“Can’t my diabetes be managed without insulin injections?’ This is one of the most common questions patients ask when doctors discuss starting insulin. “Fear of injections remains a major reason for delaying insulin therapy, even when it is clearly required. This hesitation, often referred to as insulin inertia, is an important cause of poor blood sugar control and can increase the risk of long-term complications,” noted Dr Milind Patil, assistant professor, Department of Endocrinology, DPU Super Specialty Hospital, Pimpri, Pune.For many patients, the needle itself becomes a psychological barrier between insulin and effective treatment. Although modern insulin needles are very small and cause minimal discomfort, anxiety related to injections is common. “This often leads to missed doses or complete avoidance of insulin,” explained Dr Patil.Some others find it inconvenient to inject insulin during busy work schedules or at the workplace. In such situations, inhaled insulin is touted to offer “a more convenient and patient-friendly alternative, helping improve adherence to insulin therapy”, said Dr Vijay Negalur, HoD Diabetology, KIMS Hospitals, Thane.This rapid-acting inhaled insulin, recently introduced in India under the name Afrezza by Cipla, is said to offer an important alternative for selected patients who are otherwise reluctant to start insulin therapy. “By reducing needle use, it can improve patient comfort, confidence, and adherence to treatment, especially in those who struggle with multiple daily injections,” said Dr Patil.While it does not replace all insulin injections, it significantly reduces the burden of multiple daily pricks and is said to offer greater flexibility in daily life.How is it used?Unlike conventional insulin, which is injected under the skin, inhaled insulin is absorbed through the lung epithelium, which acts as an interface for absorption into the bloodstream. “It works like a fast-acting insulin but starts working faster than the conventional insulin and also leaves the body much faster,” said Dr Pranav Ghody, consultant endocrinologist and diabetologist, Wockhardt Hospitals, Mumbai Central.The dry powder, approved by the FDA for adults with type 1 or type 2 diabetes to reduce mealtime glucose spikes, is delivered via a small, discreet inhaler using single-use cartridges (4, 8, and 12 units). “It reaches the bloodstream faster than injectable rapid-acting insulins like lispro or aspart,” said Dr Hetashvi Gondaliya, diabetes and endocrinology, CK Birla Hospitals, Jaipur.Story continues below this adHow does it work?Before starting inhaled insulin, lung function tests must be done. The insulin molecule is the same as that of traditional insulin. The key difference lies in the route of administration, said Dr Negalur.So, the insulin is not new; the delivery method is different, clarified Dr Negalur.Once inhaled, insulin is absorbed through the lungs. It then enters the bloodstream and helps control the rise in blood sugar after eating.“Inhaled insulin primarily helps in controlling post-meal blood sugar levels. It is a rapid-acting insulin and is used before meals. For patients who require multiple short-acting insulin doses each day, inhaled insulin can significantly reduce the number of injections,” said Dr Patil.Story continues below this adPatients can take it three times a day before breakfast, lunch, and dinner, said Dr Negalur.Is inhaled insulin better than injectable insulin?In terms of effectiveness, inhaled insulin is almost similar to injectable insulin, said Dr Negalur.It is not superior, but is said to offer:*Better acceptance in patients who want to avoid multiple injections*More convenient for travel and holidays*Easy to use at the workplace*No need to carry needles or syringes*Ease of use and convenienceThe main advantage is comfort and convenience, not stronger action, said Dr Negalur.Story continues below this adIts ultra-rapid absorption through lungs provides earlier postprandial glucose lowering, mimicking natural beta-cell response, “though dosing may require 1.5 times more units than injectable ones for equivalent effect due to bioavailability differences,” remarked Dr Gondaliya.Can inhaled insulin completely replace injections? No, experts affirmed. In Type 1 diabetes, patients still need basal insulin, which is only available as an injection. Adults aged 18 years and older with type 1 (must pair with basal insulin) or type 2 diabetes are eligible to use inhaled insulin for prandial glucose coverage, said Dr Gondaliya.Is inhaled insulin suitable for all diabetic patients?However, inhaled insulin is not suitable for everyone. It should not be used in patients with lung diseases such as asthma or chronic obstructive pulmonary disease (COPD), and it is also contraindicated in smokers. Lung function tests are required before starting therapy and during follow-up. “If there is worsening of lung function while using inhaled insulin, the medicine has to be stopped,” added Dr Ghody. Conventional insulin is injected under the skin using an injection (Photo: Freepik)In cases of Type-1 diabetes, Dr Rajiv Kovil, head of diabetology and weight loss expert, Zandra Healthcare, and co-founder of Rang De Neela Initiative, said, “Fixed cartridge dosing limits the flexibility of small dose titrations that subcutaneous insulin easily allows, especially for variable meals. Moreover, neither the lungs nor the subcutaneous tissue is a physiological route for insulin delivery. So, clinical nuance and patient selection remain critical,” said Dr Kovil.Story continues below this adIt is contraindicated in active smokers, recent ex-smokers (