Afrezza Disease Interactions

The use of inhaled insulin is contraindicated in patients with chronic lung disease such as asthma and COPD. Acute bronchospasm has been observed after an inhaled insulin dosage. Prior to initiating therapy with an inhaled insulin product, it is recommended to evaluate all patients medical history, physical examination and spirometry (FEV1) to identify potential underlying lung disease.

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Rapid acting inhaled insulin may predispose certain patients to develop diabetic ketoacidosis (DKA). In clinical trials, subjects with type 1 diabetes receiving inhaled insulin were more likely to develop DKA than patients receiving comparator agents. It is recommended to increase the frequency of glucose monitoring and to consider using an alternate route of administration, if appropriate, in patients at risk for DKA, such as patients with an acute illness or infections.

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In clinical trials, lung cancer was observed in smoker and non-smoker patients using inhaled insulin. In patients with active lung cancer, a prior history of lung cancer, or in patients at risk for lung cancer, it is recommended to consider whether the benefits of inhaled insulin use outweigh this potential risk.

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Insulin requirements may be diminished in patients with renal or hepatic impairment due to reduced insulin metabolism and, in the latter case, also to reduced capacity for gluconeogenesis. Lower initial dosages may be appropriate, with careful monitoring of plasma glucose levels and dosing adjustments.

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Hypokalemia may commonly occur during treatment with insulin. Use with caution in patients who may be particularly at risk of developing hypokalemia (e.g., patients using potassium-lowering medications, patients taking medications sensitive to serum potassium concentrations).

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Hypoglycemia may commonly occur during treatment with insulin and/or oral hypoglycemic agents. Care should be taken in patients who may be particularly susceptible to the development of hypoglycemic episodes during the use of these drugs, including those who are debilitated or malnourished, those with defective counterregulatory mechanisms (e.g., autonomic neuropathy and adrenal or pituitary insufficiency), and those receiving beta-adrenergic blocking agents.

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