Meet Jennifer Haws. She just started using EXUBERA, the first commercially available inhalable insulin from Pfizer. She's not a senior. She's not homebound. And so far she likes it. Which came as somewhat of a surprise to me personally, since I've been quoted as teasing about how impractical it seems. Jennifer disagrees.
DM) Jen, can you tell us about yourself, and what led you to inhalable insulin?
JH) I live in Des Moines, Iowa, and work for a Credit Union as the Mortgage Loan Assistant. I am 29 years old and to give an actual diagnosis date is hard; when I was 12, they thought I might have type 2, ran some tests, put me on insulin for about a week and that's all I can remember the doctor doing about it.
Then back in 1999, I had a miscarriage and during some tests after that, they said that I was type 2. They put me on pills, which did little for me, so I was quickly put on shots 4 times a day. Then I fell into the denial stage as many diabetics do, I was on and off with doctor visits and testing. And then in 2004, my Mom passed away suddenly after suffering from diabetes and many complications from it. It took about a year, but I finally decided I needed to take control of my own care and went back to my PCP. She went through the diet education and carb counting and I started that along with Actoplusmet and Lantus at night. My numbers came down and we stayed with that, just waiting for inhalable insulin to come out on the market.
My doctor had done extensive research, and said I would be a perfect candidate for Exubera. We just had to wait for its release.
DM) Why exactly did your doctor feel Exubera was the right treatment for you?
JH) I believe it's because in the past I have shown much insulin resistance so my dosages had to be rather high. I just know that she said I was perfect for it. All you have to do to qualify is take a breathing test to make sure you have the lung capacity before they can prescribe it, but that was a piece of cake! No pun intended.
DM) How long have you been using the inhalable? And what has your experience been? Was it difficult to learn/start?
JH) I started on it September 25th, 2006, so it's very new. So far, I absolutely love it, it is SOOOOO easy, painless and simple!
I watched the videos on the Exubera website before starting, so that I would be a step ahead. They explain it all step by step. It was very easy to learn. According to my weight (265), I should take 2 of the 3mg blisters, which is the max dosage, but my doctor decided to weigh on the side of caution for the first month and I take one 1mg blister and one 3mg blister before each meal. I believe she chose correctly because my numbers are almost all within range. The dosing is based on the fact that you plan to eat about the same about of carbs at each meal. For me, I eat about 30 carbs at meals and then usually one snack before bed of 15 carbs.
DM) How many times a day do you dose in total? Is it comfortable to inhale?
JH) I take one 1mg blister and one 3mg blister before each meal. It is very easy and comfortable to inhale. There is no aftertaste, sore throat or any complications. Sometimes I find that with the 3mg blister, if I inhale too fast, the powder hits the back of my throat and tickles a little, causing the urge to cough, but that is easily fixed just by inhaling slower.
JH) Now according to popular belief, this thing is huge. But in reality, it is not. People think "inhaler" and first thing they think of is something like an asthma inhaler. It is not that small either.
It is about 6 inches long when compacted, but about 10-11 inches fully extended (which is only done when dosing). It is about an inch and a half in diameter, so it fits nicely in a quart size plastic storage bag top to bottom then I roll the excess bag around it. That's how I store it in my purse so that it keeps clean from anything in my purse.
As for using it in public, I am still getting used to that. It's new and a little unusual, but so far has not attracted any attention. Sometimes I will use it in the car before going into a restaurant, but only if I know that my meal will come quickly, since you can only dose max 10 minutes before eating.
DM) Can you share a story or two about your Exubera use? Anything especially good, bad, or funny happen to you with it?
JH) I have not had any bad experiences with it, but my friends at work have been real comedians about it and refer to it as my "insulin bong."
DM) Have you seen a positive effect on your glucose control (A1c or otherwise)?
Since I just started, I have not had an A1c yet since being on Exubera. But my previous A1c was 13 and on Sept. 25, 2006 with diet and my oral med, it is currently at 8.1. I believe that my next A1c will come down again to a very nice number, as my testing shows that my current BG levels are averaging about 100, and I no longer have the after-meal spikes that I was experiencing prior to Exubera. It is comforting to finally have such good control!
DM) Is it very expensive? Covered by your insurance?
As for cost, my insurance covers it at the highest co-pay level of $35, but that is much less than paying a co-pay for needles AND insulin. As for cost if it was not covered, the sticker price on the starter kit was $182.00, but it only ran me $35 as my co-pay. The starter kit included 90 3mg blisters, 180 1mg blisters, 2 replacement "filters" (to be changed every two weeks), one replacement chamber, and one complete unit consisting of the chamber, filter, and base. The base only needs replacing after a year of use. My replacement cost for the blisters and the necessary filters each month after will just be one copay of $35. So for about a dollar a day.... and NO SHOTS....YAHOOO!
DM) Would you recommend Exubera to others?
ABSOLUTELY. Wow, what an advancement in the treatment of diabetes! This would be so nice for all those people with needle phobia too! I am just so excited about it!
DM) So it sounds like you'll happily continue using it, without any contingencies or issues?
I plan to keep using it as long as I can. The only concern I have is that my husband and I want to have children, and if and when the time comes that I become pregnant, I am not sure about use then. But I'm sure hoping that I can continue then, too.
Thank you, Jen, for sharing your life and treatment with us. **NOTE: Jen has promised to provide us an update here at DiabetesMine.com after she's been using the inhalable for at least three months. We'd all like to hear about the longer-term experience, I'm sure!