Insulin (inhalation)

Insulin is a hormone that lowers glucose (sugar) levels in the blood. Insulin inhalation is a fast-acting insulin that begins to work about 15 minutes after you inhale it, peaks in about 1 hour, and continues to work for 2 to 4 hours.

Insulin inhalation (inhaled through the mouth) is used to help control blood sugar in adults with diabetes mellitus.

If you have type 1 diabetes, you will also need to use a long-acting injectable insulin.

If you have type 2 diabetes, insulin inhalation may be the only medicine you need to manage your blood sugar. However, your doctor may also prescribe a long-acting injectable insulin or a diabetes medicine that you take by mouth.

Insulin inhalation may also be used for purposes not listed in this medication guide.

Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may change your dose from time to time. Use the medicine exactly as directed.

Use insulin (inhalation) at the start of a meal.

Insulin (inhalation) is a powder that comes in a plastic cartridge designed to fit into the inhaler device that comes with the insulin. You can only place one cartridge in the inhaler device at a time. Each inhaler device can be used for up to 15 days before you need to replace it with a new one.

Each blue cartridge of insulin (inhalation) powder is equal to 4 units of injectable insulin. Each green cartridge is equal to 8 units of injectable insulin. If your dose is more than 8 units, you will need to use more than one cartridge. Always use the smallest number of cartridges possible to get your correct dose. For example, if your dose is 12 units, use one 4-unit cartridge and one 8-unit cartridge to make 12 units. For a dose of 16 units, use two 8-unit cartridges. Follow the dosing chart provided with this medicine to learn how to combine cartridges for the correct dose.

Insulin (inhalation) cartridges come in a plastic blister card that is sealed inside a foil package. Store each unopened foil package in a refrigerator. An unopened foil package that is not refrigerated must be used within 10 days.

When you open the foil package, take out only the number of cartridges you need for your dose, put the remaining blister card back into the foil package, and return it to the refrigerator. Let the cartridges you need for your dose sit at room temperature for 10 minutes before using them.

Once you have opened a foil package, you can store it at room temperature. After you tear open an individual blister-card strip, you must use the cartridges in that strip within 3 days.

You will need to check your blood sugar often. You may also need lung function tests every 6 to 12 months.

You may experience low blood sugar (hypoglycemia) and feel very hungry, dizzy, irritable, confused, anxious, or shaky. To quickly treat hypoglycemia, eat or drink something with fast-acting sugar (like fruit juice, hard candy, crackers, raisins, or non-diet soda).

Your doctor may prescribe a glucagon injection kit in case you have severe hypoglycemia. Make sure your family or close friends know how to give you this injection in an emergency.

Also, watch for signs of high blood sugar (hyperglycemia) such as increased thirst or urination.

Blood sugar levels can be affected by stress, illness, surgery, exercise, alcohol use, or skipping meals. Ask your doctor before changing your dose or medication schedule.

Insulin is just one part of a treatment plan that may also include diet, exercise, weight management, regular blood sugar testing, and special medical care. Follow your doctor's instructions very closely.

In case of emergency, wear or carry medical identification to inform others that you have diabetes.

Insulin (inhalation) can lead to sudden or serious lung issues. You should not use insulin (inhalation) if you smoke or have recently stopped smoking, or if you have a long-term lung condition like COPD or asthma.

You should not use this medicine if you are allergic to insulin, or if you are having low blood sugar (hypoglycemia). Insulin inhalation can cause sudden or serious lung issues. Do not use this medicine if you have:

• chronic lung disease, such as asthma or chronic obstructive pulmonary disease (COPD); or
• diabetic ketoacidosis (contact your doctor for treatment).

Do not use insulin inhalation if you smoke or have quit smoking within the past 6 months.

In studies with insulin inhalation, lung cancer was seen in a small number of people. Your doctor will test your lung function before and during your treatment with insulin inhalation.

Insulin inhalation is not approved for anyone younger than 18 years old.

Tell your doctor if you have ever had:

• asthma, COPD, or other breathing issues;
• lung cancer;
• liver or kidney disease; or
• if you use other inhaled medicines.

Tell your doctor if you also take pioglitazone or rosiglitazone (sometimes found in combinations with glimepiride or metformin). Taking certain oral diabetes medicines while using insulin may raise your risk of serious heart issues.

Follow your doctor's directions about using this medicine if you are pregnant or become pregnant. Managing diabetes is very important during pregnancy, and high blood sugar can lead to complications for both the mother and the baby.

It may not be safe to breastfeed while using this medicine. Ask your doctor about any risks.

Get emergency medical help if you have signs of an insulin allergy: redness or swelling at the injection site, an itchy skin rash all over your body, trouble breathing, fast heartbeats, sweating, feeling faint, or swelling in your tongue or throat.

Insulin may cause serious side effects. Call your doctor right away if you experience:

• bronchospasm (wheezing, chest tightness, trouble breathing);
• fluid retention--weight gain, swelling in your hands or feet, feeling short of breath; or
• low potassium--leg cramps, constipation, irregular heartbeats, fluttering in your chest, increased thirst or urination, numbness or tingling, muscle weakness or a limp feeling.

Common side effects of insulin may include:

• low blood sugar;
• cough; or
• sore throat.

This is not a complete list of side effects, and others may occur. Call your doctor for medical advice about side effects. You can report side effects to the FDA at 1-800-FDA-1088.

If you forget to take your dose at the start of a meal, take the medicine as soon as you remember. Do not take two doses at once.

Seek emergency medical help or call the Poison Help line at 1-800-222-1222. An overdose of insulin can lead to dangerous low blood sugar (hypoglycemia). Symptoms may include drowsiness, confusion, blurred vision, numbness or tingling in your mouth, trouble speaking, muscle weakness, clumsy or jerky movements, seizures (convulsions), or loss of consciousness.

Do not smoke while using insulin (inhalation). If you begin smoking, you will need to stop using insulin (inhalation) and switch to a different type of insulin to manage your blood sugar.

Insulin can cause low blood sugar. Avoid driving or operating machinery until you understand how insulin affects you.

Avoid drinking alcohol or taking medications that contain alcohol.

Many other medicines can change your blood sugar levels, and some can make insulin work better or worse. Some drugs can also reduce the signs of low blood sugar, which makes it harder to know when your blood sugar is low. Inform all your health care providers about every medicine you are currently using and any new medicines you start or stop. This includes prescription and over-the-counter medicines, vitamins, and herbal products.