For decades, there was only one way to get insulin into the body: injection under the skin. Insulin pens and pumps offered some measure of discretion and flexibility, but people uncomfortable with needles and catheters have been, in a word, stuck.

Not for long. Scientists are developing a range of new ways to deliver insulin to the body. Some of these ideas are still in the pro­totype stage, including a patch that administers insulin through the skin just as a nicotine patch administers nicotine. Encapsulation Systems in Havertown, Pa., for example, has successfully conducted human trials on its first ­insulin patch, but the device is still not yet FDA-approved.

Several other small companies, including Bentley Pharmaceuticals in Exeter, N.H., are conducting clinical trials on insulin nasal sprays as well. Whereas sprays and patches are still years away from FDA approval, there have been some very real steps away from needles. Exubera, for example, an inhaled insulin made by Pfizer that was approved by the FDA in 2006, was the first new insulin-delivery option on the market since insulin was discovered in the 1920s. But the others are on their way: a handful of major phar­maceutical companies have reached the last phase of clinical trials.

Some people with diabetes may wonder why the “insulin bong,” the nickname given to the Exubera inhaler because of its distinctive shape, needed to look quite so much like
drug paraphernalia, but the more enduring question was whether it worked. Inhaling insulin certainly has some advantages: for one, it allows the body to reach peak insulin levels much more quickly than injections can. On average, Exubera users attained peak levels in 49 minutes, compared with 105 minutes for regular insulin.

But inhalers do have their drawbacks. Some concerns persist about inhaled in­sulin’s effect on the lungs. In clinical trials, some patients experienced reduced lung function, which Pfizer, on further study, found to be medically insignificant. Respiratory infections can also make absorption difficult—which could make a common cold potentially dangerous for people who rely on inhaled insulin. Unlike asthma, which is commonly treated with an inhaler, diabetes requires very precise insulin doses; despite Pfizer’s insistence, some doctors weren’t convinced inhalers would be able to offer the same degree of exactness as an injection. Exubera also didn’t necessarily mean the end of needles: because it was only available as a rapid-acting insulin for mealtimes, patients still had to inject long-acting insulin as part of their daily routine. 
—Justin Ewers

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