callous but if the facts of the possible side effects were placed on the packaging the taking it would be informed consent,not having it would be literally a matter of life & death,for some people in these places.It could be subsidised or given at cost in return for data being given to the company which could then be given to the FDA who may reconsider their decision based on it.
Posted by ronangel
29th Jun 2010
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Uncertainty of inhalant dosage
In the past, some insulin-by-inhalant schemes have fallen short of widespread adoption because patients aren't as sure they're getting the correct dosage when it's not injected into them. That could be the biggest obstacle here again.
Posted by scottmace2002
29th Jun 2010
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