Diabetes Talking

Question:

– Hide quoted text — Show quoted text – The patches (like the nicotine or hormone ones) look more promising. No. They don’t. I did some student research work on those 20 years ago, and the dosage control mechanisms have *never* worked in a regulable way for insulin on patches. They’re too affected by skin contact issues and release mechanisms. They’re basically the reverse of the Glucowatch issues, which uses interstitial fluid withdrawn osmotically and takes *3 hours* to start being useful and has to be recalibrated every day. I shall therefore inform the drug companies that their recent development of a potential system for delivery of the large insulin molecule across the skin boundary is flawed and quote your twenty year old bullshit as fact. I’m sure a student experiment in the 80s means more than billions of dollars in research.

Never read up on the research that created Norplant, did you? "I know whereof I speak". Read my lips: "Dosage." Read them again. "Dosage." And one last time. "Dosage." Getting control of osmotic transfer across the skin is a bitch and a half. Unless they’ve invented some exceedingly clever way to maintain good physical contact in the face of physical motion, cold weather, sleep, excitement and other changes in blood flow, removal of the patch, sweat, etc., and they’ve implemented a dynamic control to deal with the variations of insulin required and insulin delivered as the patch is used up, they’re wasting your time and mine and somebody’s money. Getting proteins across the skin has been well understood and mastered since the invention of DMSO. Stop thinking that everything you see in a paper for the first time hasn’t already been hashed out, especially when it sounds like a really obvious idea.

Response:

It’s rarely a genuine phobia: it’s usually a strong reluctance. Phobias and this sort of fear are easily treatable: progressive desensitization works *wonders*. Although…. When I was a kid in diabetic camp, there was this newly diagnosed 15 year-old there as a camper. (Some junior staff, like me, were 15.) She hated it, resented it, and refused to give her own shot. The Doc said "Fine. You don’t shoot up, you don’t eat." He tested her bg regularly, kept an eye on her ketones, and it took her 3 days to get over herself and take the damn shot. She was *pissed*, but I agreed with him completely: she was enjoying all the attention and pity too much to do it on her own. Hunger, however, was a great incentive.

Hmmm.  As an adult who used insulin, and a jet injector to administer it, I vastly preferred having a choice. I keep my jet injectors against the day that I will need them, and practice with sterile saline. The doctor’s actions to compel the girl to use a needle remind me a dialog I had several years ago with a father who refused to get his daughter a jet injector on principle: he believed she should get over her needle phobia, and administered her shots until she would do it herself. It all seemed vaguely and wierdly sexual to me, sort of like the same sense of lurking sexuality I got when I read "Dracula". I’m probably wrong, and have a mind in the gutter to boot. But that’s just my problem! Cheers, Jonathan "Ex-Jet Injector" Mills, who believes in both free choice and logical consequences for adults (and recognizes that unemancipated teens are -not- adults) Fasting Bg today = 117 and blood pressure unusually low at 94/50. But I’m not dead yet!  :-)

Response:

The patches (like the nicotine or hormone ones) look more promising. No. They don’t. I did some student research work on those 20 years ago, and the dosage control mechanisms have *never* worked in a regulable way for insulin on patches. They’re too affected by skin contact issues and release mechanisms. They’re basically the reverse of the Glucowatch issues, which uses interstitial fluid withdrawn osmotically and takes *3 hours* to start being useful and has to be recalibrated every day.

I shall therefore inform the drug companies that their recent development of a potential system for delivery of the large insulin molecule across the skin boundary is flawed and quote your twenty year old bullshit as fact. I’m sure a student experiment in the 80s means more than billions of dollars in research. R — All killer no filler ratty at flyingrat.net New webthingy is www.flyingrat.net

Response:

– Hide quoted text — Show quoted text – It’s rarely a genuine phobia: it’s usually a strong reluctance. Phobias and this sort of fear are easily treatable: progressive desensitization works *wonders*. Although…. When I was a kid in diabetic camp, there was this newly diagnosed 15 year-old there as a camper. (Some junior staff, like me, were 15.) She hated it, resented it, and refused to give her own shot. The Doc said "Fine. You don’t shoot up, you don’t eat." He tested her bg regularly, kept an eye on her ketones, and it took her 3 days to get over herself and take the damn shot. She was *pissed*, but I agreed with him completely: she was enjoying all the attention and pity too much to do it on her own. Hunger, however, was a great incentive. Hmmm.  As an adult who used insulin, and a jet injector to administer it, I vastly preferred having a choice. I keep my jet injectors against the day that I will need them, and practice with sterile saline.

That’s cool. A jet injector would have been fine, but this was roughly 25 years ago. I don’t believe they were in common use at that time, and the girl’s folks certainly hadn’t sprung for one. The doctor’s actions to compel the girl to use a needle remind me a dialog I had several years ago with a father who refused to get his daughter a jet injector on principle: he believed she should get over her needle phobia, and administered her shots until she would do it herself. It all seemed vaguely and wierdly sexual to me, sort of like the same sense of lurking sexuality I got when I read "Dracula". I’m probably wrong, and have a mind in the gutter to boot. But that’s just my problem!

There are some sexual undertones to injections: the piercing of the body against one’s will, or accepted grudgingly against reservations, certainly has "rape" overtones.

Response:

I’ve never really understood the needle phobia. ( OK I still not on insulin but not because I’m scared of needles.  Considering the fact that diabetics often stick themselves I would think a neele is no biggie.

I agree. For me the finger prick for testing is LOTS more uncomfortable that shooting up. The needles are so sharp and are coated with a lubricant (I think). I hardly feel them. On the other hand, it sure would be handy to be able to use an inhaler instead of a pen before chomping into a piece of pizza. Well, that’s my two cents for the day. I guess I should do some work now. :-7 T o m  Dillon DBDz Type I 1975

Response:

Bear in mind that many people with type 2 are inappropriately delaying insulin because of needle phobia. Inhaled insulin would help those people. I’ve never really understood the needle phobia. ( OK I still not on insulin but not because I’m scared of needles.  Considering the fact that diabetics often stick themselves I would think a neele is no biggie.

It’s rarely a genuine phobia: it’s usually a strong reluctance. Phobias and this sort of fear are easily treatable: progressive desensitization works *wonders*. Although…. When I was a kid in diabetic camp, there was this newly diagnosed 15 year-old there as a camper. (Some junior staff, like me, were 15.) She hated it, resented it, and refused to give her own shot. The Doc said "Fine. You don’t shoot up, you don’t eat." He tested her bg regularly, kept an eye on her ketones, and it took her 3 days to get over herself and take the damn shot. She was *pissed*, but I agreed with him completely: she was enjoying all the attention and pity too much to do it on her own. Hunger, however, was a great incentive.

Response:

says… I was told that inhaled insulin worked, but that there were concerns about the long-term effects on lung capacity and effeciency.  Also, I think there is only a Regular equivalent, so you still would need to inject a long lasting insulin. Jim Michael The patches (like the nicotine or hormone ones) look more promising.

No. They don’t. I did some student research work on those 20 years ago, and the dosage control mechanisms have *never* worked in a regulable way for insulin on patches. They’re too affected by skin contact issues and release mechanisms. They’re basically the reverse of the Glucowatch issues, which uses interstitial fluid withdrawn osmotically and takes *3 hours* to start being useful and has to be recalibrated every day.

Response:

Scrimmo, I’m not sure if anyone really answered your question. I’m sure many of the m.h.d. readers are interested in an answer. There are several insulin projects in development. The two that I have seen the most of are from 1) Inhale/Pfizer/Aventis.   This one is closest to market, and last I heard was still looking at filing their FDA application this year, hoping for US availability in 2003.  The 10% bio-availability issue is nonsense, since many of our drugs have low bio-availability. IMHO, safety will be the primary concern here. I get LOTS of inquiries from patients on this item, and if safety and pricing concerns are satisfied, then I expect a lot of patients to want this. Bear in mind that many people with type 2 are inappropriately delaying insulin because of needle phobia. Inhaled insulin would help those people. For recent info check, http://www.pfizer.com/pfizerinc/about/press/exubera0615b.html http://www.pfizer.com/pfizerinc/about/press/exubera0615.html www.inhale.com Inhale has developed the inhaler, Aventis has developed the insulin, and Pfizer has tested and will market the product. This uses a dry powder spun in air to deliver the insulin to your lungs. 2) Novo / Aradigm These guys have a very nice demo of their unit. http://www.aradigm.com/tech/tech_mstr.html , if you have Real Player. The actual inhaler is more sophisticated than the Inhale method. They use a liquid in little blisters on a strip. The inhaler forces you to inhale at the proper speed or it won’t trigger. This one is not as far along, probably looking at 2004 – 2005 availability. 3) Lilly / Alkermes –  As far as I can tell they are in last place with inhaled insulin research. Lilly seems to be losing their leadership position in new product development. It is hard to tell when this one might be available. You can look at the Alkermes web site for info. http://www.alkermes.com/technologies/air_inhaler.html Cheers, William C Biggs, MD

– Hide quoted text — Show quoted text – Does anyone know or have any information on when inhaleable insulin is to be made available to the public? Have trials been finished? Is it awaiting placement on the PBS? (I am from Australia) Ryan

Response:

Bear in mind that many people with type 2 are inappropriately delaying insulin because of needle phobia. Inhaled insulin would help those people.

I’ve never really understood the needle phobia. ( OK I still not on insulin but not because I’m scared of needles.  Considering the fact that diabetics often stick themselves I would think a neele is no biggie. Compared to some other things that people do to stay alive, sticking yourself with a needle seems pretty moderate. PS: OT: I don’t know if you have been following everything, but there is a newbie who claims that eating to raise bgs above 120 because he feels hypo-like symptoms at 110 is a good thing. I ask you, in particular because I think other newbies should know.

Response:

Thankyou for your help. Much appreciated. When someone posts a reply to a question letting it be known they are a doctor, it is a lot easier to trust their opinion!. I will check out those websites. Ryan. – Hide quoted text — Show quoted text – Scrimmo, I’m not sure if anyone really answered your question. I’m sure many of the m.h.d. readers are interested in an answer. There are several insulin projects in development. The two that I have seen the most of are from 1) Inhale/Pfizer/Aventis.   This one is closest to market, and last I heard was still looking at filing their FDA application this year, hoping for US availability in 2003.  The 10% bio-availability issue is nonsense, since many of our drugs have low bio-availability. IMHO, safety will be the primary concern here. I get LOTS of inquiries from patients on this item, and if safety and pricing concerns are satisfied, then I expect a lot of patients to want this. Bear in mind that many people with type 2 are inappropriately delaying insulin because of needle phobia. Inhaled insulin would help those people. For recent info check, http://www.pfizer.com/pfizerinc/about/press/exubera0615b.html http://www.pfizer.com/pfizerinc/about/press/exubera0615.html www.inhale.com Inhale has developed the inhaler, Aventis has developed the insulin, and Pfizer has tested and will market the product. This uses a dry powder spun in air to deliver the insulin to your lungs. 2) Novo / Aradigm These guys have a very nice demo of their unit. http://www.aradigm.com/tech/tech_mstr.html , if you have Real Player. The actual inhaler is more sophisticated than the Inhale method. They use a liquid in little blisters on a strip. The inhaler forces you to inhale at the proper speed or it won’t trigger. This one is not as far along, probably looking at 2004 – 2005 availability. 3) Lilly / Alkermes –  As far as I can tell they are in last place with inhaled insulin research. Lilly seems to be losing their leadership position in new product development. It is hard to tell when this one might be available. You can look at the Alkermes web site for info. http://www.alkermes.com/technologies/air_inhaler.html Cheers, William C Biggs, MD Does anyone know or have any information on when inhaleable insulin is to be made available to the public? Have trials been finished? Is it awaiting placement on the PBS? (I am from Australia) Ryan

Response:

Does anyone know or have any information on when inhaleable insulin is to be made available to the public? Have trials been finished? Is it awaiting placement on the PBS? (I am from Australia) Ryan

Tried by several companies, take-up of the insulin component was woeful. Only 10% of the inhaled dose was absorbed in some cases.. http://www.diabetes.org.uk/balance/181/181bth.htm a reference to it and the ongoing research. It’s by no means ready for release. FR — All killer no filler ratty at flyingrat.net New webthingy is www.flyingrat.net

Response:

Does anyone know or have any information on when inhaleable insulin is to be made available to the public? Have trials been finished? Is it awaiting placement on the PBS? (I am from Australia) Ryan

When pigs dance the Charleston wearing shoes made out of weiner dogs. More seriously, there’s been talk about this for years, and actually some fascinating and positive tests posted here more recently. But getting an entirely new diabetes treatment past the FDA is going to take serious work, unless there is some blatantly large benefit of it. And that is unclear. The dosage issues I had heard about with nasal insulin are apparently not present with the inhaled stuff, so it *is* interesting.

Response:

says… I was told that inhaled insulin worked, but that there were concerns about the long-term effects on lung capacity and effeciency.  Also, I think there is only a Regular equivalent, so you still would need to inject a long lasting insulin. Jim Michael

The patches (like the nicotine or hormone ones) look more promising. Ratty — All killer no filler ratty at flyingrat.net New webthingy is www.flyingrat.net

Response:

– Hide quoted text — Show quoted text – Does anyone know or have any information on when inhaleable insulin is to be made available to the public? Have trials been finished? Is it awaiting placement on the PBS? (I am from Australia) Ryan Tried by several companies, take-up of the insulin component was woeful. Only 10% of the inhaled dose was absorbed in some cases.. http://www.diabetes.org.uk/balance/181/181bth.htm a reference to it and the ongoing research. It’s by no means ready for release. FR I must not give in … must resist.. an’t take this very much longer… OK. OK. I’m going to say it. In other words, don’t hold your breath.

hehe Ratty — Email: ratty at flyingrat.net Diabetes pages http://diabetes.flyingrat.net

Response:

- Hide quoted text — Show quoted text – Does anyone know or have any information on when inhaleable insulin is to be made available to the public? Have trials been finished? Is it awaiting placement on the PBS? (I am from Australia) Ryan Tried by several companies, take-up of the insulin component was woeful. Only 10% of the inhaled dose was absorbed in some cases.. http://www.diabetes.org.uk/balance/181/181bth.htm a reference to it and the ongoing research. It’s by no means ready for release. FR

I must not give in … must resist.. an’t take this very much longer… OK. OK. I’m going to say it. In other words, don’t hold your breath.

Response:

I was told that inhaled insulin worked, but that there were concerns about the long-term effects on lung capacity and effeciency.  Also, I think there is only a Regular equivalent, so you still would need to inject a long lasting insulin. Jim Michael

– Hide quoted text — Show quoted text – Does anyone know or have any information on when inhaleable insulin is to be made available to the public? Have trials been finished? Is it awaiting placement on the PBS? (I am from Australia) Ryan Tried by several companies, take-up of the insulin component was woeful. Only 10% of the inhaled dose was absorbed in some cases.. http://www.diabetes.org.uk/balance/181/181bth.htm a reference to it and the ongoing research. It’s by no means ready for release. FR — All killer no filler ratty at flyingrat.net New webthingy is www.flyingrat.net

Response:

Does anyone know or have any information on when inhaleable insulin is to be made available to the public? Have trials been finished? Is it awaiting placement on the PBS? (I am from Australia) Ryan

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